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Background: Bibliometric analysis has gained increasing interest as an efficient method to visualize COVID-19 research trends and patterns. This analysis may help to describe the profile of scientific contribution of allergy and clinical immunology specialists in the current COVID-19 pandemic. One of the arguments to support the leading role of allergists and clinical immunologists in the COVID-19 pandemic control is their expertise on disease mechanisms. We hypothesized that this role could also have an impact in the COVID-19 literature. Therefore, our objective was to compare the proportion of COVID-19 related publications dealing with the "mechanism" research topic between allergy and non-allergy journals. Method(s): This study involves a large-scale bibliometric analysis of more than 205,000 COVID-19 publications. This evaluation is embedded into the Covid Content Curation Project (0011-3638- 2020- 000001, Health Department of Navarra Government, Spain), an ongoing research to design an artificial intelligence platform for grading the relevance for decision making of COVID-19 scientific publications. We used web scraping functionalities of the Covid Content Curation platform to obtain a complete and up-to- date list of COVID-19 publications. Exclusion criteria were duplicate publications, publications from the preprint servers, publications published before March 1, 2020 or after December 31, 2021, or with any missing date data. Result(s): After exclusion criteria, 205,982 COVID-19 publications were available for analysis. The cumulative total of COVID-19 publications in allergy journals was 923 (4.48;95% CI: 4.20 to 4.78). The number of COVID-19 publications dealing with "mechanism" as a research topic was 13.22 (95% CI: 10.03 to 16.41) percentage points greater among allergy journals than non-allergy journals (p < 0.001) (Figure 1). Conclusion(s): These results show that the "mechanism" research topic is of greater prevalence in COVID-19 publications of allergy journals than non-allergy journals, and support the hypothesis that the prominent role of allergists and clinical immunologists in the COVID-19 pandemic control, based on their expertise on disease mechanisms, may also have an impact in the COVID-19 literature.
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Background: The COVID-19 pandemic is considered as a major challenge of the 21st century medicine around the world. Prolonged post-COVID symptoms of the respiratory system remain a topical issue: dry annoying cough, respiratory failure, and discomfort in the lung projection area. Thus, in COVID-infected patients, the assessment of respiratory system functional state with postcoid respiratory symptoms is undoubtedly important that is the aim of our study. Method(s): To achieve this aim, 56 patients (18 to 65 years of age, 33-females, 23-males) with post-COVID respiratory symptoms who referred to the Scientific Research Institute of Allergology, Asthma and Clinical Immunology (Tskaltubo, Georgia) for further diagnosis and treatment were involved in the study. Result(s): Respiratory status: external respiratory functioning status and spirometry features were assessed using computer spirometry -Spirolab 3. Analysis of the results showed that in the above patients, defects in forced expiratory time (FET < 6 min) were observed. According to the basic parameters of spirometry, the slight changes in FEV1;FVC FEV1/VC (Tiffeneau-Pinelli index) were revealed;Only 6 (10%) patients showed a mild obstruction, 4 of irreversible type and only 2 patients had reversible broncho-obstruction. In addition, mild restriction was determined in only 5 (9%) patients. Restrictive changes were detected in patients with a history of severe course of COVID infection and CT severity scores 12-21. Significant changes were observed in the PEF-peak expiratory flow rate in 35 (61%) patients the PEF index was reliably lower, by 70% or more, compared to the norm. Conclusion(s): Obstruction of medium and small bronchus was also reported in the majority of patients. MEF50%, MEF25% indicators were reliably reduced, undoubtedly indicating the importance of COVID 19 infection in the development and course of respiratory symptoms. The study reaffirmed the need for spirometry in the management and monitoring of COVID infection. Information on changes in spirometry parameters in COVID patients and patients with post-COVID respiratory symptoms is still scarce, however, the study in this area is undoubtedly promising.
