Humoral and cell-mediated immune responses to BNT162b2 vaccine against SARS-CoV-2 in people with cystic fibrosis.

People with cystic fibrosis (pwCF) were considered to be clinically vulnerable to COVID-19 and were therefore given priority in the vaccination campaign. Vaccines induced a humoral response in these patients that was comparable to the response observed among the general population. However, the role of the cell-mediated immune response in providing long-term protection against SARS-CoV-2 in pwCF has not yet been defined. In this study, humoral (antibody titre) and cell-mediated immune responses (interferon-γ release) to the BNT162b2 vaccine were measured at different time points, from around 6-8 months after the 2nd dose and up to 8 months after the 3rd dose, in 118 CF patients and 26 non-CF subjects. Subjects were sampled between November 2021 and September 2022 and followed-up for breakthrough infection through October 2022. pwCF mounted a cell-mediated response that was similar to that observed in non-CF subjects. Low antibody titres (<1st quartile) were associated with a higher risk of breakthrough infection (HR: 2.39, 95 % CI: 1.17-4.88), while there was no significant association with low INF-γ levels (<0.3 IU/mL) (HR: 1.38, 95 % CI: 0.64-2.99). Further studies are needed in subgroup of pwCF receiving immunosuppressive therapy, such as organ transplant recipients. This data is important for tailoring vaccination strategies for this clinically vulnerable population.

Respiratory failure: a patient's perspective and clinical cases

The major morbidity and mortality from COVID-19 is due to acute viral pneumonitis that evolves to ARDS. Furthermore, COVID-19 patients may be affected by extrarespiratory involvement, including cardiac, renal, neurological and vascular complications. Different hospitals reorganised their logistical structures to optimise the care of COVID-19 patients and ensure infection control, and the public health scenario worldwide was characterised by the rapid spread of multidisciplinary units specifically dedicated to COVID-19 patients. This chapter describes the personal experience and clinical case of a previously healthy and active patient who suffered from severe COVID-19. Two other cases of patients hospitalised because of severe acute respiratory failure due to COVID-19 are also discussed.Copyright © ERS 2021.

Post-COVID-19 sequelae

This chapter explores the currently available knowledge (as at October 2021) about the long-term clinical consequences of COVID-19. Distinction between cardiorespiratory and extra-cardiorespiratory sequelae can facilitate understanding of the post-COVID sequelae problem and may aid the clinical management of patients. The strength of the recommendations is highlighted at the end of each paragraph.Copyright © ERS 2021.

Respiratory outcomes at 6 months follow up after SARSCov-2 infection in people with cystic fibrosis

Background: The severity of Covid-19 and its long-term effects in people with cystic fibrosis (pwCF) are poorly defined. Aim and objectives: To evaluate respiratory outcomes 6 months after SARS-Cov-2 infection in pwCF. Method(s): The study was based on pwCF enrolled from October 15, 2020 to June 30, 2021 in the DECO COVID-19 project, a multicentre prospective study supported by the Italian Ministry of Health (COVID-2020-12371781), that involved 3 Regional Reference Centres for CF (Milan, Rome and Verona). We enrolled pwCF tested with real time polymerase chain reaction (RT-PCR) for SARS-Cov-2 on nasopharyngeal swab for suggestive symptoms of Covid19 and/or for hospital admission. After 6 months follow up, we compared changes in percent predicted forced expiratory volume in one second (ppFEV1) and the rate of pulmonary exacerbations between patients positive or negative for SARS-Cov-2. Result(s): We enrolled 28 pwCF with RT-PCR confirmed infection (median age: 30 years, range: 6-66) and 130 negative to RT-PCR test (median age: 24 years, range: 5-63). The median baseline ppFEV values (range) were 91 (34-114) and 79 (25-117) in those positive and negative to RT-PCR, respectively (P= 0.256). After 6 months ppFEV1 changes were not significantly different between groups (median, interquartile range: 0.8% -5.0;4.0 among positive and +2%, -5.0;6.0 among those who tested negative, P = 0.618). The rates of pulmonary exacerbations were 0.17 per person-month among patients who tested positive and 0.14 in negative pwCF (Incidence rate ratio: 1.19, 95% CI: 0.80-1.76). Conclusion(s): In our CF population, SARS-Cov-2 infection did not impact negatively on respiratory outcomes at 6 months follow up.

