Ganoderma Lucidum- A Potential Medicinal Mushroom Against MDR Isolates from The Secondary Infections of Covid-19

The severe acute respiratory syndrome produced by COVID-19 is a highly infectious and pathogenic viral infection. Many COVID-19 patients have secondary bacterial infections, which enhance disease and increase death, particularly when requiring invasive mechanical ventilation. One of the most important medicinal mushrooms, Ganoderma lucidum, has been used for food, feed, and medication since the dawn of humanity. The present investigation aims to discover the potential of the medicinal mushroom Ganoderma lucidum inhibited multidrug-resistant isolates from secondary infection of Covid-19 patients. Isolation and identification of urine samples from secondary infection of post-Covid-19 patients and evaluate the antibiotic sensitivity assay, as identification of bioactive compounds, anti-inflammatory and antioxidant activity from Ganoderma lucidum. Totally 6 clinical urine samples were collected from the age group 45 to 60;3 were male, and 3 were female. In total, nine bacteria and 10 fungi were isolated and identified. As antibiotic sensitivity assays of ceftriaxone, fluoroquinolones, azithromycin and amphotericin, nystatin and fluconazole were performed by the disc diffusion method against bacteria and fungi, the zone of inhibition was maximal in Klebsiella pneumoniae and Fusarium oxysporum. The aqueous and ethanolic extracts of Ganoderma lucidum were analyzed for the bioactive compounds, viz., steroids, flavonoids, alkaloids and phenolic compounds. The effect of the anti-inflammatory activity of the aqueous extract was excellent. The activity of the DPPH assay was maximum in aqueous and ethanolic extracts of all concentrations (100 to 500 ml). Antibiotic resistance could probably rise due to the frequent prescription of broad-spectrum empiric antimicrobials to COVID-19 patients. Hence, Ganoderma lucidum can be exploited to prevent secondary infection in COVID-19 patients.

IDWeek 2022

IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS) and the Society of Infectious Diseases Pharmacists (SIDP). For the first time since the COVID-19 public health emergency began, IDWeek 2022 returned to in-person attendance. It was held in Washington, D.C., and the meeting comprised 5 days of live sessions and on-demand content that included posters and oral presentations.Copyright © 2023 Clarivate.

Socially Vulnerable Patients with Inflammatory Bowel Disease Are at Increased Risk for Vaccine Preventable Illness

INTRODUCTION: Inflammatory bowel disease (IBD) affects patients across diverse ethnic, minority, cultural, and socioeconomic backgrounds;however, the relationship between these social determinants of health (SDOH) and IBD outcomes is not well-studied. SDOH have a known impact on disparities in vaccination, but these effects may be more salient in the IBD population where patients are at greater risk for vaccine-preventable illness from immunosuppressive therapies. The social vulnerability index (SVI) is a tool provided by Centers for Disease Control that can identify individuals at risk for health care disparities by estimating neighborhood-level social need on a 0-1 scale (higher scores indicating greater social vulnerability). Utilizing census tract-level SVI data, we aimed to identify the relationship between the SDOH and vaccination rates in patients with IBD. METHOD(S): We used a retrospective cohort design of patients seen at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address listed in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, electoral district, and religious affiliation, we used multivariable linear regression to examine the relationship between SVI and vaccination against influenza, Covid-19, pneumococcal pneumonia (conjugate and polysaccharide), and Zoster. RESULT(S): 15,245 patients with IBD were included and the percent of unvaccinated individuals was high across all vaccine types: flu (42.8%), Covid-19 (50.9%), pneumonia (62.4%), and Zoster (89.6%). High total levels of social vulnerability were associated with lower vaccination rates across all vaccine groups: flu (B -1.3, 95% CI -1.5, -1.2, p<0.001), Covid-19 (B -0.99, 95% CI -1.1, -0.88), p<0.001), pneumonia (B -0.21, 95% CI -0.27, -0.14, p<0.001), Zoster (B -0.23, 95% CI -0.27, -0.19, p<0.001). On SVI sub-scales, high scores in Socioeconomic Status, Household Composition, and Housing/Transportation were important predictors of vaccine uptake while Minority Status/Language was non-significant (Table 1). CONCLUSION(S): Living in a socially vulnerable community is associated with lower vaccination rates across all vaccine types. Higher scores on neighborhood level Socioeconomic Status, Household Composition, and Housing/Transportation were also associated with lower vaccine uptake. Many factors may affect why socially vulnerable patients are under-vaccinated, including a lack of patient and provider knowledge of routine vaccines, lack of access to care, and poor trust in vaccines and healthcare system. Further research is needed improve IBD health maintenance in gastroenterology clinics and ensure equitable distribution of vaccines to socially vulnerable patients. [Formula presented] [Formula presented]Copyright © 2023