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Background: Vaccination plays an essential role in controlling SARS-CoV- 2 pandemics. Due to initial concerns about hypersensitivity reactions (HR) to these new vaccines, our department, in articulation with Primary Healthcare Services (PHS) has developed several strategies to support COVID-19 vaccination. This work aims to describe those strategies and report the results. Method(s): The strategies developed for COVID-19 vaccination, from March to December 2021, included: 1) telephone support for health professionals (TS for HP) from the Vaccination Centres (VC), 2) priority appointments (PA) of patients classified as a higher risk for HR, 3) hospital vaccination of high-risk patients as defined by the national health authority. A retrospective and descriptive analysis of the support activity developed and from the data of patients vaccinated at the hospital in the same period were performed. Result(s): During the considered period, our department screened 1618 patients: 420 (26%) through telephone support for HP (TS for HP) from VC and 1198 (74%) at priority appointments (PA). After TS for HP, community vaccination (CV) was recommended in 87% (n = 364) of cases and a PA was advised in 13% (n = 56). Of the patients evaluated in PA, 80% were recommended CV, with restriction of the vaccine to administer in 28% of them. We always found an option to vaccine all. At the hospital were vaccinated 178 patients, 83% (n = 147) women, median age (P25-75) 61 (46-76) years. Hospital vaccination criteria were: past history of multiple drug HR (n = 93;52%), HR to vaccines (n = 46;26%), HR to the 1st dose of anti-SARS- CoV- 2 vaccine (n = 30;17%), idiopathic anaphylaxis (n = 10;6%) and systemic mastocytosis (n = 2;1%). 15% of patients (n = 26) performed skin tests with vaccines, which were negative in 25 and inconclusive in 1 case. 145 (82%) were first shots, 32 (18%) second shots, and one booster shot. Only one patient had a mild immediate reaction (2nd booster vaccination), promptly treated with antihistamine and corticosteroid. Conclusion(s): The collaboration strategies adopted by our department allowed the vaccination of 1618 patients and avoided vaccination delays in most of the VC contacts. In our sample, hospital vaccination of patients at higher risk for HR was safe.
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Background: Mast cell disorders (MCDs) are characterized by the proliferation and accumulation of mast cells in different tissues and their inappropriate release of mediators. Primary MCDs include systemic and cutaneous mastocytosis and monoclonal MC activation syndrome. They manifest with symptoms ranging from rash to anaphylaxis, idiopathic or elicited by heterogeneous factors, including vaccines. Vaccines are useful to prevent severe lung disease and mortality in COVID-19. Early reports of allergic reactions to COVID-19 vaccines emerged;however, their frequency is low. There are limited data on the safety of COVID-19 vaccine for immediate allergic reactions in high-risk patients like those with MCDs. To date, data concerning both the type of premedication and its need in these patients undergoing COVID-19 vaccines are limited. The objective of this study is to evaluate the safety of COVID-19 vaccine in patients with MCDs. Method(s): We included retrospectively patients with primary MCDs, according to WHO criteria, attending the Clinical Immunology and Allergy Unit at AO Mauriziano from June 2000 to December 2021, who underwent COVID-19 vaccination. We reported demographic and clinical data and noted -by phone call -vaccine type, premedication scheme, and contingent reactions. Result(s): We enrolled 44 patients (22 female, 50%), with a median age at diagnosis of 43.4 yrs. 25 patients had ISM, 8 CM, and 11 MMCAS. Median tryptase level was 44.3 ng/ml. 17 patients had history of anaphylaxis, none after vaccination. 37 patients (84.1%) underwent COVID-19 vaccination, 7 refused it. 32 completed the vaccination course, and 5 received two doses only. 25 patients were fully vaccinated with mRNA vaccine. The PEG-allergic one underwent Ad26.COV2.S vaccine, another one had first ChAdOx1, then mRNA-1273. All patients were vaccinated in hospital setting and observed for one hour. Most patients continued the daily antihistamine;9 started it few days before the injection;4 patients underwent vaccination without premedication. None showed anaphylaxis. One patient had immediate flushing;another had a delayed asthma exacerbation. A non-premedicated patient had immediate urticaria at first dose, while he tolerated others with AH The small cohort and the retrospective design limit this study. Nonetheless, the absence of severe hypersensitivity reactions to COVID-19 vaccines in our patients with MCDs, is an important finding. Conclusion(s): Our results confirm that patients with MCDs may be safely vaccinated to COVID-19.
