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1.
Nature ; 595(7868): 572-577, 2021 07.
Article in English | MEDLINE | ID: covidwho-1246378

ABSTRACT

BNT162b2, a nucleoside-modified mRNA formulated in lipid nanoparticles that encodes the SARS-CoV-2 spike glycoprotein (S) stabilized in its prefusion conformation, has demonstrated 95% efficacy in preventing COVID-191. Here we extend a previous phase-I/II trial report2 by presenting data on the immune response induced by BNT162b2 prime-boost vaccination from an additional phase-I/II trial in healthy adults (18-55 years old). BNT162b2 elicited strong antibody responses: at one week after the boost, SARS-CoV-2 serum geometric mean 50% neutralizing titres were up to 3.3-fold above those observed in samples from individuals who had recovered from COVID-19. Sera elicited by BNT162b2 neutralized 22 pseudoviruses bearing the S of different SARS-CoV-2 variants. Most participants had a strong response of IFNγ+ or IL-2+ CD8+ and CD4+ T helper type 1 cells, which was detectable throughout the full observation period of nine weeks following the boost. Using peptide-MHC multimer technology, we identified several BNT162b2-induced epitopes that were presented by frequent MHC alleles and conserved in mutant strains. One week after the boost, epitope-specific CD8+ T cells of the early-differentiated effector-memory phenotype comprised 0.02-2.92% of total circulating CD8+ T cells and were detectable (0.01-0.28%) eight weeks later. In summary, BNT162b2 elicits an adaptive humoral and poly-specific cellular immune response against epitopes that are conserved in a broad range of variants, at well-tolerated doses.


Subject(s)
Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19 Vaccines/immunology , COVID-19/immunology , SARS-CoV-2/immunology , T-Lymphocytes/immunology , Adolescent , Adult , CD8-Positive T-Lymphocytes/immunology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , Epitopes, T-Lymphocyte/immunology , Female , Humans , Immunoglobulin G/immunology , Immunologic Memory , Interferon-gamma/immunology , Interleukin-2/immunology , Male , Middle Aged , SARS-CoV-2/chemistry , Spike Glycoprotein, Coronavirus/chemistry , Spike Glycoprotein, Coronavirus/immunology , Th1 Cells/immunology , Young Adult
2.
World Neurosurg ; 150: e445-e465, 2021 06.
Article in English | MEDLINE | ID: covidwho-1135597

ABSTRACT

OBJECTIVE: To replace educational opportunities lost during the coronavirus disease 2019 (COVID-19) pandemic, the Department of Neurosurgery at Lenox Hill Hospital produced an open-access webinar series ("BRAINterns") that covered a broad range of health care topics with a focus on neurosurgery. METHODS: This 8-week webinar series ran from July 1 to August 28, 2020. An optional exit survey was distributed to participants. Data were analyzed to characterize and better understand trends among a global cohort of participants. RESULTS: A total of 16,484 people registered for BRAINterns, and 6675 took the survey (40.5% response rate). Responders represented 87 countries, of which the majority were from the United States and Canada (90.48%, n = 6039). Responders were primarily female (82.9%, n = 5521). Racial and ethnic representation was majority Asian (42%, n = 2798), followed by White (22.7%, n = 1514), Hispanic/Latino (16.2%, n = 1080), and Black and African American (7.7%, n = 516). Participants reported hearing about BRAINterns through various social media platforms (72.18%, n = 4818)-the most popular was TikTok (33.4%, n = 2232). Overall, 93.4% of participants reported that the course was a good use of their time during the pandemic, and 86.7% reported that the course helped replace lost opportunities. CONCLUSIONS: These data demonstrate that webinar-based education is an effective method of expanding access to careers in medicine and in particular, neurosurgery, to traditionally underrepresented populations. Social media can be a powerful tool to combat barriers to early exposure and vastly improve diversity within the field.


Subject(s)
Internship and Residency/trends , Neurosurgery/education , Social Media , Videoconferencing/trends , Adolescent , Adult , Aged , COVID-19 , Career Choice , Child , Cultural Diversity , Curriculum , Female , Humans , Male , Middle Aged , Pandemics , Surveys and Questionnaires , Young Adult
3.
Nature ; 586(7830): 594-599, 2020 10.
Article in English | MEDLINE | ID: covidwho-1091471

ABSTRACT

An effective vaccine is needed to halt the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. Recently, we reported safety, tolerability and antibody response data from an ongoing placebo-controlled, observer-blinded phase I/II coronavirus disease 2019 (COVID-19) vaccine trial with BNT162b1, a lipid nanoparticle-formulated nucleoside-modified mRNA that encodes the receptor binding domain (RBD) of the SARS-CoV-2 spike protein1. Here we present antibody and T cell responses after vaccination with BNT162b1 from a second, non-randomized open-label phase I/II trial in healthy adults, 18-55 years of age. Two doses of 1-50 µg of BNT162b1 elicited robust CD4+ and CD8+ T cell responses and strong antibody responses, with RBD-binding IgG concentrations clearly above those seen in serum from a cohort of individuals who had recovered from COVID-19. Geometric mean titres of SARS-CoV-2 serum-neutralizing antibodies on day 43 were 0.7-fold (1-µg dose) to 3.5-fold (50-µg dose) those of the recovered individuals. Immune sera broadly neutralized pseudoviruses with diverse SARS-CoV-2 spike variants. Most participants had T helper type 1 (TH1)-skewed T cell immune responses with RBD-specific CD8+ and CD4+ T cell expansion. Interferon-γ was produced by a large fraction of RBD-specific CD8+ and CD4+ T cells. The robust RBD-specific antibody, T cell and favourable cytokine responses induced by the BNT162b1 mRNA vaccine suggest that it has the potential to protect against COVID-19 through multiple beneficial mechanisms.


