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1.
Indian J Pathol Microbiol ; 65(4): 902-906, 2022.
Article in English | MEDLINE | ID: covidwho-2100021

ABSTRACT

COVID-19 pandemic caused by SARS-CoV-2 virus has been around for 2 years causing significant health-care catastrophes in most parts of the world. The understanding of COVID-19 continues to expand, with multiple newer developments such as the presence of asymptomatic cases, feco-oral transmission, and endothelial dysfunction. The existing classification was developed before this current understanding. With the availability of recent literature evidences, we have attempted a classification encompassing pathogenesis and clinical features for better understanding of the disease process. The pathogenesis of COVID-19 continues to evolve. The spiked protein of the SARS-CoV-2 virus binds to ACE2 receptors causes direct cytopathic damage and hyperinflammatory injury. In addition to alveolar cells, ACE2 is also distributed in gastrointestinal tract and vascular endothelium. ACE2-SARS-CoV-2 interaction engulfs the receptors leading to depletion. Accumulation of Ang2 via AT1 receptor (AT1R) binding causes upregulation of macrophage activity leading to pro-inflammatory cytokine release. Interleukin-6 (IL-6) has been attributed to cause hyperinflammatory syndrome in COVID-19. In addition, it also causes severe widespread endothelial injury through soluble IL-6 receptors. Thrombotic complications occur following the cleavage and activation of von Willebrand factor. Based on the above understanding, clinical features, organ involvement, risk stratification, and disease severity, we have classified COVID-19 patients into asymptomatic, pulmonary, GI, and systemic COVID-19 (S-COVID-19). Studies show that the infectivity and prognosis are different and distinct amongst these groups. Systemic-COVID-19 patients are more likely to be critically ill with multi-organ dysfunction and thrombo-embolic complications.


Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Pandemics , Angiotensin-Converting Enzyme 2 , Peptidyl-Dipeptidase A/metabolism
2.
2022 Global Conference on Robotics, Artificial Intelligence and Information Technology, GCRAIT 2022 ; JOUR: 160-168,
Article in English | Scopus | ID: covidwho-2097597

ABSTRACT

The present work propose an improved SEIR model that considers isolation and repeated nucleic acid detection factors. It was applied to the Kashgar Region, Xinjiang, China, to predict the changing trend of the number of confirmed cases and the number of susceptible individuals in Kashgar, and to evaluate and analyze local policy interventions. Model perform four predictive analyses of the epidemic situation in Kashgar. Comprehensive nucleic acid testing, isolation of asymptomatic patients, increasing isolation time and different proportions of the population isolated, control of population flow. Improved kinetic parameters were obtained using the Monte Carlo method. The theoretical estimation of the epidemic using the improved SEIR infectious disease dynamics model was in good agreement with the actuality of the epidemic in Kashgar. The analysis showed that in the areas with large area and dense population, repeat nucleic acid detection, quarantine of asymptomatic individuals and control the contact rate between people can quickly and effectively inhibit development of the local epidemic. © 2022 IEEE.

3.
J Theor Biol ; 557: 111335, 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2095714

ABSTRACT

Repeat asymptomatic testing in order to identify and quarantine infectious individuals has become a widely-used intervention to control SARS-CoV-2 transmission. In some workplaces, and in particular health and social care settings with vulnerable patients, regular asymptomatic testing has been deployed to staff to reduce the likelihood of workplace outbreaks. We have developed a model based on data available in the literature to predict the potential impact of repeat asymptomatic testing on SARS-CoV-2 transmission. The results highlight features that are important to consider when modelling testing interventions, including population heterogeneity of infectiousness and correlation with test-positive probability, as well as adherence behaviours in response to policy. Furthermore, the model based on the reduction in transmission potential presented here can be used to parameterise existing epidemiological models without them having to explicitly simulate the testing process. Overall, we find that even with different model paramterisations, in theory, regular asymptomatic testing is likely to be a highly effective measure to reduce transmission in workplaces, subject to adherence. This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics".