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Case report Cytomegalovirus (CMV) causes latent asymptomatic infection in most adults worldwide. Immunodeficiency or immune activation can disrupt viral suppression and lead to viral reactivation, occasionally causing a mononucleosis-like illness in otherwise healthy immunocompetent people. A 37-year- old female presented with a 10-day history of fevers, chills, right-sided neck tenderness, rapidly expanding rash, as well as myalgia, arthralgia, and weakness. She had received her first dose of tozinameran (Pfizer-BioNTech COVID-19 mRNA vaccine) 11 days prior to symptom onset. She was admitted to hospital for further investigations, and was seen by an allergy/clinical immunology specialist, with the diagnosis initially felt to be a delayed serum sickness-like reaction to the vaccine. On admission to hospital, the patient was febrile (37.8C) and tachycardic (122 beats/min). Her physical examination was remarkable for right-sided submandibular tenderness, diffuse blanchable, nonpruritic, erythematous, maculopapular rash, and mild facial swelling. There were no effused joints, lymphadenopathy, nor splenomegaly. Bloodwork showed pancytopenia and mild liver transaminase elevation. Blood cultures were negative. Multiple PCR tests for COVID-19 were negative. Monospot and serology for HBV, HIV, and B. burgdorferi were negative. CMV serology was positive, but unavailable until after discharge. ANA and rheumatoid factor were negative. CT head demonstrated nonspecific edema in the right submandibular area without abscess. On outpatient follow-up, the patient reported symptom resolution over two months. Repeat CMV titres two months post hospitalisation showed strongly elevated IgG, which upon consultation with infectious diseases was felt to represent CMV reactivation (Table 1). CMV viral load was negative. Pancytopenia resolved and transaminases normalized. She received her second dose of tozinameran 4 months post first dose with prophylactic valacyclovir 1g once daily for 1 week prior to and 1 week post vaccination as recommended by infectious diseases and remained asymptomatic. This case is the first known description of CMV reactivation secondary to COVID-19 vaccination. It may be underdiagnosed due to nonspecific symptomatology, as CMV seropositivity ranges from 60-100% of all adults. While causality has yet to be established, recognition of this condition may allow appropriate treatment and prophylaxis in order to facilitate safe COVID-19 vaccination in affected individuals. The patient has provided verbal consent through the telephone for the publication of this case report due to the current COVID-19 pandemic, with written consent to follow.
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Background: The development of vaccines against coronavirus disease 2019 (COVID-19) and the report of associated allergic reactions has led to growing concern about their safety, especially in populations at risk for anaphylaxis such as patients with systemic mastocytosis. Method(s): We conducted a retrospective descriptive analysis of patients with systemic mastocytosis referred to our Allergy and Clinical Immunology Department, between June 2021 and February 2022, for COVID-19 vaccination. Patients were divided into two groups according to their risk of allergic reaction: low/moderate-risk (no history of severe allergic reaction, with or without a history of allergic disease) and high-risk (history of any severe allergic reaction). All patients were premedicated with 60 mg of oral prednisolone 24 hours and 1 hour prior inoculation, and with an oral antihistamine 1 hour before vaccine administration. Low/moderate-risk patients were monitored for 30 minutes after vaccine inoculation. High-risk patients got a peripheral venous access and remained under medical surveillance for 60 minutes. Result(s): A total of 45 patients were included in the analysis: 62.2% females, with a mean age of 48.8 years (range: 22-85). All patients had indolent systemic mastocytosis subtype, with a median tryptase level of 15.6 ng/mL (range: 4.3-185 ng/mL);11 (24.4%) were in the high-risk group (8 with history of anaphylaxis to hymenoptera venom and 3 with prior drug anaphylaxis). Low/moderate-risk and high-risk groups had similar median levels of serum tryptase (15.5 vs. 16.6 ng/ mL, p = 0.932). All patients received BNT162b2 mRNA COVID-19 vaccine and a total of 118 doses were administered (24.6% in the high risk group). No adverse events, including allergic reactions, after vaccine inoculation were recorded during the surveillance period. Conclusion(s): To our knowledge, this is the largest series reporting safety of a mRNA COVID-19 vaccine in patients with systemic mastocytosis. Our data reinforce the fact that even patients with increased risk for allergic reactions can be safely vaccinated against COVID-19, and that earlier concerns should be abandoned so a widespread immunization can be achieved.
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With accumulating data on severe course of SARS-CoV-2/COVID-19 infection in children, it should be taken into account that immunocompromised patients are at increased risk of complications and death due to this disease. Currently vaccination is the only option to prevent the disease. Nowadays more and more data are coming on vaccination in children and in patients with immune deficiencies. In this paper, Polish National Consultants in pediatric oncology and hematology and clinical immunology present recommendations on vaccination in children with malignancies or after hematopoietic cell transplantation. These recommendations are based on ECIL-9 guidelines, adopted to national situation and updated with the latest information. With the fast changing knowledge and statements provided by Center for Disease Control (CDC), Food and Drug Administration (FDA) and European Med-icines Agency (EMA), such recommendations need to be regularly updated. Nevertheless, individual risk/benefit ratio should be always assessed for each patient, particularly in the case of the risk of poor immunological response to immunization.Copyright © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.
