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2.
Preprint in English | EuropePMC | ID: ppcovidwho-294081

ABSTRACT

Background: Housing and access to healthcare pose particular challenges to asylum seekers and refugees. The study aim was to assess their infection risk during the COVID-19 pandemic. <br><br>Methods: We provide the first event-free, prospective study on SARS-CoV-2 cases among adult asylum seekers/refugees in Europe. SARS-CoV-2 genome and antibody titers were determined in adult asylum seekers/refugees living in shared accommodation in Lübeck, Germany at two time-points and compared to the results from a local population-based cohort. <br><br>Findings: In November/December 2020, we detected 2/97 PCR- (2·1%;95% confidence interval [CI]: 0·4-6·3%) and 4/97 (4·1%;CI: 1·4-9·2%) seropositive asylum seekers/refugees compared to 3/2547 (0·1%;CI: 0·0-0·3%) PCR-positive and 12/2547 (0·5%;CI: 0·3-0·8%) seropositive probands in the control sample. In February 2021, 2/67 (3·0%;CI: 0·5-9·1%) PCR-, and 25/67 (37·3%;CI: 27·4-48·1) antibody-positive individuals were found in the study group in comparison to 2/2371 (0·1%;CI: 0·0-0·3% and 38/2371 (1·6%;CI: 1·2-2·1%) in the control group. Age, sex, or facility equipment did not impact the results. "Living-with-own-children-in-the-shelter” was significantly positively correlated with infection risk. Importantly, none of the PCR-positive refugees were aware of their infection. Only 32·9% of the asylum seekers were willing to be vaccinated compared to 85·5% in the control population. <br><br>Interpretation: Refugees residing in shared accommodations represent a high-risk group for SARS-CoV-2 infection and transmission. The present study suggests a need for (i) tailored testing strategies, (ii) improved information of this subgroup, and (iii) high-priority vaccination. <br><br>Funding Information: The study was funded by the Federal Ministry of Education and Research.<br><br>Declaration of Interests: C.K. serves as medical advisor to Centogene for genetic testing reports in the fields of movement disorders and dementia, excluding Parkinson's disease and serves on the Scientific Advisory Board of Retromer Therapeutics. Neither activity represents a conflict of interest. Likewise, none of the other authors declares any financial conflict of interest.<br><br>Ethics Approval Statement: The ethics committee of the University of Lübeck approved the study (Az. 20-150). All participants gave written informed consent. All study materials were translated into the refugees' native languages, and interpreters were available on-site at the study center.

3.
Infection ; 49(6): 1299-1306, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1482322

ABSTRACT

PURPOSE: Thorough knowledge of the nature and frequency of co-infections is essential to optimize treatment strategies and risk assessment in cases of coronavirus disease 2019 (COVID-19). This study aimed to evaluate the multiplex polymerase chain reaction (PCR) screening approach for community-acquired bacterial pathogens (CABPs) at hospital admission, which could facilitate identification of bacterial co-infections in hospitalized COVID-19 patients. METHODS: Clinical data and biomaterials from 200 hospitalized COVID-19 patients from the observational cohort of the Competence Network for community-acquired pneumonia (CAPNETZ) prospectively recruited between March 17, 2020, and March 12, 2021 in 12 centers in Germany and Switzerland, were included in this study. Nasopharyngeal swab samples were analyzed on hospital admission using multiplex real-time reverse transcription (RT)-PCR for a broad range of CABPs. RESULTS: In total of 200 patients Staphylococcus aureus (27.0%), Haemophilus influenzae (13.5%), Streptococcus pneumoniae (5.5%), Moraxella catarrhalis (2.5%), and Legionella pneumophila (1.5%) were the most frequently detected bacterial pathogens. PCR detection of bacterial pathogens correlated with purulent sputum, and showed no correlation with ICU admission, mortality, and inflammation markers. Although patients who received antimicrobial treatment were more often admitted to the ICU and had a higher mortality rate, PCR pathogen detection was not significantly related to antimicrobial treatment. CONCLUSION: General CABP screening using multiplex PCR with nasopharyngeal swabs may not facilitate prediction or identification of bacterial co-infections in the early phase of COVID-19-related hospitalization. Most patients with positive PCR results appear to be colonized rather than infected at that time, questioning the value of routine antibiotic treatment on admission in COVID-19 patients.