4.
Mol Med ; 28(1): 40, 2022 04 09.
Article in English | MEDLINE | ID: covidwho-2089157

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already caused 6 million deaths worldwide. While asymptomatic individuals are responsible of many potential transmissions, the difficulty to identify and isolate them at the high peak of infection constitutes still a real challenge. Moreover, SARS-CoV-2 provokes severe vascular damage and thromboembolic events in critical COVID-19 patients, deriving in many related deaths and long-hauler symptoms. Understanding how these processes are triggered as well as the potential long-term sequelae, even in asymptomatic individuals, becomes essential. METHODS: We have evaluated, by application of a proteomics-based quantitative approach, the effect of serum from COVID-19 asymptomatic individuals over circulating angiogenic cells (CACs). Healthy CACs were incubated ex-vivo with the serum of either COVID-19 negative (PCR -/IgG -, n:8) or COVID-19 positive asymptomatic donors, at different infective stages: PCR +/IgG - (n:8) and PCR -/IgG + (n:8). Also, a label free quantitative approach was applied to identify and quantify protein differences between these serums. Finally, machine learning algorithms were applied to validate the differential protein patterns in CACs. RESULTS: Our results confirmed that SARS-CoV-2 promotes changes at the protein level in the serum of infected asymptomatic individuals, mainly correlated with altered coagulation and inflammatory processes (Fibrinogen, Von Willebrand Factor, Thrombospondin-1). At the cellular level, proteins like ICAM-1, TLR2 or Ezrin/Radixin were only up-regulated in CACs treated with the serum of asymptomatic patients at the highest peak of infection (PCR + /IgG -), but not with the serum of PCR -/IgG + individuals. Several proteins stood out as significantly discriminating markers in CACs in response to PCR or IgG + serums. Many of these proteins particiArticle title: Kindly check and confirm the edit made in the article title.pate in the initial endothelial response against the virus. CONCLUSIONS: The ex vivo incubation of CACs with the serum of asymptomatic COVID-19 donors at different stages of infection promoted protein changes representative of the endothelial dysfunction and inflammatory response after viral infection, together with activation of the coagulation process. The current approach constitutes an optimal model to study the response of vascular cells to SARS-CoV-2 infection, and an alternative platform to test potential inhibitors targeting either the virus entry pathway or the immune responses following SARS-CoV-2 infection.


Subject(s)
COVID-19 , Humans , Immunoglobulin G , Nucleic Acid Amplification Techniques , SARS-CoV-2
5.
Scand J Prim Health Care ; : 1-8, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2087491

ABSTRACT

OBJECTIVE: Evaluating the prevalence of long-COVID symptoms in patients with a history of mild or asymptomatic infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the factors associated with developing long-COVID. DESIGN: A nationwide cohort study. Using a centralized database, we have identified patients with and without a history of SARS-CoV-2 infection 1-6 months before data collection. Patients were asked to fill out an online questionnaire through text messages. SETTING: Israeli general practice. SUBJECTS: 2755 persons participated in the study in September 2021 (a response rate of 7.5%): 819 with and ,936 without a history of SARS-CoV-2 infection. MAIN OUTCOME MEASURES: We asked patients to provide details about their demographic status, medical history, COVID-related variables and the presence of long-COVID symptoms. RESULTS: Most prevalent long-COVID symptoms were decreased smell sensation (35.1% vs. 4.3%, p < 0.001), decreased taste sensation (25.2% vs. 3.2%, p < 0.001), memory disturbances (36.9% vs. 14.4%, p < 0.001), dyspnea (24.2% vs. 10.7%, p < 0.001) and arthralgia (33% vs. 16.3%, p < 0.001). Risk factors associated with long-COVID included female gender, symptomatic COVID-19, overweight or obesity and the presence of dyslipidemia. About 34.6% of participants reported not returning to their baseline health condition after the acute illness. CONCLUSION: Long-COVID is frequently seen following a mild symptomatic COVID-19 infection and, to a lesser extent, following an asymptomatic SARS-CoV-2 infection. Primary care physicians should be aware of these symptoms and consider this option in their differential diagnosis. Health policymakers should expect a significant impact of this syndrome on public health.Key PointsLong-COVID has emerged as a significant health problem with a serious impact on normal daily function• Long-COVID symptoms were evident in patients with mild symptomatic disease and in asymptomatic patients to a lesser extent.• Risk factors for having Long-COVID symptoms include female gender, symptomatic disease, increased BMI, and the presence of dyslipidemia.• Fatigue, dyspnea, weakness, decreased libido, weight changes, memory, and sleep disturbances were associated with not returning to the baseline health state.