Subject(s)
Antibodies, Viral/immunology , Coronavirus Infections/immunology , Pneumonia, Viral/immunology , Th1 Cells/immunology , Viral Vaccines/immunology , Adult , Antibodies, Neutralizing/immunology , CD8-Positive T-Lymphocytes/cytology , CD8-Positive T-Lymphocytes/immunology , COVID-19 , COVID-19 Vaccines , Coronavirus Infections/prevention & control , Cytokines/immunology , Female , Germany , Humans , Immunoglobulin G/immunology , Male , Middle Aged , Pandemics , Th1 Cells/cytology , Viral Vaccines/administration & dosage , Viral Vaccines/adverse effects , Young Adult
6.
World Neurosurg ; 142: 314-317, 2020 10.
Article in English | MEDLINE | ID: covidwho-704931

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has infected more than 13 million people on a global scale and claimed more than half million deaths across 213 countries and territories. While the focus is currently on recovery from the pandemic, the disease has significantly changed the way we practice medicine and neurosurgery in New York City and the United States. Apart from the emergency cases, several health systems across the country have similarly started to perform elective surgeries. Although COVID-19 screening and testing guidelines have been proposed and adopted by many hospitals, these may not adequately protect the operating room personnel who are in proximity to the patient for prolonged periods. There are concerning reports of especially high transmission rates of COVID-19 in transmucosal head and neck procedures conducted by otolaryngologists and neurosurgeons, despite attempts at wearing what constitutes appropriate personal protective equipment. METHODS: Here, we describe a simple technique of additional draping that can be used for all cranial, endonasal, spinal, and neurointerventional cases to limit the transmission of coronavirus. RESULTS: The proposed technique offers a simple, commonly available, cost-effective alternative that avoids the use of additional retractor systems. Moreover, this technique can be used in all neurosurgical procedures. CONCLUSIONS: With the rising concerns regarding airborne spread of the virus, we expect that these precautions will prove highly useful as we enter the recovery phase of this pandemic and hospitals attempt to prevent a return to widespread infection. In addition, its availability and cost effectiveness make this technique especially attractive to practical use in centers with limited resources.


Subject(s)
Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurosurgical Procedures/instrumentation , Pneumonia, Viral/transmission , Surgical Drapes , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Humans , Nasal Cavity , Natural Orifice Endoscopic Surgery , Neuroendoscopy/instrumentation , Neuroendoscopy/methods , Neurosurgical Procedures/methods , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , SARS-CoV-2
7.
J Neurointerv Surg ; 12(7): 643-647, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-327010

ABSTRACT

BACKGROUND: Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. METHODS: We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. RESULTS: Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. CONCLUSION: Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.


Subject(s)
Betacoronavirus , Coronavirus Infections/surgery , Coronavirus Infections/transmission , Health Personnel/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurosurgical Procedures/standards , Pneumonia, Viral/surgery , Pneumonia, Viral/transmission , COVID-19 , Humans , Neurosurgical Procedures/adverse effects , Operating Rooms/methods , Operating Rooms/standards , Pandemics , Personal Protective Equipment/standards , SARS-CoV-2
8.
World Neurosurg ; 139: 289-293, 2020 07.
Article in English | MEDLINE | ID: covidwho-232517

ABSTRACT

BACKGROUND: The Coronavirus disease 2019 (COVID-19) outbreak has left a lasting mark on medicine globally. METHODS: Here we outline the steps that the Lenox Hill Hospital/Northwell Health Neurosurgery Department-located within the epicenter of the pandemic in New York City-is currently taking to recover our neurosurgical efforts in the age of COVID-19. RESULTS: We outline measurable milestones to identify the transition to the recovery period and hope these recommendations may serve as a framework for an effective path forward. CONCLUSIONS: We believe that recovery following the COVID-19 pandemic offers unique opportunities to disrupt and rebuild the historical patient and office experience as we evolve with modern medicine in a post-COVID-19 world.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hospitals, Urban/standards , Neurosurgery/standards , Neurosurgical Procedures/standards , Pneumonia, Viral/epidemiology , COVID-19 , Coronavirus Infections/surgery , Health Personnel/standards , Humans , Neurosurgery/methods , Neurosurgical Procedures/methods , New York City/epidemiology , Pandemics , Pneumonia, Viral/surgery , SARS-CoV-2
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