Construction and use of a risk stratification instrument for vaccination of elderly against Covid-19 / Construção e utilização de instrumento de estratificação de risco para vacinação de idosos contra a Covid-19 / Construcción y uso de un instrumento de estratificación de riesgo para la vacunación del anciano contra el Covid- 19

Objetivo: Relatar a experiência da construção e utilização de um instrumento de estratificação de risco para vacinação de idosos contra a COVID-19. Métodos: Relato da experiência desenvolvida no município de Massapê ­ Ceará, durante o ano de 2021, a partir do início da campanha de vacinação de idosos contra a COVID-19. Descrição da Experiência: Por conta da escassez de imunobiológicos, na fase inicial da vacinação contra a COVID-19, a Secretaria da Saúde do município de Massapê, estado do Ceará, criou um instrumento para estratificação de riscos sanitários, epidemiológicos e sociais dos idosos, contendo seus dados sociodemográficos e as comorbidades. Após o estabelecimento das variáveis, foram estabelecidos escores para os estratos de risco, que foram classificados em baixo (um a três pontos), médio (quatro a seis pontos), alto (sete a nove pontos) e muito alto (dez pontos e mais). Considerações Finais: O estudo mostra que, apesar da pandemia de COVID-19, uma crise sanitária global sem precedentes como já dito, ações pontuais, mesmo que localizadas, podem ter efeito em cadeia e ser replicadas em outros cenários e momentos.

Objective: To report the experience of building and using a risk stratification instrument for vaccinating the elderly against COVID-19. Methods: Report of the experience developed in the municipality of Massapê - Ceará, during the year 2021, from the beginning of the vaccination campaign for the elderly against COVID-19. Experience Description: Due to the scarcity of immunobiologicals, in the initial phase of vaccination against COVID-19, the Department of Health of the municipality of Massapê, state of Ceará, created an instrument to stratify the health, epidemiological and social risks of the elderly, containing sociodemographic data and comorbidities of the elderly. After establishing the variables, scores were established for the risk strata, which were classified as low (one to three points), medium (four to six points), high (seven to nine points) and very high (ten points and more). Final Considerations: The study shows that, despite the COVID-19 pandemic, an unprecedented global health crisis as already mentioned, specific actions, even if localized, can have a chain effect and be replicated in other scenarios and times.

Objetivo: Relatar la experiencia de construcción y uso de un instrumento de estratificación de riesgo para la vacunación de ancianos contra la COVID-19. Métodos: Informe de la experiencia desarrollada en el municipio de Massapê - Ceará, durante el año 2021, desde el inicio de la campaña de vacunación de ancianos contra la COVID-19. Descripción de la Experiencia: Debido a la escasez de inmunobiológicos, en la fase inicial de la vacunación contra la COVID-19, la Secretaría de Salud del municipio de Massapê, estado de Ceará, creó un instrumento para estratificar los riesgos sanitarios, epidemiológicos y sociales de los ancianos, que contiene datos sociodemográficos y comorbilidades de los ancianos. Luego de establecer las variables, se establecieron puntajes para los estratos de riesgo, los cuales se clasificaron en bajo (uno a tres puntos), medio (cuatro a seis puntos), alto (siete a nueve puntos) y muy alto (diez puntos y más). Consideraciones finales: El estudio muestra que, a pesar de la pandemia de COVID-19, una crisis sanitaria mundial sin precedentes como ya se mencionó, las acciones específicas, aunque sean localizadas, pueden tener un efecto en cadena y replicarse en otros escenarios y tiempos.

Retinal vein occlusion in the general population after COVID-19 vaccination and infection.

