ABSTRACT
A 59-year-old man presented with a widespread morbilliform rash after receiving the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. He had no significant medical history and no known allergies. He did not take any regular medication. He developed pruritus without rash 4 h after his first vaccine. This resolved after 10 days without intervention. One day after his second dose, he developed an extensive pruritic morbilliform eruption on his trunk and limbs, affecting 35% of his body surface area. with no mucous membrane involvement. The rash persisted for 4 weeks after his second vaccination and he was referred to dermatology. Eosinophils were raised at 0.54 and liver function tests were normal. Antinuclear antibodies and extractable nuclear antigen were negative. Complement levels were normal. Histology showed mild epidermal acanthosis, spongiosis and subcorneal vesicles. Within the superficial to mid-dermis, there was a mixed chronic inflammatory infiltrate comprising lymphocytes, plasma cells, neutrophils and numerous eosinophils. Direct immunofluorescence was negative. He received a tapering dose of oral prednisolone with mometasone topically. Despite substantial improvement with this regimen, his rash began to worsen 2 days following discontinuation of oral prednisolone. He was still using daily mometasone on cessation of oral steroids. He was trialled on oral doxycycline for 1 month, which led to a marked improvement in the morbilliform rash. Despite improvement in the rash, the patient reported ongoing intense daily pruritus which was having a marked impact on his quality of life. He has commenced on narrowband ultraviolet B (UVB) phototherapy to treat his persistent pruritis, with good effect to date. Morbilliform eruptions have been reported as a cutaneous manifestation of COVID-19 and as a side-effect of mRNA vaccines. Proposed mechanisms for the development of skin rashes post-mRNA vaccines include viral protein expression following vaccination, prior infection with COVID-19 causing cross-reaction with the mRNA vaccine encoded antigen and vaccine components acting as haptens inducing a T helper 2 inflammatory reaction characterized by interleukin (IL)-4 and IL-13 expression. Drug-induced maculopapular eruptions typically resolve within 7-14 days on withdrawal of the culprit medication. The persistent nature in our patient may imply a complex immune response. The use of phototherapy to treat inflammatory dermatoses and pruritic conditions such as nodular prurigo is well described. The antipruritic effect of phototherapy is thought to work via modulation of both the neural pathways involved in itch and local immune cells in the skin. Our case highlights that phototherapy can be used in the treatment of cutaneous side-effects that arise after COVID-19 vaccines. To the best of our knowledge, this case is one of the first to use narrowband UVB phototherapy to treat a cutaneous side-effect of an mRNA vaccine.
ABSTRACT
Due to the recent and ongoing pandemic - COVID-19 - there was an urgency to determine a method to delay the continuously rapid development of the new virus. As a result, Ultraviolet-C (UVC) light, also known as Ultraviolet Germicidal Irradiation (UVGI), has been in higher demand because of its known ability to disinfect quickly and effectively. However, because of its short wavelength/higher energy, either 222nm or 254nm, material degradation is usually much more accelerated than Ultraviolet-A (UVA) or Ultraviolet-B (UVB). At this moment, this study only observed color change when exposing polystyrene to UVC light, and it is believed that this is one of the first studies, if not the first, conducted with this material. Polystyrene was selected because of its availability, abundance of relevant research (ie. UVA/UVB exposure results), and its use in weathering standards. Additionally, since there are no standards specifically about UVC exposure, this preliminary research may provide some direction. © 2022 Society of Plastics Engineers. All rights reserved.
ABSTRACT
In this study, we found that the current droop (J-droop) in AlGaN-based UVB light-emitting diodes was more obvious at higher temperatures, despite both the main and parasitic peaks undergoing monotonic decreases in their intensity upon an increase in the temperature. The slower temperature droop (T-droop) did not occur when the forward current was increased to temperatures greater than 298 K. After an aging time of 6000 h, the emission wavelengths did not undergo any obvious changes, while the intensity of the parasitic peak barely changed. Thus, the degradation in the light output power during long-term operation was not obviously correlated to the existence of the parasitic peak.
ABSTRACT
There is global interest in both the beneficial and detrimental health effects of ultraviolet-C (UVC) radiation in the wavelength range 200-230 nm (known as Far-UVC). Technology using Far-UVC is proposed as a highly effective control measure for reducing the transmission of COVID-19. Far-UVC, and other wavelengths of UVC, are well-known to efficiently inactivate pathogens in air and on surfaces. Although studies have shown irradiation of skin with 254 nm UV results in DNA damage in the epidermal basal layer, irradiation with Far-UVC (222 nm) shows minimal DNA damage and only in the granular layer, which is comprised of non-proliferating keratinocytes. Therefore, accumulation of these DNA photoproducts would not be expected to be associated with cancer risk. It has also been shown that even high doses of Far-UVC exposure to human skin do not induce erythema. However, the effects of Far-UVC on the immune system are, to the best of our knowledge, unknown. It is well-reported that both ultraviolet B (UVB 280-315 nm) and ultraviolet-A (UVA 315-400 nm) have effects on cutaneous Langerhans cells (LC), inducing migration from the epidermis to the draining lymph nodes, thereby suppressing skin immune function. Here we present data generated in a range of skin types (Fitzpatrick II-V) demonstrating little or no impact of Far-UVC on the cutaneous immune system, as assessed by Langerhans cell migration, at doses of up to 3,000 mJ/cm2 (US daily limit is 450 mJ/cm2). These results support the safety of filtered Far-UVC use, which could have a transformative effect on public health, allowing effective virus inactivation and reduction of transmission independent of human behavior. Conflict of interest disclosure: the authors state no conflict of interest. However, MJC and RPH are directors of Ten Bio Ltd, a company focused on developing human skin explant models.