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This review presents state-of-the-art knowledge and identifies knowledge gaps for future research in the area of exercise-associated modifications of infection susceptibility. Regular moderate-intensity exercise is believed to have beneficial effects on immune health through lowering inflammation intensity and reducing susceptibility to respiratory infections. However, strenuous exercise, as performed by professional athletes, may promote infection: in about half of athletes presenting respiratory symptoms, no causative pathogen can be identified. Acute bouts of exercise enhance the release of pro-inflammatory mediators, which may induce infection-like respiratory symptoms. Relatively few studies have assessed the influence of regularly repeated exercise on the immune response and systemic inflammation compared to the effects of acute exercise. Additionally, ambient and environmental conditions may modify the systemic inflammatory response and infection susceptibility, particularly in outdoor athletes. Both acute and chronic regular exercise influence humoral and cellular immune response mechanisms, resulting in decreased specific and non-specific response in competitive athletes. The most promising areas of further research in exercise immunology include detailed immunological characterization of infection-prone and infection-resistant athletes, examining the efficacy of nutritional and pharmaceutical interventions as countermeasures to infection symptoms, and determining the influence of various exercise loads on susceptibility to infections with respiratory viruses, including SARS-CoV-2. By establishing a uniform definition of an "elite athlete," it will be possible to make a comparable and straightforward interpretation of data from different studies and settings.
Subject(s)
COVID-19 , Respiratory Tract Infections , Exercise/physiology , Humans , Immunity, Cellular , Inflammation , Respiratory Tract Infections/prevention & control , SARS-CoV-2ABSTRACT
As the SARS-CoV-2 virus shares relatively large protein sequences homologous to grass pollens, dust mites, and molds, our objective was to assess the potential overlap between the COVID-19 mRNA vaccines from Pfizer-BioNtech and Moderna and known allergens. We found 7 common allergens with potential for cross-reactivity with the Pfizer vaccine and 19 with the Moderna vaccine, including common grasses, molds, and dust mites. T-cell mediated antigen cross-reactivity between viruses and allergens is a relatively new area of study in clinical immunology;a discipline that may be particularly useful regarding the SARS-CoV-2 virus and the allergic response in humans. These results suggest that vaccination with the Pfizer-BioNtech and Moderna COVID-19 vaccines may contribute to T-cell cross-reactivity with allergens that impact allergic asthma and allergic rhinitis. Further research should assess the clinical implications of COVID-19 vaccination on the severity and symptomatology of the allergic disease, in addition to natural viral infection. Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.
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BACKGROUND: Given the rapid development of clinical immunology technologies, students majoring in laboratory medicine should master the technological principles and application of clinical laboratory immunology. However, many are required to take online courses due to COVID-19 restrictions, which highlights the need to revisit teaching strategies. Recently, various medical education courses (such as Biochemistry, Physiology, etc.) have implemented the flipped classroom (FC) and team-based learning (TBL) methods, resulting in more positive teaching evaluations. To promote the students' mastery of the difficult knowledge effectively during the online teaching work, we evaluated the performance of online FC-TBL in a clinical laboratory immunology course. METHODS: Sixty-two third-year students from two classes majoring in Laboratory Medicine were recruited and divided into two groups, including one group with traditional lecture-based learning teaching strategy (LBL group) and the other group with LBL or online FC combined with TBL teaching strategy (FC-TBL group). We selected three chapters to conduct FC-TBL teaching in class. All participants took in-class quizzes and final examinations that targeted the same knowledge points. Finally, all participants completed anonymous questionnaires asking for their perceptions of the respective teaching models. In addition, we conducted a survey of teaching suggestions by a FC-TBL class of students majoring in Laboratory Medicine. RESULTS: The FC-TBL group (vs LBL group) had significantly higher scores on the in-class quizzes and final examinations, and also reported high satisfaction with the FC-TBL model. These findings indicate that FC-TBL is suitable for clinical laboratory immunology, as the participants quickly gained essential knowledge. Specifically, FC-TBL helped to "increase learning motivation," "promote self-directed learning skills," "extend more related knowledge," "enhance problem-solving abilities," "enhance clinical reasoning abilities," and "enhance communication skills." For participants' suggestions, 48.38% (15/31) students held positive attitude to FC-TBL teaching strategy compared to 25.81% (8/31) students who considered FC-TBL teaching strategy still needs continuous improvement, and 25.81% (8/31) students reported that they believed FC-TBL teaching strategy was perfect and no further suggestions. CONCLUSIONS: Online FC-TBL effectively enhanced learning activity among students of a clinical laboratory immunology course. This is particularly useful in the COVID-19 context.