INTRODUCTION: Retinal vein occlusion (RVO) is mostly a consequence of vascular risk factors (VRF). COVID-19 vaccines have been related to vascular and thrombotic events (VTE). OBJECTIVE: To assess the RVO incidence in the general population in our health area and the possible relation with COVID-19 infection and vaccination. METHODS: Demographic features, classic VRF, thrombophilia data, COVID-19 status, and Framingham risk score were collected prospectively. RESULTS: 472 consecutive patients studied over 13 years with RVO were included (Valdecilla Cohort). Classic VRFs were present in 90%, antiphospholipid syndrome in 12.3%, and genetic thrombophilia in 13.5%. Ninety-one percent of RVO patients were vaccinated and 6.8% suffered COVID-19 infection. In the cohort, no patient had a new RVO after vaccination or infection. In the general population, 20 subjects had RVO after receiving the vaccine (0.006%). Overall, 8 cases occurred in the first-month post-vaccination and 12 after 30 days. In the early and late groups, there are 3 and 4 patients respectively, with a low-intermediate risk Framingham score. Twenty-nine patients in the cohort suffered SARS-CoV-2 infection, twenty-seven of them had RVO before infection. Two patients with low-risk Framingham scores had RVO after infection, one of them early (<1 month). CONCLUSIONS: Vaccination and COVID-19 might be involved in the development of RVO in some cases, mainly in patients without VRF, thrombophilia, or chronic inflammatory conditions and with a lower Framingham score, especially in the first month after vaccination or infection.

Immunogenicity, effectiveness and safety of COVID-19 vaccine in older adults living in nursing homes: A real-life study.

INTRODUCTION: BNT162b2 (BioNTech and Pfizer) is a nucleoside-modified mRNA vaccine that provides protection against SARS-CoV-2 infection and is generally well tolerated. However, data about its efficacy, immunogenicity and safety in people of old age or with underlying chronic conditions are scarce. PURPOSE: To describe BNT162b2 (BioNTech and Pfizer) COVID-19 vaccine immunogenicity, effectiveness and reactogenicity after complete vaccination (two doses), and immunogenicity and reactogenicity after one booster, in elders residing in nursing homes (NH) and healthy NH workers in real-life conditions. METHODS: Observational, ambispective, multicenter study. Older adults and health workers were recruited from three nursing homes of a private hospital corporation located in three Spanish cities. The primary vaccination was carried out between January and March 2021. The follow-up was 13 months. Humoral immunity, adverse events, SARS-CoV-2 infections, hospitalizations and deaths were evaluated. Cellular immunity was assessed in a participant subset. RESULTS: A total of 181 residents (mean age 84.1 years; 89.9% females, Charlson index ≥2: 45%) and 148 members of staff (mean age 45.2 years; 70.2% females) were surveyed (n:329). After primary vaccination of 327 participants, vaccine response in both groups was similar; ≈70% of participants, regardless of the group, had an antibody titer above the cut-off considered currently protective (260BAU/ml). This proportion increased significantly to ≈ 98% after the booster (p<0.0001 in both groups). Immunogenicity was largely determined by a prior history of COVID-19 infection. Twenty residents and 3 workers were tested for cellular immunity. There was evidence of cellular immunity after primary vaccination and after booster. During the study, one resident was hospitalized for SARS-CoV-2. No SARS-CoV-2-related deaths were reported and most adverse events were mild. CONCLUSIONS: Our results suggest that the BNT162b2 mRNA COVID-19 vaccine is immunogenic, effective and safe in elderly NH residents with underlying chronic conditions.

COVID-19 vaccination rate and willingness of an additional dose among inflammatory bowel disease patients receiving biologic therapy: Fearless and with desire.

