ABSTRACT
Introduction: Immune responses following SARS-CoV-2 vaccination in patients with inflammatory bowel disease (IBD) are not well characterised, and limited data is available regarding the humoral immune response related to the underlying bowel disease and serum concentrations of biologics and thiopurine metabolites. Aims & Methods: This prospective, observational study included adult patients with ulcerative colitis (UC) and Crohn's disease (CD), and healthy controls. Sera were analysed for antibodies binding the receptor binding domain (RBD) of the SARS-CoV-2 Spike protein, and anti-RBD >=70 AU/ml was defined as serologic response. Anti-RBD and serum concentrations of the ongoing immunosuppressive medications were measured prior to, and 2-5 weeks after the second vaccine dose. The aims of this study were to explore the serologic response associated with the underlying bowel disease and immunosuppressive medications including serum concentrations of biologics and thiopurine metabolites. Result(s): The study included 958 IBD patients (380 UC, 578 CD), median age 40 (Q1;Q3 29;52), and 323 healthy controls, age 44 (33;56). The type and frequency of ongoing immunosuppressive therapy was comparable between the UC and CD patients. The median (Q1;Q3) anti-RBD level (AU/ml) was lower in patients (618 (192;4370)) compared to controls (3355 (896;7849)) post vaccination (p<0.001), and the antibody levels were lower in CD (439 (174;3304)) compared to UC (1088 (251;5975)) (p<0.001). No association between serum concentration and serologic response was demonstrated in patients treated with tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + thiopurines, vedolizumab, and ustekinumab. Patients treated with TNFi + thiopurines with low 6-thioguanine nucleotides (6-TGN) levels (<3.5 pmol/8x108RBC) demonstrated a higher response rate (93%) than patients who had 6-TGN levels within the therapeutic range (>=3.5 pmol/8x108RBC) (53%) (p=0.003). In the multiple regression model, UC as compared to CD, higher BMI, and mRNA-1273 vaccine were associated with higher odds for serologic response (Table). Older age and patients on treatment with TNFi + thiopurines were associated with lower odds ratios for a serologic response (Table). Treatment with TNFi monotherapy, disease activity (CRP, calprotectin, disease indices) gender and smoking were not associated with serologic response. Conclusion(s): No association between serum drug concentrations for any biologics and the humoral immune response to SARS-CoV-2 vaccines were demonstrated. However, TNFi in combination with thiopurines were associated with an attenuated serologic response, and the serologic response in general was significantly reduced in CD compared to UC patients. Our results indicate that SARS-CoV-2 vaccines can be provided without consideration to the timing of biologic doses in IBD patients and will aid decision-making regarding re-vaccinations and tailoring of medication in order to keep vulnerable IBD patients protected against serious SARSCoV-2 infection.
ABSTRACT
INTRODUCCIÓN: La reciente pandemia por SARS-CoV-2 (COVID-19) ha hecho resurgir preocupación sobre la exposición inadvertida del equipo quirúrgico a agentes infecciosos transmisibles por vía aérea durante el acto quirúrgico. El objetivo de este trabajo es describir la confección de un sistema de filtrado simple y de bajo costo que permite reducir el riesgo de exposición al virus, particularmente en el proceso de aspiración, recambio y remoción del neumoperitoneo en cirugía laparoscópica. MATERIALES Y MÉTODO: Se diseñó e implementó un circuito cerrado de evacuación y de filtrado del neumoperitoneo en cirugías ginecológicas laparoscópicas en un centro de salud terciario. El circuito incluye un filtro HEPA (High Efficiency Particulate Air) y una trampa de vacío que contiene una solución de inactivación en base a amonio cuaternario o hipoclorito de sodio. RESULTADOS: Desde su implementación se han realizado 17 cirugías laparoscópicas ginecológicas por diversas patologías. Dos de ellas fueron en pacientes Covid-19 (+). A la fecha no se han reportado contagios en el equipo médico que participó en la cirugía. CONCLUSIONES: Es posible implementar un sistema de evacuación del neumoperitoneo en cirugía laparoscópica presumiblemente eficaz en minimizar el riesgo de exposición al virus SARS-COV-2 (Covid-19). Su bajo costo lo hace especialmente recomendable en países en vías de desarrollo.
INTRODUCTION: The recent SARS-CoV-2 (COVID-19) pandemics has raised concern on the incidental exposition of health team to air transmissible infectious agents during surgeries. The main goal of this work is to communicate a simple and low-cost filtering system allowing to reduce the risk of contagion related to the virus, associated with pneumoperitoneum removal during surgical laparoscopy. METHODS: A closed circuit of gas removal and filtering was developed and implemented in laparoscopic gynecologic procedures at a tertiary teaching hospital. The circuit included an HEPA (High Efficiency Particulate Air) filter and a vacuum trap containing an inactivating solution based on quaternary ammonium or sodium hypochlorite. RESULTS: Since its introduction, seventeen laparoscopic surgeries have been carried out for different gynecologic pathologies. Two of them in Covid (+) cases. To date, no contagion has been reported among health teammates participating in these surgeries. CONCLUSIONS: It is possible to implement a pneumoperitoneum evacuation system in laparoscopic surgery presumably effective in minimizing the risk of exposure to the SARS-COV-2 virus (Covid-19). Its low cost makes it especially recommended in developing countries.