Subject(s)
COVID-19 , Laboratories, Clinical , Humans , Pandemics , Laboratories , LearningABSTRACT
SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The SARS-CoV-2 pandemic quickly spread throughout the world after it was first identified in Wuhan, China in 2019. Severe cases of hypoxic respiratory failure have since filled hospitals over the past few years. We present a case of an immunosuppressed patient with persistent respiratory failure from SARS-CoV-2, with a failure to mount antibody response, treated with convalescent plasma. CASE PRESENTATION: We present a 54-year-old female with a past medical history significant for rheumatoid arthritis on immunosuppression with methotrexate, prednisone, sulfasalazine, and rituximab who presented with diarrhea, cough, and shortness of breath. She was unvaccinated and tested positive for COVID-19 pneumonia, which was treated with corticosteroids and Remdesevir. CT thorax revealed diffuse infiltrates (Figure-1). She had progressive hypoxia requiring ICU stay and her course was complicated by inferior wall STEMI, requiring Intra-aortic balloon pump and intubation given worsening hypoxia. She had progressive improvement and was discharged from the hospital on 4 L of supplemental oxygen after a 30-day hospital stay. She presented two days after discharge with cough, fevers and increasing oxygen requirements up to 100% high flow nasal cannula. She was septic and was treated with steroids and antibiotics. She was febrile despite broad spectrum antibiotics. CT thorax demonstrated diffuse infiltrates worsened from the previous and steroid dosing was increased (Figure-2). No obvious source of infection was found, and further evaluation revealed positive Covid-19 RT-PCR. Despite her initial infection occurring two months prior, COVID-19 anti-spike and anti-nucleocapsid antibodies were negative. She was treated with two doses of convalescent plasma and had improvement in her oxygenation, going from 80% high-flow nasal cannula to 6L of supplemental oxygen within two days of administration. DISCUSSION: It's unclear whether immunosuppressed patients with rheumatologic disease are at an increased risk of severe SARS-CoV-2 infection. However, the use of immunosuppressants places patients at risk of an improper immune response to infection. In immunocompetent patients, the typical time to negative SARS-CoV-2 RT-PCR is 3 weeks after positivity (1), and most patients develop antibodies within 2-3 weeks after viral exposure (2). Anti-CD20 monoclonal antibodies like rituximab, commonly used for rheumatologic diseases, can hinder humoral immunity, and impair vaccine response (3). Given our patient's immunosuppressive regimen, we suspect she failed to mount an immune response to COVID-19, resulting in 56 days of infection without an adequate antibody response, successfully treated with convalescent plasma. CONCLUSIONS: Patients with significant immunosuppression regimens may fail to produce antibody responses to SARS-CoV-2, resulting in prolonged infection. Reference #1: Rodríguez-Grande, C., Adán-Jiménez, J., Catalán, P., Alcalá, L., Estévez, A., Muñoz, P., Pérez-Lago, L., de Viedma, D. G., Adán-Jiménez, J., Alcalá, L., Aldámiz, T., Alonso, R., Álvarez, B., Álvarez-Uría, A., Arias, A., Arroyo, L. A., Berenguer, J., Bermúdez, E., Bouza, E., … de la Villa, S. (2021). Inference of active viral replication in cases with sustained positive reverse transcription-PCR results for SARS-CoV-2. Journal of Clinical Microbiology, 59(2). https://doi.org/10.1128/JCM.02277-20 Reference #2: Boechat, J. L., Chora, I., Morais, A., & Delgado, L. (2021). The immune response to SARS-CoV-2 and COVID-19 immunopathology – Current perspectives. In Pulmonology (Vol. 27, Issue 5). https://doi.org/10.1016/j.pulmoe.2021.03.008 Reference #3: Eisenberg, R. A., Jawad, A. F., Boyer, J., Maurer, K., McDonald, K., Prak, E. T. L., & Sullivan, K. E. (2013). Rituximab-treated patients have a poor response to influenza vaccination. Journal of Clinical Immunology, 33(2). https://doi.org/10.1007/s10875-012-9813-x DISCLOSURES No relevant relationships by Issa Makki No relevant relationships by John Parent No relevant relationships by Jay Patel No relevant relationships by Ruchira Sengupta
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SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Myocarditis is inflammation of the heart muscle, and its onset is usually followed by an inciting event such as a viral infection. Here, we report a case of myocarditis in an adolescent male with no significant medical history who presented with chest pain after his second dose of the covid vaccine. CASE PRESENTATION: An 18-year old male presented with no significant past medical/surgical history presented with chest pain. His only triggering event was receiving the second dose of his covid vaccine. A physical examination, chest x-ray, electrocardiogram, and echocardiogram revealed no significant findings. His laboratory findings were positive for myocardial damage with elevated troponin. All other laboratories for autoimmune and inflammation were negative. He was transferred to another facility for cardiac MRI, which subsequently had findings consistent with myocarditis. He remained asymptomatic, and laboratories were normalized. He was discharged and, on follow-up, remained