6.
Annals of Applied Statistics ; 16(4):2505-2522, 2022.
Article in English | Scopus | ID: covidwho-2079607

ABSTRACT

As the coronavirus disease 2019 (COVID-19) has shown profound effects on public health and the economy worldwide, it becomes crucial to as-sess the impact on the virus transmission and develop effective strategies to address the challenge. A new statistical model, derived from the SIR epidemic model with functional parameters, is proposed to understand the impact of weather and government interventions on the virus spread in the presence of asymptomatic infections among eight metropolitan areas in the United States. The model uses Bayesian inference with Gaussian process priors to study the functional parameters nonparametrically, and sensitivity analysis is adopted to investigate the main and interaction effects of these factors. This analysis reveals several important results, including the potential interaction effects between weather and government interventions, which shed new light on the effective strategies for policymakers to mitigate the COVID-19 outbreak. © Institute of Mathematical Statistics, 2022.

7.
Epidemiol Infect ; 150: e171, 2022 Sep 27.
Article in English | MEDLINE | ID: covidwho-2076949

ABSTRACT

Coronavirus disease 2019 (COVID-19) asymptomatic cases are hard to identify, impeding transmissibility estimation. The value of COVID-19 transmissibility is worth further elucidation for key assumptions in further modelling studies. Through a population-based surveillance network, we collected data on 1342 confirmed cases with a 90-days follow-up for all asymptomatic cases. An age-stratified compartmental model containing contact information was built to estimate the transmissibility of symptomatic and asymptomatic COVID-19 cases. The difference in transmissibility of a symptomatic and asymptomatic case depended on age and was most distinct for the middle-age groups. The asymptomatic cases had a 66.7% lower transmissibility rate than symptomatic cases, and 74.1% (95% CI 65.9-80.7) of all asymptomatic cases were missed in detection. The average proportion of asymptomatic cases was 28.2% (95% CI 23.0-34.6). Simulation demonstrated that the burden of asymptomatic transmission increased as the epidemic continued and could potentially dominate total transmission. The transmissibility of asymptomatic COVID-19 cases is high and asymptomatic COVID-19 cases play a significant role in outbreaks.


Subject(s)
COVID-19 , Epidemics , Humans , Middle Aged , Computer Simulation , COVID-19/epidemiology , COVID-19/transmission , Disease Outbreaks , SARS-CoV-2 , Asymptomatic Infections
8.
J Infect Dis ; 226(8): 1382-1384, 2022 Oct 17.
Article in English | MEDLINE | ID: covidwho-2077786

ABSTRACT

There is limited evidence on vaccine effectiveness against asymptomatic or mild Omicron infections. We estimated that recent third doses of messenger RNA or inactivated vaccines reduced the risk of self-reported infection by 52% (95% confidence interval, 17%-73%) among randomly sampled adults during the Omicron BA.2-dominated surge in Hong Kong.


Subject(s)
BNT162 Vaccine , COVID-19 , Adult , COVID-19/prevention & control , COVID-19 Vaccines , Hong Kong/epidemiology , Humans , RNA, Messenger , SARS-CoV-2 , Vaccines, Inactivated
9.
Current Pediatric Research ; 25(11), 2021.
Article in English | EMBASE | ID: covidwho-2073396

ABSTRACT

The management protocols in children are mainly governed by symptoms severity and atypical cases. COVID-19 in pediatric group of patients can be asymptomatic. The aim to conduct the study was to assess the benefits and timely management of COVID19 when it is transmitted from the silent carriers like children. The two research questions below were determined. * Whether children are more dangerous than adults in spreading of infection? * How long lasts viral shedding after recovery? We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of s of Reviews of Effects, as well as foreign literature with English translations. Extra information and data have been collected from Google Scholar and American Society for Microbiology (ASM). No randomized controlled trial studies had been conducted in children with COVID-19 yet. Information on patients' age range, comorbidities, methods of treatment, and effects on mortality, morbidity were extracted. As a conclusion, this study shows that children are less susceptible to COVID-19 disease than adults, also the symptoms are less sever than in adults and with regard to transmission, no evidence suggesting vertical transmission (intrauterine) except one case or through breastfeeding of COVID-19 virus. Finally, children are much immune than any other age group and this immunity is more resistant to COVID-19 as this is explained in details[1]. Copyright © 2021 Scientific Publishers of India. All rights reserved.

