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Journal of Hepatology ; 77:S551, 2022.
Article in English | EMBASE | ID: covidwho-1996642


Background and aims: Hepatitis C virus (HCV) infection is a major global health problem in adults & children. The recent efficacy of Direct Acting Anti-viral therapy (DAA) has cure rates of 99% in adults and adolescents. These drugs were licensed for children 3–12 yrs during the recent coronavirus pandemic. To ensure equitable access, safe & convenient supply during lockdown, we established a virtual national treatment pathway for children with HCV in England & evaluated its feasibility, efficacy & treatment outcomes. Method: A paediatric Multidisciplinary Team Operational Delivery Network (pMDT ODN), supported by NHS England (NHSE), was established with relevant paediatric specialists to provide a single point of contact for referrals & information. Referral & treatment protocolswere agreed for HCV therapy approved byMHRA& EMA. On referral the pMDT ODN agreed the most appropriate DAA therapy based on clinical presentation & patient preferences, including ability to swallow tablets. Treatment was prescribed in association with the local paediatrician & pharmacist, without the need for children & families to travel to national centres. All children were eligible for NHS funded therapy;referral centres were approved by the pMDT ODN to dispense medication;funding was reimbursed via a national NHSE agreement. Demographic & clinical data, treatment outcomes & SVR 12 were collected. Feedback on feasibility & satisfaction on the pathway was sought from referrers. Results: In the first 6 months, 34 childrenwere referred;30- England;4-Wales;median (range) age 10 (3.9–14.5) yrs;15M;19F: Most were genotype type 1 (17) & 3 (12);2 (1);4 (4). Co-morbidities included: obesity (2);cardiac anomaly (1);Cystic Fibrosis (1);Juvenile Arthritis (1). No child had cirrhosis. DAA therapy prescribed: Harvoni (21);Epclusa (11);Maviret (2). 27/34 could swallow tablets;3/7 received training to swallowtablets;4/7 are awaiting release of granules.11/27 have completed treatment and cleared virus;of these 7/11 to date achieved SVR 12. 30 children requiring DAA granule formulation are awaiting referral and treatment. Referrers found the virtual process easy to access, valuing opportunity to discuss their patient’s therapy with the MDT & many found it educational. There were difficulties in providing the medication through the local pharmacy. However there are manufacturing delays in providing granule formulations because suppliers focused on treatments for COVID, leading to delays in referring and treating children unable to swallow tablets. Conclusion: The National HCV pMDT ODN delivers high quality treatment & equity of access for children & young people, 3–18 yrs with HCV in England, ensuring they receive care close to home with 100% cure rates.

Transfusion ; 60(SUPPL 5):277A-278A, 2020.
Article in English | EMBASE | ID: covidwho-1044239


Background/Case Studies: Routine testing of donations for COVID-19 antibody was implemented as a tool to evaluate donor suitability for convalescent plasma (CCP) donation, monitor geographic and demographic trends, and associate COVID-related symptoms (Sx) to serological test results. We report initial results of antibodyreactive donors and associated responses regarding their Sx >14d prior to donation. Study Design/Methods: Starting June 15, 2020, allogeneic donors were tested using the Ortho Anti-SARSCoV2 Total Ig Test. Reactive donors were invited to an online survey ≈2 weeks post-donation;eligibility criteria were ≥ age 18, English proficiency and an email on file. The survey inquired about COVID-related Sx and COVID testing performed outside the blood center. Sx duration and severity were not ascertained. Donor responses were linked via DIN to operational data. Results/Findings: During the first 6 weeks, cumulative seroprevalence was 1.5% (8588 reactive/573,586 donations tested). Reactive rates were higher in first-time vs repeat donors (2.4 vs 1.3%, X2 p<0.0001), and in Hispanic and African American donors vs Caucasians (3.5% vs 1.4%, p<0.0001). Antibody (Ab) prevalence did not differ by sex, and the age group with the highest rate was 18-24yo (3.1%). Modest differences were observed by geography, ranging from 1.3% Ab prevalence in the West to 1.9% in the Northeast. The range of reported Sx from 1546 survey respondents was 0 to 12, with 44% of donors indicating they were asymptomatic pre-donation. The average number of Sx was 2.9 for all donors, and 5.2 from those with any reported symptom. Ortho-reactive donors who previously tested reactive reported more Sx on average than previously nonreactive donors (4.0 vs 2.5 Sx), as did those diagnosed with COVID-19 by a healthcare provider (5.0 vs 2.3). Fatigue (41%), myalgia (35%), headache (33%), cough (29%), loss of smell (29%) and taste (28%), and fever (22%) were most commonly reported. The number of Sx reported did not differ by presence or count of 5 chronic health conditions associated with increased COVID morbidity. An algorithm to select candidate CCP donors based on the 3 most common symptoms identified 357 donors (23%), while also requiring a diagnostic test or physician diagnosis yielded 177 donors (11.4%). S/CO ratios correlated with symptom number, with asymptomatic infections or those with 1-4 symptoms having lower S/COs (median S/CO < 85) than those with 5-8 Sx(median S/CO 108) or 9-12 Sx (median S/CO 170);Kruskal-Wallis p<0.0001. Conclusions: The demographics and geographic associations with COVID-19 Ab prevalence were generally consistent with widely reported findings. Prior symptoms of donors may be useful in identifying suitability for convalescent plasma collection.