Subject(s)
COVID-19 , Coinfection , Community-Acquired Infections , Legionella pneumophila , Pneumonia , Cohort Studies , Coinfection/diagnosis , Coinfection/epidemiology , Community-Acquired Infections/diagnosis , Humans , Multiplex Polymerase Chain Reaction , Prospective Studies , SARS-CoV-2
4.
United European Gastroenterol J ; 9(9): 1081-1090, 2021 11.
Article in English | MEDLINE | ID: covidwho-1469560

ABSTRACT

BACKGROUND: Corona virus disease 2019 (COVID-19) patients are at increased risk for thromboembolic events. It is unclear whether the risk for gastrointestinal (GI) bleeding is also increased. METHODS: We considered 4128 COVID-19 patients enrolled in the Lean European Open Survey on SARS-CoV-2 (LEOSS) registry. The association between occurrence of GI bleeding and comorbidities as well as medication were examined. In addition, 1216 patients from COKA registry were analyzed focusing on endoscopy diagnostic findings. RESULTS: A cumulative number of 97 patients (1.8%) with GI bleeding were identified in the LEOSS registry and COKA registry. Of 4128 patients from the LEOSS registry, 66 patients (1.6%) had a GI bleeding. The rate of GI bleeding in patients with intensive care unit (ICU) admission was 4.5%. The use of therapeutic dose of anticoagulants showed a significant association with the increased incidence of bleeding in the critical phase of disease. The Charlson comorbidity index and the COVID-19 severity index were significantly higher in the group of patients with GI bleeding than in the group of patients without GI bleeding (5.83 (SD = 2.93) vs. 3.66 (SD = 3.06), p < 0.01 and 3.26 (SD = 1.69) vs. 2.33 (SD = 1.53), p < 0.01, respectively). In the COKA registry 31 patients (2.5%) developed a GI bleeding. Of these, the source of bleeding was identified in upper GI tract in 21 patients (67.7%) with ulcer as the most frequent bleeding source (25.8%, n = 8) followed by gastroesophageal reflux (16.1%, n = 5). In three patients (9.7%) GI bleeding source was located in lower GI tract caused mainly by diverticular bleeding (6.5%, n = 2). In seven patients (22.6%) the bleeding localization remained unknown. CONCLUSION: Consistent with previous research, comorbidities and disease severity correlate with the incidence of GI bleeding. Also, therapeutic anticoagulation seems to be associated with a higher risk of GI bleeding. Overall, the risk of GI bleeding seems not to be increased in COVID-19 patients.


Subject(s)
COVID-19/epidemiology , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Child , Child, Preschool , Comorbidity , Critical Illness , Diverticular Diseases/diagnosis , Europe/epidemiology , Female , Gastroesophageal Reflux/complications , Gastrointestinal Hemorrhage/etiology , Hospitalization , Humans , Infant , Intensive Care Units , Male , Middle Aged , Peptic Ulcer/diagnosis , Registries , Severity of Illness Index , Young Adult
5.
Infection ; 2021 Oct 08.
Article in English | MEDLINE | ID: covidwho-1460516

ABSTRACT

PURPOSE: Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. METHODS: 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. RESULTS: Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). CONCLUSION: In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.

6.
Clin Microbiol Infect ; 2021 Sep 20.
Article in English | MEDLINE | ID: covidwho-1415295

ABSTRACT

OBJECTIVES: To investigate the response of the immune system (and its influencing factors) to vaccination with BNT162b2 or mRNA-1273. METHODS: 531 vaccinees, recruited from healthcare professionals, donated samples before, in between, and after the administration of the two doses of the vaccine. T- and B-cell responses were examined via interferon-γ (IFN-γ) release assay, and antibodies against different epitopes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (S1 and NCP) were detected via ELISA and surrogate neutralization assay. Results were correlated with influencing factors such as age, sex, prior infection, vaccine received (BNT162b2 or mRNA-1273), and immunosuppression. Furthermore, antinuclear antibodies (ANAs) were measured to screen for autoimmune responses following vaccination with an mRNA vaccine. RESULTS: No markers of immunity against SARS-CoV-2 were found before the first vaccination. Two weeks after it, specific responses against SARS-CoV-2 were already measurable (median ± median absolute deviation (MAD): anti-S1 IgG 195.5 ± 172.7 BAU/mL; IgA 6.7 ± 4.9 OD; surrogate neutralization 39 ± 23.7%), and were significantly increased two weeks after the second dose (anti-S1 IgG 3744 ± 2571.4 BAU/mL; IgA 12 ± 0 OD; surrogate neutralization 100 ± 0%, IFN-γ 1897.2 ± 886.7 mIU/mL). Responses were stronger for younger participants (this difference decreasing after the second dose). Further influences were previous infection with SARS-CoV-2 (causing significantly stronger responses after the first dose compared to unexposed individuals (p ≤ 0.0001)) and the vaccine received (significantly stronger reactions for recipients of mRNA-1273 after both doses, p < 0.05-0.0001). Some forms of immunosuppression significantly impeded the immune response to the vaccination (with no observable immune response in three immunosuppressed participants). There was no significant induction of ANAs by the vaccination (no change in qualitative ANA results (p 0.2592) nor ANA titres (p 0.08) from pre-to post-vaccination. CONCLUSIONS: Both vaccines elicit strong and specific immune responses against SARS-CoV-2 which become detectable one week (T-cell response) or two weeks (B-cell response) after the first dose.