Jing Si Herbal Drink as a prospective adjunctive therapy for COVID-19 treatment: Molecular evidence and mechanisms

Background: SARS-CoV-2 has led to a sharp increase in the number of hospitalizations and deaths from pneumonia and multiorgan disease worldwide;therefore, SARS-CoV-2 has become a global health problem. Supportive therapies remain the mainstay treatments against COVID-19, such as oxygen inhalation, antiviral drugs, and antibiotics. Traditional Chinese medicine (TCM) has been shown clinically to relieve the symptoms of COVID-19 infection, and TCMs can affect the pathogenesis of SARS-CoV-2 infection in vitro. Jing Si Herbal Drink (JSHD), an eight herb formula jointly developed by Tzu Chi University and Tzu Chi Hospital, has shown potential as an adjuvant treatment for COVID-19 infection. A randomized controlled trial (RCT) of JSHD as an adjuvant treatment in patients with COVID-19 infection is underway Objectives: This article aims to explore the efficacy of the herbs in JSHD against COVID-19 infection from a mechanistic standpoint and provide a reference for the rational utilization of JSHD in the treatment of COVID-19. Method(s): We compiled evidence of the herbs in JSHD to treat COVID-19 in vivo and in vitro. Result(s): We described the efficacy and mechanism of action of the active ingredients in JSHD to treat COVID-19 based on experimental evidence. JSHD includes 5 antiviral herbs, 7 antioxidant herbs, and 7 anti-inflammatory herbs. In addition, 2 herbs inhibit the overactive immune system, 1 herb reduces cell apoptosis, and 1 herb possesses antithrombotic ability. Conclusion(s): Although experimental data have confirmed that the ingredients in JSHD are effective against COVID-19, more rigorously designed studies are required to confirm the efficacy and safety of JSHD as a COVID-19 treatment.Copyright © 2021

Research progress on the analysis of active ingredients and elements in Fritillaria ussuriensis Bulbus

Fritillaria ussuriensis Bulbus, a genuine medicinal material of Northeast China, is the dry bulb of Fritillaria ussuriensis Maxim. It contains various active ingredients, such as alkaloids, alkaloids glycosides, adenosines, polysaccharides, and trace elements . It has antitussive, eliminating phlegm, antiasthmatic, antiulcer, antiplatelet aggregation, and anti-inflammatory. The qualitative and quantitative analysis of alkaloids, polysaccharides, nucleosides, and trace elements in Fritillaria ussuriensis Bulbus were reviewed, which is helpful for its cultivation and accurate application, and would provide a new choice for the treatment of coronavirus disease 2019 (COVID-19). © 2022

Bioavailability of iron and its potential to improve the immune system and ward off COVID-19: a review

Iron is a mineral that plays an important role, especially to prevent anaemia through the production of red blood cells. Iron also plays a role in physiological processes, such as the activation of enzymes and hormones, as well as increasing the immune system in warding off various viral infections. Therefore, iron bioavailability needs to be considered to take the greatest benefit of iron. This review discussed the factors that can affect the bioavailability of iron, various technologies to increase the bioavailability, and its potential in enhancing the immune system. Iron bioavailability can be increased by fortification, fermentation, the addition of vitamin C, and iron encapsulation. Under conditions of adequate iron intake, iron plays an important role in enhancing the immune system through controlling lymphocytes and T cell proliferation. However, excess iron consumption can be at risk of weakening the host's immune response to viruses. Therefore, the appropriate level of iron intake must be maintained accurately to be used optimally and has the potential to ward off viral infections, including the Sars-CoV-2 virus as the cause of COVID-19.Copyright © 2023, Rynnye Lyan Resources. All rights reserved.