asymptomatic. DISCUSSION: Covid vaccine-induced myocarditis has become a prominent issue. As of March 2022, there are 2323 preliminary reports of myocarditis/pericarditis following either mRNA vaccine, with most cases being young male adolescents. Prior vaccination, such as the smallpox vaccine, has a well-documented history of causing myocarditis, initially thought to be a rare occurrence, it had a prevalence as high as 10% when reviewed. A similar pattern may be observed with the covid vaccine;thus, this complication can be significantly underestimated, and physicians must be vigilant. Thus, cardiac MRI should be pursued if clinically suspected. It has been shown to provide reliable clinical information even in the early phases of inflammation as well as the extent of the inflammatory process, and it avoids invasive procedures1 It can also be used prognostically to monitor disease status. Myocarditis may be immune-related. Key observations include increased systemic reactogenicity and immunogenicity in younger study participants in Pfizer-biotech clinical trials. However, another report showed no difference in spike antibody between patients with myocarditis and those without myocarditis post-covid mRNA vaccine, arguing against a hyperimmune response2. Another plausible mechanism is molecular mimicry between the spike protein and self-antigens, showing cross-reactivity between human peptides in the body, including alpha-myosin3, which may explain why only mRNA covid vaccine causes this complication. Currently, there is no causal relationship, but numerous hypotheses are being examined. CONCLUSIONS: Myocarditis must be recognized as a complication of the covid vaccine and a possible differential of chest pain,specifically in young men in the current pandemic.Early referral of cardiac MRI, if unavailable at centers, is essential for diagnosis and prognostication,given the unknown sequela of this disease. Reference #1: M. Giulia Gagliardi and Bruno Polletta Paolo Di Renzi, Gagliardi, M. G., M. Giulia Gagliardi Department of Cardiology and Cardiac Surgery, Polletta, B., Bruno Polletta Department of Cardiology and Cardiac Surgery, Renzi, P. D., & Paolo Di Renzi Department of Radiology Fatebenefratelli-Isola Tiberina Hospital. (1999, January 26). MRI for the diagnosis and follow-up of Myocarditis. Circulation. Retrieved April 13, 2022, from https://www.ahajournals.org/doi/full/10.1161/circ.99.3.457/a Reference #2: Muthukumar, A., Alagarraju Muthukumar Department of Pathology (A.M., Narasimhan, M., Madhusudhanan Narasimhan Department of Pathology (A.M., Li, Q.-Z., Quan-Zhen Li Department of Immunology (Q.-Z.L.), Mahimainathan, L., Lenin Mahimainathan Department of Pathology (A.M., Hitto, I., Imran Hitto https://orcid.org/0000-0002-9928-4175 Department of Pathology (A.M., Fuda, F., Franklin Fuda Department of Pathology (A.M., Batra, K., Kiran Batra Department of Radiology (K.B.), Jiang, X., Xuan Jiang Department of Internal Medicine (Q.-Z.L., Zhu, C., Chengsong Zhu Department of Internal Medicine (Q.-Z.L., Schoggins, J., … Al., E. (2021, June 16). In-depth evaluation of a case of presumed myocarditis after the second dose of COVID-19 mrna vaccine. Circulation. Retrieved March 31, 2022, from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056038 Reference #3: Vojdani, A., & Kharrazian, D. (2020, August). Potential antigenic cross-reactivity between SARS-COV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clinical immunology (Orlando, Fla.). Retrieved March 31, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246018/ DISCLOSURES: No relevant relationships by Aaron Douen No relevant relationships by Sudhanva Hegde No relevant relationships by Marc Sukhoo-Pertab
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Background: Since end Dec. 2021, the Omicron SARS-CoV-2 strains have appeared while previous β,g,α or d strains have disappeared. Methods: Analysis of clinical, humoral, cellular and inflammation responses in known patients from the Clinical Immunology Unit [CIU] after Omicron COVID. Recruitment January 1st to June 30th, 2022. Comparison with data of 54 CIU COVID patients from the first wave [1stW]. Measured parameters: β2microglobulin [β2m], C3, C4, ferritin, ECP, anti Spike1 [S1] for Wuhan and Omicron B1.159, ab anti NCP (nucleocapsids) and neutralizing antibodies [NeuAb], Ab phenotyping, leucocyte repartition, lymphocyte phenotyping. Patients: 118 Omicron infected [OmiP]: M 31%, F 69% (Vac 64%, noVac 36%): 24 previously “Naïve COVID” [NaCOV], 18 noVac with a previous β,g,α or d COVID, 64 Vac with no previous COVID and 12 Vac with a previous COVID. Results: No difference between OmiP and 1stW in the kinetics of response to S1 (Omicron or WT) in the first 6 months. It peaks between 45 to 60 d. Anti-NCP ab peaks at 30 to 45 d and is still present ≥ 5 months. Prior infection and/or vaccination is associated with a 2- 3-fold increase of previously detected anti-S1 Wuhan and anti- S1 Omicron. NaCOV develop ab to S1 Wuhan but in much lesser amounts than 1stW. Among OmiP no increased counts of eosinophils and NK as observed in 1stW, neither any increase in β2m and CRP. The majority of OmiP have elevated serum ECP and increased polyclonal ab production for ≥ 4 months. Conclusions: Omicron induces a different immune response than previous strains of SARS-CoV-2.