7.
Neonatology ; : 1-2, 2021 Sep 02.
Article in English | MEDLINE | ID: covidwho-1403142
8.
Emerg Microbes Infect ; 10(1): 1515-1518, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1313723

ABSTRACT

We show a shift in the prevalence of respiratory viral pathogens in community-acquired pneumonia patients during the COVID-19 pandemic. Our data support the efficiency of non-pharmaceutical interventions on virus circulation except for rhinoviruses. The consequences of an altered circulation on subsequent winter seasons remain unclear and support the importance of systematic virological surveillance.


Subject(s)
COVID-19/epidemiology , Community-Acquired Infections/epidemiology , Pneumonia/epidemiology , Respiratory Tract Infections/epidemiology , Adult , Aged , Bacteria/classification , Bacteria/genetics , Bacteria/isolation & purification , COVID-19/virology , Community-Acquired Infections/microbiology , Community-Acquired Infections/virology , Female , Germany/epidemiology , Humans , Male , Middle Aged , Pandemics , Pneumonia/microbiology , Pneumonia/virology , Prevalence , Prospective Studies , Respiratory Tract Infections/microbiology , Respiratory Tract Infections/virology , SARS-CoV-2/genetics , SARS-CoV-2/physiology , Viruses/classification , Viruses/genetics , Viruses/isolation & purification , Young Adult
10.
J Pediatric Infect Dis Soc ; 9(5): 620-621, 2020 Nov 10.
Article in English | MEDLINE | ID: covidwho-919278

ABSTRACT

The reason for the apparently lower infection rate of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to adults is still unclear. Here, we report on 4 schoolchildren with heavy exposure to SARS-CoV-2 with no clinical signs of coronavirus disease 2019, repeated negative nasopharyngeal swabs for SARS-CoV-2 RNA, and no seroconversion.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Family Health , Pneumonia, Viral/transmission , Betacoronavirus/isolation & purification , COVID-19 , Child , Disease Transmission, Infectious , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
11.
Infection ; 48(6): 971-974, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-631448

ABSTRACT

PURPOSE: The first SARS-CoV-2 cases in Europe were reported in January 2020. Recently, concern arose on unrecognized infections before this date. For a better understanding of the pandemic, we retrospectively analyzed patient samples for SARS-CoV-2 from the prospective CAPNETZ study cohort. METHODS: We used nasopharyngeal swab samples from a cohort of well characterized patients with community acquired pneumonia of the CAPNETZ study group, recruited from different geographic regions across Germany, Austria, the Netherlands, and Switzerland between 02nd December 2019 and 28th April 2020. Multiplex real-time RT-PCR for a broad range of respiratory pathogens and SARS-CoV-2 real-time RT-PCR were performed on all samples. RESULTS: In our cohort, respiratory pathogens other than SARS-CoV-2 were detected in 21.5% (42/195) of patients with rhinovirus as the most frequently detected pathogen. The detection rate increased to 29.7% (58/195) when SARS-CoV-2 was included. No SARS-CoV-2 positive sample was detected before end of March 2020. CONCLUSIONS: Respiratory viral pathogens accounted for a considerable number of positive results but no SARS-CoV-2 case was identified before the end of March 2020.


Subject(s)
COVID-19/epidemiology , Community-Acquired Infections/epidemiology , Pneumonia/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , Cohort Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/etiology , Community-Acquired Infections/history , Female , Germany , History, 21st Century , Humans , Male , Middle Aged , Multiplex Polymerase Chain Reaction , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/history , SARS-CoV-2 , Young Adult
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