COVID-19 VACCINE: A SURVEY ON HESITANCY IN PATIENTS WITH CELIAC DISEASE

Background and aim: COVID-19 vaccination campaign represents the most relevant way to overcome the pandemic. COVID-19 vac-cines have been developed at the fastest known pace yet;such a fast production has led to concerns among general population wor-ldwide about safety and efficacy of COVID-19 vaccines. Specifically, patients affected by chronic illnesses, such as Celiac Disease (CeD), may have greater apprehension. The immune status of CeD patients has been studied in literature, however the actual risk of infections is not clear, depending on various factors such as suboptimal nutri-tional status. Information on vaccine hesitancy plays a pivotal role in the development of an efficient vaccine campaign. In our study, we aimed at evaluating COVID-19 vaccine hesitancy among CeD patients, its reasons and determinants. Materials and methods: An anonymous validated questionnaire formulated on the EUSurvey web platform was sent to a mailing list of CeD patients followed at our “Celiac Center” of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan. The questions focused on socio-demographic data, disease-related and lifestyle data, attitude to vaccinations in general and predisposition to the COVID-19 vaccine. Hesitancy was defined by a negative answer to the question “Would You accept to get vaccinated tomorrow against COVID-19?”. Among the hesitant, COVID-19 vaccine refusing patients were defined as those who answered negatively to the fol-lowing question: “Would You eventually accept it in the future when more data is available?”. We evaluated the reasons and the factors associated (determinants) to hesitancy, by calculating Adjusted Odds Ratio (AdjOR) with 95% confidence intervals (CI). Results: The questionnaire was sent to 346 patients with a response rate of 29.8% (103). Among the respondents, 25.2% of patients were hesitant, with a total refusal rate of 4.8%. The main reason was the fear of adverse events (68.2%). Among the hesitant patients, 23% declared that their opinion was influenced by CeD. A positive atti-tude towards general vaccinations, a perceived good knowledge about COVID-19 and related vaccines and the adherence to GFD were determinants significantly associated to vaccine willingness (respective AdjOR of 16.48, 95% C.I. 3.34–81.31;6.50, 95% C.I. 1.44–29.22;12.71, 95% C.I. 1.82–88.58).(figure presented) Conclusions: Most CeD patients would accept COVID-19 vaccines. Data on the reasons and the determinants of vaccine hesitancy plays a pivotal role in the development of an efficient vaccine campaign

Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

To evaluate outcomes of COVID-19 patients with pneumonia-related hypoxaemic acute respiratory failure (hARF) undergoing continuous positive airway pressure therapy (CPAP) treatment, hence, a multicentre, observational, prospective study was conducted between 7 March 2020 and 21 April 2020 in three high-dependency units (HDU) at two hospitals in Milan, Italy. The primary outcome was CPAP failure defined as the occurrence of either intubation or death due to any cause during hospital high-dependency units (HDU) stay while secondary outcomes included the weaning from CPAP to oxygen therapy (CPAP success), all-cause in-hospital and 30-day mortality. A total of 157 patients with hARF (median (IQR) PaO2/FIO2 ratio 142.9 (96.7-203.2)) underwent helmet CPAP with an initial median (IQR) FIO2 of 0.6 (0.5-0.6) and mean positive end-expiratory pressure (PEEP) of 10.8+or-2.3 cmH₂O. The most prevalent comorbidities were arterial hypertension (44.0%), diabetes (22.9%), ischaemic cardiac disease (17.2%) and chronic arrhythmia (10.8%). Hypoxaemia generally improved when CPAP treatment was initiated: median (IQR) values of PaO2/FIO2 ratio at baseline on oxygen therapy (142.9 (96.7-203.2)) significantly improved when helmet CPAP was used after 6 h (205.6 (140.0-271.1), p<0.0001). However, an increase of at least 30% in PaO2/FIO2 ratio during helmet CPAP application in comparison to oxygen therapy was found only in 52% of the population. Median (IQR) duration of helmet CPAP treatment was 6 days. Only 4 patients discontinued helmet CPAP because of intolerance. CPAP failure was observed in 70 (44.6%) patients: 34 (21.7%) were intubated and 36 (22.9%) died during the HDU stay. 87 (55.4%) patients improved during the HDU stay, weaned to oxygen therapy and transferred to the general ward. No patients were intubated during the first hours after CPAP initiation or under high emergency conditions. Among those who died in HDU, pneumonia-related deaths were detected in 26 patients, while non-pneumonia related in 10 patients, including pulmonary embolisms (n=5), end-stage renal failure (n=2), cerebrovascular accident (n=1), end-stage heart failure (n=1) and septic shock (n=1). Among the 34 patients who were intubated in HDU and transferred to the ICU, nine (26.5%) died. A total of 65 (41.4%) patients had a Do-Not-Intubate (DNI) status on HDU admission: 36 died and 29 survived. At the multivariable analysis, CPAP failure was associated with the severity of pneumonia on admission (HR (95% CI) 2.9 (1.3-6.2), p=0.009) and higher baseline values of interleukin-6 (HR (95% CI) 1.0 (1.0-1.0), p<0.009). The all-cause in-hospital and 30-day mortality rates were 28.7% and 28.0%, respectively.