10.
Int J Environ Res Public Health ; 19(20)2022 Oct 11.
Article in English | MEDLINE | ID: covidwho-2071409

ABSTRACT

INTRODUCTION: Since the advent of 2019 novel coronavirus (COVID-19), the coexistence between social stigma and depression symptoms (depression hereafter) in COVID-19 patients has been mentioned, but the mechanisms involved remains unclear. This study aimed to explore how the stigma affects depression during the mid-pandemic period. METHODS: A cross-sectional survey using non-probability sampling was conducted among asymptomatic COVID-19 carriers in Shanghai, China (April 2022). An online questionnaire was used to obtain information on demographic characteristics and psychological traits. Logistic regression and path analysis were performed to analyze the depression risk factors and examine the mediation model, respectively. RESULTS: A total of 1283 participants (59.6% men) were involved in this study, in which 44.7% of carriers reported having depression. Univariate analyses found that education level (OR 0.575; 95% CI 0.448-0.737) and doses of vaccine (OR 1.693; 95% CI 1.042-2.750), were significantly associated with depression among asymptomatic carriers. The association between social stigma and depression was fully mediated by their feelings of entrapment and decadence (indirect effect = 0.204, p < 0.001; direct effect = -0.059, p = 0.058). The mediating role of entrapment between stigma and depression was moderated by age group (estimate = 0.116, p = 0.008). CONCLUSION: Mental health issues resulting from the COVID-19 pandemic are increasingly apparent in China and require urgent attention and responses. These findings provide new perspectives for the early prevention of depression in asymptomatic carriers.


Subject(s)
COVID-19 , Social Stigma , Male , Humans , Female , Pandemics , COVID-19/epidemiology , Depression/psychology , Cross-Sectional Studies , China/epidemiology , Anxiety/psychology
11.
International Journal of Modeling Simulation and Scientific Computing ; 13(04), 2022.
Article in English | Web of Science | ID: covidwho-2070589

ABSTRACT

In this research, we are interested in discussing the evolution of the COVID-19 infection cases and predicting the spread of COVID-19 disease in Algeria and India. To this aim, we will approximate the transmission rate in terms of the measures taken by the governments. The least square method is used with an accuracy of 95% for fitting the artificial solution with the real data declared by WHO for the purpose of approximating the density of asymptomatic individuals for COVID-19 disease. As a result, we obtained the different values of the basic reproduction number (BRN) corresponding to each measure taken by the governments. Moreover, we estimate the number of asymptomatic infected persons at the epidemic peak for each country. Further, we will determine the needed ICU beds (intense medical carte beds) and regular treatment beds. Also, we provide the outcome of governmental strategies in reducing the spread of disease. Combining all these components, we offer some suggestions about the necessity of using the recently discovered vaccines as Pfizer/Bioentec and Moderna for limiting the spread of the COVID-19 disease in the studied countries.