ABSTRACT
Background: COVID-19 convalescent plasma (CCP) was shown to reduce disease progression if high-titre CCP is administered in early infection. CCP donors have a risk profile like first time donors, especially with respect to window-period viral transmissions. Pathogen reduction (PR) could mitigate that risk, but may have impact on quality and quantity of plasma proteins, including neutralizing antibodies. It has been shown that different IgG subclasses contribute differently to CCP neutralizing activity, raising the question of a potential impact of PR on different IgG subclasses. Aims: Side-by-side comparison of the impact of 3 commercially available PR technologies on total IgG and subclasses quantity and subclass distribution in CCP. Methods: 36 apheresis CCP donations collected with a MCS+ 9000 plasmapheresis device (Haemonetics S.A., Switzerland), or DigiPla 80 (Sichuan Nigale Biomed, China) plasmapheresis device (650-750 ml) were allocated to 3 study groups with 12 units respectively. The impact of amotosalen/UVA (AS)-treatment (INTERCEPT Blood System, Cerus) against Riboflavin UVB (RB) (Mirasol Pathogen Reduction System, Terumo BCT), AS against Methylene Blue (MB) (Theraflex MB, Macopharma) and RB against MB on the quantity and distribution of IgG and subclasses was assessed in a side-by-side comparison study with a nephelometric analyser (BN II System, Siemens Healthcare). PRtreatment was conducted immediately post collection. All samples for analysis were frozen within 6 h post collection and stored at -75°C until testing. All samples were analysed simultaneously with the same device, the same lot of reagents and the same operator. Results: IgG subclass distributions were not significantly changed post PR-treatment with all 3 technologies (p > 0.05). There was also no significant difference in the median loss of concentration for IgG1 and IgG2 between the three technologies (p > 0.05). The median loss (%) of IgG3 (2.1 and 2.6-fold compared to AS and MBtreatment respectively, p < 0.01) and IgG4 (1.6 and 5.9-fold compared to AS and MB-treatment respectively, p < 0.01) post RBtreatment was significantly higher. The median loss (%) of IgG4 post AS-treatment was significantly higher compared to MB-treatment (3.5-fold, p < 0.01). Summary/Conclusions: The 3 commercially available PR systems do not significantly change the IgG subclass distribution, but impact differently IgG3 and IgG4 post-treatment loss. It was reported that IgG1 and IgG3 play an important role in neutralization, which should be considered when planning PR-treatment for CCP. .
ABSTRACT
Far UV-C, informally defined as electromagnetic radiation with wavelengths between 200 and 230 nm, has characteristics that are well-suited to control of airborne pathogens. Specifically, Far UV-C has been shown to be highly effective for inactivation of airborne pathogens;yet this same radiation has minimal potential to cause damage to human skin and eye tissues. Critically, unlike UV-B, Far UV-C radiation does not substantially penetrate the dead cell layer of skin (stratum corneum) and does not reach germinative cells in the basal layer. Similarly, Far UV-C radiation does not substantially penetrate through corneal epithelium of the eye, thereby preventing exposure of germinative cells within the eye. The most common source of Far UV-C radiation is the krypton chloride excimer (KrCl*) lamp, which has a primary emission centered at 222 nm. Ozone production from KrCl* lamps is modest, such that control of indoor ozone from these systems can be accomplished easily using conventional ventilation systems. This set of characteristics offers the potential for Far UV-C devices to be used in occupied spaces, thereby allowing for improved effectiveness for inactivation of airborne pathogens, including those that are responsible for COVID-19.
ABSTRACT
COVID-19 morbidity and mortality are driven by poor immune regulation. Narrowband ultraviolet B (NB-UVB) phototherapy is standard of care in a number of immune-dysregulated diseases. To assess the efficacy of NB-UVB phototherapy for improving COVID-19 outcomes in high-risk, hospitalized, we developed the Adaptive Photo-Protection Trial. This is a multi-center, prospective, double-blinded, randomized, placebo-controlled trial. The pilot phase results are reported here. Consecutive patients admitted with a positive COVID-19 PCR were screened for eligibility. Enrolled subjects were computer randomized 1:1 to NB-UVB or placebo phototherapy. Subjects were treated daily with escalating doses on 27% of their body surface area for up to 8 consecutive days. Primary outcomes were safety and efficacy, defined as persistent or painful erythema and 28-day mortality. Comparisons were made via non-parametric exact tests. Patients in treatment (n = 15) and placebo (n = 15) arms had similar demographics. No adverse events occurred. Twenty eight-day mortality was 13.3% in treatment vs. 33.3% in placebo arms (p = 0.39). NB-UVB phototherapy in hospitalized COVID-19 patients was safe. Decreased mortality was observed in treated patients but this was statistically non-significant. Given its low-cost, scalability, and adjunctive nature, NB-UVB has the potential to improve COVID-19 outcomes. Continuation of this trial is warranted.