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Background: COV19-ID score questionnaire and its lab model are useful for early triage of COVID-19 patients, alleviating the burden on laboratories, emergency rooms and hospital wards. End of December, Omicron variants appears, Delta strains disappears. Other viral diseases than COVID-19 are back, needing to be distinguished. Aim: Adapting previous screening questionnaires. Methods: Analysis of clinical data from informed and consenting patients with Omicron COVID between January 1st and June 30th. Information was collected from patients from the COVID centre [CoC] and the Clinical Immunology Unit [CIU] of Hôpital De La Tour. Results: Data analysed: 7752 CoC patients (M 46%,F 54%,Vac 70%, noVac 30%), 168 CIU patients (M 29%,F 71%,Vac 61%,noVac 39%). All RT-PCR+ were analysed for early (CoC & CIU) and persistent symptoms (CIU). Most common and relevant symptoms: cough, fever, rhinorrhoea, headache, sore throat, history of contact, muscular stiffness, fatigue. No clinical or statistical difference between Vac and noVac patients. Persistent fatigue, lasting sore throat, susceptibility to infections (sinusitis, bronchitis) were reported for ≥ 4 months in >45% of CIU. Severity of symptoms: much less severe than with β,g,α or d variants. Conclusion: Reported symptoms are statistically different from those of the 2 previous years of pandemic. Screening questionnaires and scores remain useful for the early triage, in discriminating between SAR-CoV-2 and other viral infections, follow-up of Long COVID syndrome, but need to be adapted with each variant of consequence of SARS-CoV-2.
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INTRODUCTION: Numerous analyses demonstrate substantial health-economic impacts of primary vaccine effects (preventing or mitigating clinical manifestations of the diseases they target), but vaccines may also be associated with secondary effects, previously known as nonspecific, heterologous, or off-target effects. AREAS COVERED: We define key concepts to distinguish primary and secondary vaccine effects for health economic analyses, summarized terminology used in different fields, and perform a systematic review of health economic analyses focused on secondary vaccine effects (SVEs). EXPERT OPINION: Health economists integrate evidence from multiple fields, which often use incomplete or inconsistent definitions. Like regulators and policy makers, health economists require high-quality evidence of specific effects. Consistent with the limited evidence on mechanisms of action for SVEs, the associated health economic literature remains highly limited, with 4 studies identified by our systematic review. The lack of specific and well-controlled evidence that supports quantification of specific SVEs limits the consideration of these effects in vaccine research, development, regulatory, and recommendation decisions and health economic analyses.
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Vaccines , Cost-Benefit Analysis , Health Policy , Humans , Immunization, Secondary , PolicyABSTRACT
The human immune system protects the body against invasive organisms and kicks into a hyperactive mode in COVID-19 patients, particularly in those who are critically sick. Therapeutic regimens directed at the hyperactive immune system have been found to be effective in the treatment of patients with COVID-19. An evolving potential treatment option is therapy with mesenchymal stem cells (MSCs) due to their regenerative and reparative ability in epithelial cells. Clinical trials have reported the safe usage of MSC therapy. Systemic effects of MSC treatment have included a reduction in pro-inflammatory cytokines and a decrease in the levels of CRP, IL-6, and lactase dehydrogenase, which function as independent biomarkers for COVID-19 mortality and respiratory failure.
Treatment of COVID-19 is becoming increasingly difficult because of new variants, such as Delta, and more recently Omicron. Each virus variant becomes smarter at being able to evade the body's immune system, vaccines and drug treatments. The biggest challenge in treating COVID-19 is when the body's immune system starts to become hyperactive. In such a scenario, the immune system releases the compounds that are supposed to be released in small doses all at once. Thus, overwhelming the body and causing many complications. One possible solution to this is the mesenchymal stem cell. Multiple clinical trials have shown that mesenchymal stem cells can heal all different cell types in the body and stop the hyperactive immune system.