Effective vaccines against the SARS-CoV-2 are already available and offer a promising action to control the COVID-19 pandemic. IBD patients on biological agents accept the vaccine as well as an additional dose if recommended. BACKGROUND: Vaccination against COVID-19 prevents its severe forms and associated mortality and offers a promising action to control this pandemic. In September 2021, an additional dose of vaccine was approved in patients with immunosuppression including IBD patients on biologic agents. We evaluated the vaccination rate and additional dose willingness in this group of at risk patients. METHODS: A single-center, cross-sectional study was performed among IBD patients on biologic agents and eligible for an additional dose of the COVID-19 vaccine. IBD clinical characteristics and type of vaccine and date of administration were checked in medical records. Acceptance was evaluated after telephone or face-to-face surveys in IBD patients. RESULTS: Out of a total of 344 patients, 269 patients (46.1% male; mean age 47±16 years; Crohn's disease 73.6%) were included. Only 15 (5.6%) patients refused the COVID-19 vaccine mainly (40%) for conviction (COVID-19 pandemic denial). 33.3% would re-consider after discussing with their doctor and/or receiving information on the adverse effects of the vaccine. Previous to the additional dose, the COVID-19 vaccination was present in 94.4% of patients (n=254). Adverse effects occurred in 53.9% of the cases, mainly pain in the arm (40%). Up to 94.1% of the patients agreed to an additional dose and 79.4% had already received the additional dose at the final time of the assessment. CONCLUSIONS: IBD patients on biological agents accept the vaccine as well as an additional dose if recommended. Physicians in charge of IBD units should provide information and confidence in the use of the vaccine in these IBD patients.

Systemic lupus erythematosus myocarditis after COVID-19 vaccination.

INTRODUCTION: Cases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine. OBJECTIVE: Describe another possible mechanism of myocarditis after COVID-19 vaccination. CASE PRESENTATION: We describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex. RESULTS AND DISCUSSION: Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine. CONCLUSION: Given the pathogenic rationales, the association between SLE and myocarditis should be considered.

The heart and SARS-CoV-2. / Corazón y SARS-CoV-2.

SARS-CoV-2 is currently causing a persistent COVID-19 pandemic, which poses a risk of causing long-term cardiovascular sequels in the population. The viral mechanism of cell infection through the angiotensin 2 converter enzyme receptor and the limited antiviral innate immune response are the suspected causes for a more frequent cardiovascular damage in SARS-CoV-2 infection. Knowledge of the appearance during acute infection of other cardiac conditions beyond the classical myocarditis and pericarditis, the long-term cardiac manifestations (persistent COVID-19), and the increased incidence of myocarditis and pericarditis after vaccination is of special interest in order to offer our patients best practices based on current scientific evidence.

COVID-19 vaccination among Spanish nephrologists: Acceptance and side effects.

INTRODUCTION: Four vaccines against Covid-19 have been approved to date. Their acceptance and safety have not been addressed on healthcare workers. The aim of the present study is to evaluate vaccination rates and side effects among Spanish nephrologists. METHODS: All the Spanish nephrologists were invited to participate in this survey. Data on demographics, Covid-19 infection status, received vaccine doses and side effects were collected. Acceptance and side effects were analyzed for Covid-19 vaccination. Factors associated to vaccination were assessed and a multivariate adjusted model was constructed to determine independent predictors for Covid-19 vaccine side effects. RESULTS: A total of 708 nephrologists answered the survey (460 [65%] women, mean age 44±11 years). Six-hundred and eight (86%) had received the first dose and 513 (72%) were fully vaccinated. Most of the subjects (565, 93%) received BNT162b2 (Pfizer-BioNTech®) vaccine. Among vaccinated nephrologists, 453 (75%) presented any side effect; the most frequent was local reaction (68%), followed by myalgia (44%), tiredness (39%) and headache (34%). Age (OR 0.97, 95%CI [0.95-0.99], p<0.0001) and prior Covid-19 infection (OR 2.37, 95%CI [1.27-4.42], p=0.007) were independent predictors for developing side effects with Covid-19 vaccine. Overall side effects were similar with both vaccines, being myalgia (p=0.006) and tiredness (p=0.032) more frequent with the Pfizer-BioNTech® one. CONCLUSION: Age and prior Covid-19 infection were predictors of vaccination side effects among Spanish nephrologists.