A brief review on the medicinal uses of Cordyceps militaris

Introduction: Cordyceps, a popular Chinese medication, is made by drying caterpillar-borne Cordyceps fungus. The parasite needs an insect host or larvae host to survive. To strengthen those who were lacking in vitality, it was administered in tonic form. The biological effects of Cordyceps species are well documented. Its medicinal properties are because of the chemical constituents present in the mushroom namely cordycepin, cordymin, polysaccharides, glycoprotein, ergosterol, and other extracts. Material(s) and Method(s): Some of the biological activities of C.militaris are anti-cancer, anti-oxidant, anti-inflammatory, anti-aging, immunomodulatory, antimicrobials, immunosuppressive, hypolipidemic, hypoglycemic, neuroprotective, and fertility enhancer. Because of their bioactive compounds, edible fungus like C. militaris is a multifunctional food supplement. Many mushroom species can be grown on domestic refuse, popularizing the mushroom industry in sustainable economies worldwide. Conclusion(s): C. militaris extract can improve health when added to the diet. Further, the complexity of clinical investigations and the challenges of developing therapies using mushroom extracts are both exacerbated by the abundance of bioactive chemicals present in mushrooms. Cordycepin has the most therapeutic potential of all the bioactive compounds described in the studies. Recent studies indicate that cordycepin may be effective against COVID-19's SARS-CoV-2 strain. Therefore, this review lays the groundwork for clinical use and examines the research program for the near future.Copyright © 2023 The Author(s)

Socially Vulnerable Patients with Inflammatory Bowel Disease Are at Increased Risk for Vaccine Preventable Illness

INTRODUCTION: Inflammatory bowel disease (IBD) affects patients across diverse ethnic, minority, cultural, and socioeconomic backgrounds;however, the relationship between these social determinants of health (SDOH) and IBD outcomes is not well-studied. SDOH have a known impact on disparities in vaccination, but these effects may be more salient in the IBD population where patients are at greater risk for vaccine-preventable illness from immunosuppressive therapies. The social vulnerability index (SVI) is a tool provided by Centers for Disease Control that can identify individuals at risk for health care disparities by estimating neighborhood-level social need on a 0-1 scale (higher scores indicating greater social vulnerability). Utilizing census tract-level SVI data, we aimed to identify the relationship between the SDOH and vaccination rates in patients with IBD. METHOD(S): We used a retrospective cohort design of patients seen at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address listed in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, electoral district, and religious affiliation, we used multivariable linear regression to examine the relationship between SVI and vaccination against influenza, Covid-19, pneumococcal pneumonia (conjugate and polysaccharide), and Zoster. RESULT(S): 15,245 patients with IBD were included and the percent of unvaccinated individuals was high across all vaccine types: flu (42.8%), Covid-19 (50.9%), pneumonia (62.4%), and Zoster (89.6%). High total levels of social vulnerability were associated with lower vaccination rates across all vaccine groups: flu (B -1.3, 95% CI -1.5, -1.2, p<0.001), Covid-19 (B -0.99, 95% CI -1.1, -0.88), p<0.001), pneumonia (B -0.21, 95% CI -0.27, -0.14, p<0.001), Zoster (B -0.23, 95% CI -0.27, -0.19, p<0.001). On SVI subscales, high scores in Socioeconomic Status, Household Composition, and Housing/ Transportation were important predictors of vaccine uptake while Minority Status/ Language was non-significant (Table 1). CONCLUSION(S): Living in a socially vulnerable community is associated with lower vaccination rates across all vaccine types. Higher scores on neighborhood level Socioeconomic Status, Household Composition, and Housing/Transportation were also associated with lower vaccine uptake. Many factors may affect why socially vulnerable patients are under-vaccinated, including a lack of patient and provider knowledge of routine vaccines, lack of access to care, and poor trust in vaccines and healthcare system. Further research is needed improve IBD health maintenance in gastroenterology clinics and ensure equitable distribution of vaccines to socially vulnerable patients. (Figure Presented).

Radix Isatidis polysaccharide (RIP) resists the infection of QX-type infectious bronchitis virus via the MDA5/TLR3/IRF7 signaling pathway.

Although vaccines play a major role in the prevention of infectious bronchitis (IB), Anti-IB drugs still have great potential in poultry production. Radix Isatidis polysaccharide (RIP) is a crude extract of Banlangen with antioxidant, antibacterial, antiviral, and multiple immunomodulatory functions. The aim of this study was to explore the innate immune mechanisms responsible for RIP-mediated alleviation of infectious bronchitis virus (IBV)-induced kidney lesions in chickens. Specific-pathogen-free (SPF) chicken and chicken embryo kidney (CEK) cells cultures were pretreated with RIP and then infected with the QX-type IBV strain, Sczy3. Morbidity, mortality, and tissue mean lesion scores were calculated for IBV-infected chickens, and the viral loads, inflammatory factor gene mRNA expression levels, and innate immune pathway gene mRNA expression levels in infected chickens and CEK cell cultures were determined. The results show that RIP could alleviate IBV-induced kidney damage, decrease CEK cells susceptibility to IBV infection, and reduce viral loads. Additionally, RIP reduced the mRNA expression levels of the inflammatory factors IL-6, IL-8, and IL-1ß by decreasing the mRNA expression level of NF-κB. Conversely, the expression levels of MDA5, TLR3, STING, Myd88, IRF7, and IFN-ß were increased, indicating that RIP conferred resistance to QX-type IBV infection via the MDA5, TLR3, IRF7 signaling pathway. These results provide a reference for both further research into the antiviral mechanisms of RIP and the development of preventative and therapeutic drugs for IB.