Subject(s)
COVID-19 , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , COVID-19/therapy , Humans , Immunity , Mesenchymal Stem Cell Transplantation/adverse effects , SARS-CoV-2ABSTRACT
Background and Aim of the study: SARS-CoV2 vaccines may cause immune-mediated reactions with different mechanisms, the main being: immediate and delayed hypersensitivity, dis-immune mechanisms due to Spike protein molecular mimicry and autoimmune pathogenesis. In July 2021 a new Immunology outpatients facility was inaugurated in Cardarelli Hospital - Naples, in order to respond to the increasing demand of immunological consult. Materials and Methods: We accessed our outpatients clinical files by selecting the patients with suspected immune-mediated reaction to SARS-CoV2 vaccines. We reported sex, reaction type, vaccine type, time of onset, duration, treatment, clinical outcome, result of poly-ethylene-glycole (PEG) testing, indication for continuation of vaccine program and, for 'autoimmune-like' reactions, final diagnosis and treatment. Results: Nine women reported hypersensitivity reactions with mRNA vaccines. All the subjects were skin tested for PEG: the test was positive in 5 patients, who were suggested to be vaccinated with desensitization protocol, while the other 4 underwent subsequent doses with previous anti-histamine/steroid treatment. Six patients - 5 women and 1 man - reported 'autoimmune-like' reactions: 3 have been diagnosed for Indifferentiated Connectivitis and 1 for Behcet flare. These data will be updated. Conclusions: The increasing numbers of suspected immune-mediated reactions to vaccines detected in our clinical practice show the need of empower Clinical Immunology facilities in order to improve the safety of the vaccinated population.
ABSTRACT
Background: Patients with kidney failure on dialysis or after renal transplantation have a high risk for severe COVID-19 infection, and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in patients with kidney failure, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in patients on dialysis and in kidney transplant recipients (KTRs) are still needed. Methods: In this prospective, multicentric cohort study, antibody responses to COVID-19 mRNA vaccines (BNT162b2 [BioNTech/Pfizer] or mRNA-1273 [Moderna]) were measured in 32 patients on dialysis and in 28 KTRs. SARS-CoV-2-specific antibodies and neutralization capacity were evaluated and compared with controls (n=78) of a similar age range. Results: After the first vaccination, SARS-CoV-2-specific antibodies were nearly undetectable in patients with kidney failure. After the second vaccination, 93% of the controls and 88% of patients on dialysis but only 37% of KTRs developed SARS-CoV-2-specific IgG above cutoff. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared with patients on dialysis (503±481 BAU/ml; P<0.01). Both KTRs and patients on dialysis had significantly lower IgG levels compared with controls (1992±2485 BAU/ml; P<0.001 and P<0.01, respectively). Importantly, compared with controls, neutralizing antibody titers were significantly lower in KTRs and patients on dialysis. After the second vaccination, 76% of KTRs did not show any neutralization capacity against SARS-CoV-2, suggesting impaired seroprotection. Conclusions: Patients with kidney failure show a significantly weaker antibody response compared with controls. Most strikingly, only one out of four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in KTRs and patients on dialysis.Clinical Trial registry name and registration number: Vaccination Against COVID-19 in Chronic Kidney Disease, NCT04743947.
Subject(s)
COVID-19 , Kidney Transplantation , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , Cohort Studies , Humans , Immunity , Prospective Studies , Renal Dialysis , SARS-CoV-2 , VaccinationABSTRACT
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high rate of mortality in patients with ESKD, and vaccination is hoped to prevent infection. METHODS: Between January 18 and February 24, 2021, 225 kidney transplant recipients (KTRs) and 45 patients on hemodialysis (HDPs) received two injections of mRNA BNT162b2 vaccine. The postvaccinal humoral and cellular response was explored in the first 45 KTRs and ten HDPs. RESULTS: After the second dose, eight HDPs (88.9%) and eight KTRs (17.8%) developed antispike SARS-CoV-2 antibodies (P<0.001). Median titers of antibodies in responders were 1052 AU/ml (IQR, 515-2689) in HDPs and 671 AU/ml (IQR, 172-1523) in KTRs (P=0.40). Nine HDPs (100%) and 26 KTRs (57.8%) showed a specific T cell response (P=0.06) after the second injection. In responders, median numbers of spike-reactive T cells were 305 SFCs per 106 CD3+ T cells (IQR, 95-947) in HDPs and 212 SFCs per 106 CD3+ T cells (IQR, 61-330) in KTRs (P=0.40). In KTRs, the immune response to BNT162b2 seemed influenced by the immunosuppressive regimen, particularly tacrolimus or belatacept. CONCLUSION: Immunization with BNT162b2 seems more efficient in HDPs, indicating that vaccination should be highly recommended in these patients awaiting a transplant. However, the current vaccinal strategy for KTRs may not provide effective protection against COVID-19 and will likely need to be improved.