A new polysaccharide platform constructs self-adjuvant nanovaccines to enhance immune responses.

BACKGROUND: Nanovaccines have shown the promising potential in controlling and eradicating the threat of infectious diseases worldwide. There has been a great need in developing a versatile strategy to conveniently construct diverse types of nanovaccines and induce potent immune responses. To that end, it is critical for obtaining a potent self-adjuvant platform to assemble with different types of antigens into nanovaccines. RESULTS: In this study, we identified a new natural polysaccharide from the rhizomes of Bletilla striata (PRBS), and used this polysaccharide as a platform to construct diverse types of nanovaccines with potent self-adjuvant property. In the construction process of SARS-CoV-2 nanovaccine, PRBS molecules and RBD protein antigens were assembled into ~ 300 nm nanoparticles by hydrogen bond. For HIV nanovaccine, hydrophobic effect dominantly drove the co-assembly between PRBS molecules and Env expression plasmid into ~ 350 nm nanospheres. Importantly, PRBS can potently activate the behaviors and functions of multiple immune cells such as macrophages, B cells and dendritic cells. Depending on PRBS-mediated immune activation, these self-adjuvant nanovaccines can elicit significantly stronger antigen-specific antibody and cellular responses in vivo, in comparison with their corresponding traditional vaccine forms. Moreover, we also revealed the construction models of PRBS-based nanovaccines by analyzing multiple assembly parameters such as bond energy, bond length and interaction sites. CONCLUSIONS: PRBS, a newly-identified natural polysaccharide which can co-assemble with different types of antigens and activate multiple critical immune cells, has presented a great potential as a versatile platform to develop potent self-adjuvant nanovaccines.

Bidirectional and persistent immunomodulation of Astragalus polysaccharide as an adjuvant of influenza and recombinant SARS-CoV-2 vaccine.

Respiratory viral infections, such as coronavirus disease of 2019 (COVID-19) and influenza, cause significant morbidity and mortality and have become a worldwide public health concern with tremendous economic and societal burdens. Vaccination is a major strategy for preventing infections. However, some new vaccines have an unmet need for impairing responses in certain individuals, especially COVID-19 vaccines, despite ongoing vaccine and adjuvant research. Here, we evaluated the effectiveness of Astragalus polysaccharide (APS), a bioactive polysaccharide extracted from the traditional Chinese herb Astragalus membranaceus as an immune adjuvant to regulate the efficacy of influenza split vaccine (ISV) and recombinant severe acute respiratory syndrome (SARS)-Cov-2 vaccine in mice. Our data indicated that APS as an adjuvant can facilitate the induction of high levels of hemagglutination inhibition (HAI) titer and specific antibody immunoglobulin G (IgG) and confer protection against the lethal challenge of influenza A viruses, including increased survival and amelioration of weight loss in mice immunized with the ISV. RNA sequencing (RNA-seq) analysis revealed that the NF-κB and Fc gamma R-mediated phagocytosis signaling pathways are essential for the immune response of mice immunized with the recombinant SARS-Cov-2 vaccine (RSV). Another important finding was that bidirectional immunomodulation of APS on cellular and humoral immunity was observed, and APS-adjuvant-induced antibodies persisted at a high level for at least 20 weeks. These findings suggest that APS is a potent adjuvant for influenza and COVID-19 vaccines, and has the advantages of bidirectional immunoregulation and persistent immunity.

Vaccination against Community-Acquired Pneumonia in Spanish Adults: Practical Recommendations by the NeumoExperts Prevention Group.

In the adult population, community-acquired pneumonia (CAP) is a serious disease that is responsible for high morbidity and mortality rates, being frequently associated with multidrug resistant pathogens. The aim of this review is to update a practical immunization prevention guideline for CAP in Spain caused by prevalent respiratory pathogens, based on the available scientific evidence through extensive bibliographic review and expert opinion. The emergence of COVID-19 as an additional etiological cause of CAP, together with the rapid changes in the availability of vaccines and recommendations against SARS-CoV-2, justifies the need for an update. In addition, new conjugate vaccines of broader spectrum against pneumococcus, existing vaccines targeting influenza and pertussis or upcoming vaccines against respiratory syncytial virus (RSV) will be very useful prophylactic tools to diminish the burden of CAP and all of its derived complications. In this manuscript, we provide practical recommendations for adult vaccination against the pathogens mentioned above, including their contribution against antibiotic resistance. This guide is intended for the individual perspective of protection and not for vaccination policies, as we do not pretend to interfere with the official recommendations of any country. The use of vaccines is a realistic approach to fight these infections and ameliorate the impact of antimicrobial resistance. All of the recently available scientific evidence included in this review gives support to the indications established in this practical guide to reinforce the dissemination and implementation of these recommendations in routine clinical practice.

Inhibitory effects of fucoidan from Laminaria japonica against some pathogenic bacteria and SARS-CoV-2 depend on its large molecular weight.

Fucoidan is a highly sulfated polysaccharide with a wide range of bioactivities, including anti-pathogenic activity. However, the relationship between structure and activity of fucoidan in inhibiting pathogen infections remains unclear. Here, different-molecular-weight fucoidans were prepared by photocatalytic degradation followed by membrane ultrafiltration, and their chemical structures and anti-pathogenic microbiota activity were compared. Results showed that photocatalytic degradation could effectively degrade fucoidan while its structure block and sulfate groups were not destroyed obviously. Fucoidan (90.8 kDa) of 5 mg/mL could inhibit the growth of S. aureus, S. typhimurium and E. coli, but its degradation products, Dfuc1 (19.2 kDa) and Dfuc2 (5.5 kDa), demonstrated lower inhibitory effect. In addition, compared to Dfuc1 and Dfuc2, fucoidan showed stronger capability to prevent the adhesion of S. aureus, L. monocytogenes, V. parahaemolyticus and S. typhimurium to HT-29 cells. Moreover, the inhibitory effect against SARS-CoV-2 and the binding activity to S protein were also positively correlated to molecular weight. These results indicate that natural fucoidan with higher molecular weight are more effective to inhibit these pathogenic bacteria and SARS-CoV-2, providing a better understanding of the relationship between structure and activity of fucoidan against pathogenic microbiota.

Therapeutic Applications of Fucoidans and their Potential to Act against COVID-19.

In this review article, we present the updated evidence of therapeutic applications of fucoidan (a seaweed polysaccharide) and its novel potential to treat infectious diseases such as coronavirus disease (COVID-19). Because of their many biological activities, seaweeds have been identified as a rich and useful source of bioactive chemicals. Sulfated polysaccharides from the sea are considered a source of physiologically active chemicals that might be used in medication development. Antitumor, antiviral, antioxidant, antibacterial, anticoagulant, and immune-inflammatory properties have all been described for these compounds. By interfering at various phases of viral infection, marine sulfated polysaccharide has a virucidal effect. As a result, it opens the door to the development of antiviral treatments. Virus entry into host cells is an initial process, avoiding this type of entry makes any precautionary measure effective. The inhibitory action of certain marine sulfated polysaccharides against coronavirus was tested, and fucoidan, iota-carrageenan, and sea cucumber sulfated polysaccharides all showed a substantial antiviral impact. Fucoidan is one of the useful sulfated polysaccharides that has been widely studied and explored in various research. There are different sources of fucoidans, which have been used in the treatment of viral infection. Additionally, we highlight the mechanism of action of fuocidan against COVID-19. Hence, we could suggest that COVID-19 might be prevented and treated using these sulfated polysaccharides. This review thus highlights ample evidence to support the hypothesis that a large number of drugs have been developed from powerful compounds isolated from marine seaweeds.

Docking of Glycosaminoglycans to Proteins: Methods and Challenges

Glycoscience continues to emerge as a high-value information-rich field providing medical insight in the post-genomic era. Among the glycans, glycosaminoglycans (GAGs) represent a large family of highly sulfated, complex, linear, periodic polysaccharides that display a variety of important biological roles via interaction with protein targets. One of the recent examples is that heparan sulfate, itself a GAG, facilitates SARS-CoV-2 spike protein binding to the ACE2 receptor which triggers coronavirus infection. Not only this, but certain other kinds of GAGs have also been found to inhibit SARS-CoV-2 activity considerably and have been proposed as potential therapeutics. Computational modeling is an effective tool in studying biological systems but the nature of these long periodic linear and negatively charged polysaccharides makes it challenging to model GAG systems alone or their complexes with proteins. Docking is an essential tool for understanding protein-GAG interactions, but there has been a lack of validation studies to show the reliability of docking programs in predicting protein-GAG complexes. In this work, we will show some of the challenges and limitations of current software in modeling protein-GAG interactions by docking.

Caveolae-Mediated Extracellular Vesicle (CMEV) Signaling of Polyvalent Polysaccharide Vaccination: A Host-Pathogen Interface Hypothesis.

We published a study showing that improvement in response to splenectomy associated defective, in regards to the antibody response to Pneumovax® 23 (23-valent polysaccharides, PPSV23), can be achieved by splenocyte reinfusion. This study triggered a debate on whether and how primary and secondary immune responses occur based on humoral antibody responses to the initial vaccination and revaccination. The anti-SARS-CoV-2 vaccine sheds new light on the interpretation of our previous data. Here, we offer an opinion on the administration of the polyvalent polysaccharide vaccine (PPSV23), which appears to be highly relevant to the primary vaccine against SARS-CoV-2 and its booster dose. Thus, we do not insist this is a secondary immune response but an antibody response, nonetheless, as measured through IgG titers after revaccination. However, we contend that we are not sure if these lower but present IgG levels against pneumococcal antigens are clinically protective or are equally common in all groups because of the phenomenon of "hyporesponsiveness" seen after repeated polysaccharide vaccine challenge. We review the literature and propose a new mechanism-caveolae memory extracellular vesicles (CMEVs)-by which polysaccharides mediate prolonged and sustained immune response post-vaccination. We further delineate and explain the data sets to suggest that the dual targets on both Cav-1 and SARS-CoV-2 spike proteins may block the viral entrance and neutralize viral load, which minimizes the immune reaction against viral attacks and inflammatory responses. Thus, while presenting our immunological opinion, we answer queries and responses made by readers to our original statements published in our previous work and propose a hypothesis for all vaccination strategies, i.e., caveolae-mediated extracellular vesicle-mediated vaccine memory.

Sodium alginate-hydrogel coatings on extracorporeal membrane oxygenation for anticoagulation.

Thromboembolism caused by the use of extracorporeal membrane oxygenation (ECMO) remains common among patients with existing heart diseases and contributes to significant morbidity and mortality during the COVID-19 pandemic. Various surface modification strategies have been proposed, showing that the methacrylated alginate (MA-SA) hydrogel layer is transparent, which aids the observation of the thromboembolism from the inner wall of the tubing. In the combined dynamic and static blood of ECMO tubing inner surface in vitro experiments, it was also demonstrated that the adhesion of blood clots to the surface of vessels was remarkably reduced, and the MA-SA-based hydrogel coating could significantly prolong the activated partial thrombin time and block the endogenous coagulation. The favorable properties of natural polysaccharides of hydrogel coatings make them the best surface material choices to be applied for blood-contacting medical devices and significantly improve anticoagulant performance.

A 5-year look-back at the notification and management of vaccine supply shortages in Germany.

BackgroundUnavailability of vaccines endangers the overall goal to protect individuals and whole populations against infections.MethodsThe German notification system includes the publication of vaccine supply shortages reported by marketing authorisation holders (MAH), information on the availability of alternative vaccine products, guidance for physicians providing vaccinations and an unavailability reporting tool to monitor regional distribution issues.AimThis study provides a retrospective analysis of supply issues and measures in the context of European and global vaccine supply constraints.Resultsbetween October 2015 and December 2020, the 250 notifications concerned all types of vaccines (54 products). Most shortages were caused by increased demand associated with immigration in Germany in 2015 and 2016, new or extended vaccine recommendations, increased awareness, or changes in global immunisation programmes. Shortages of a duration up to 30 days were mitigated using existing storage capacities. Longer shortages, triggered by high demand on a national level, were mitigated using alternative products and re-allocation; in a few cases, vaccines were imported. However, for long lasting supply shortages associated with increased global demand, often occurring in combination with manufacturing issues, few compensatory mechanisms were available. Nevertheless, only few critical incidents were identified: (i) shortage of hexavalent vaccines endangering neonatal immunisation programmes in 2015;(ii) distribution issues with influenza vaccines in 2018; and (iii) unmet demand for pneumococcal and influenza vaccines during the coronavirus disease (COVID)-19 pandemic.ConclusionVaccine product shortages in Germany resemble those present in neighbouring EU states and often reflect increased global demand not matched by manufacturing capacities.