12.
Epidemiol Health ; : e2022085, 2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-2066910

ABSTRACT

Objectives: After the third wave of coronavirus disease (COVID-19), by mid-February 2021, approximately 0.16% of the population was confirmed positive, which appeared to be one of the lowest rates worldwide at that time. However, asymptomatic transmission poses a challenge for COVID-19 surveillance. Therefore, a community-based serosurvey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted to understand the effectiveness of Korea's strong containment strategy. Methods: We collected 5,002 residual sera samples from January 30 to March 3, 2021 from 265 medical facilities in Seoul, 346 in Kyunggi-do' and 57 in Incheon. Among them, 60 samples from tertiary institutions were excluded. We defined the sub-regions according to the addresses of the medical facilities where the specimens were collected. Elecsys Anti-SARS-CoV-2 was used for the screening test, and positivity was confirmed using the SARS-CoV-2 sVNT Kit. Prevalence was estimated using sampling weight and the Wilson score interval for a binomial proportion with a 95% confidence interval. Results: Among the 4,942 specimens, 32 and 25 tested positive for COVID-19 in the screening and confirmatory tests, respectively. The overall crude prevalence of SARS-CoV-2 antibody was 0.51%. The population-adjusted overall prevalence was 0.55% in women and 0.38% in men. The region-specific estimation was 0.67% and 0.30% in Gyeonggi-do and Seoul, respectively. No positive cases were detected in Incheon. Conclusion: The proportion of undetected cases in South Korea remains low. Therefore, an infection control strategy with exhaustive tracing and widespread pre-emptive testing appears to be effective in containing the spread of the virus in the community.

13.
Chest Disease Reports ; 9(1) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2066765

ABSTRACT

We present a case series of patients with pulmonary embolism of unknown etiology who did not have any risk factors. According to the findings, the most likely cause of the pulmonary embolism was undiagnosed, asymptomatic, or mild Corona Virus disease-2019 (COVID-19) infections in the recent past. In the current post-pandemic era, where there has been a surge of sudden unexplained deaths and pulmonary embolism cases, this case series emphasizes the importance of pulmonary embolism evaluation in patients seeking medical care for dyspnea. Physicians should be aware of the possibility of pulmonary embolism as a late complication in patients with mild, asymptomatic, or undiagnosed COVID-19 infection. Copyright © the Author(s), 2022.

14.
Pharmaceutical Journal ; 308(7958), 2022.
Article in English | EMBASE | ID: covidwho-2065022
15.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P113, 2022.
Article in English | EMBASE | ID: covidwho-2064496

ABSTRACT

Introduction: The SARS-CoV-2 pandemic killed over 6 million people worldwide. Children were described to have predominantly mild or asymptomatic infections and to be less exposed to the virus, at least for the initial variants. In the present study, we describe how SARS-CoV-2 can silently infect tonsils and adenoids in children undergoing adenotonsillectomy. Method(s): In this cross-sectional study we assessed children who underwent adenotonsillectomy between October 2020 and September 2021 in a secondary hospital in Brazil. All the caregivers denied any symptom of acute viral upper airway infection in the month prior to surgery. Briefly, nasal cytobrush (NC), nasal wash (NW) and tonsillar tissue fragments posttonsillectomy were tested by RT-PCR, immunohistochemistry (IHC), in situ immunofluorescence (IF), and flow cytometry. Result(s): A total of 48 children (18 females, median age 5.5 years) were enrolled. None of them had been vaccinated against COVID-19 at the time of surgery. Only 2 had a history of previous COVID-19 diagnosis, 3 and 5 months, respectively, before surgery. SARS-CoV-2 RNA was detected in 25% (12) of patients-20% in palatine tonsils, 16.27% in the adenoids, 10.41% in NC, and 6.25% in NW. IHC labeling showed viral nucleoprotein presence in both adenoids and palatine tonsils, in epithelial surface and lymphoid cells from extrafollicular and follicular regions. In 5 out of 7 patients, in situ IF showed the expression of ACE2 and TMPRSS2 and viral spike protein in the tonsillar tissue. Flow cytometry revealed that SARS-CoV-2 is predominantly observed in CD123+ dendritic cells (10.57% of all tested sites), followed by CD14+ monocytes (6.32%). Conclusion(s): According to these results, the prevalence of SARS-CoV-2 infection seems to be higher than expected and underdiagnosed in children at this age group. Palatine tonsils and adenoids are important sites of infection and may be a reservoir for the virus. Nevertheless, it is still unclear the impact of these results on virus transmission.

16.
American Journal of Transplantation ; 22(Supplement 3):660, 2022.
Article in English | EMBASE | ID: covidwho-2063476

ABSTRACT

Purpose: Kidney transplantation (KT) from coronavirus disease 2019 (COVID-19) positive donors has been avoided due to concerns for donor-derived transmission and possibility of the kidney being a viral reservoir. There is no long-term safety data, and sensitive molecular testing for SARS-CoV-2 in donor kidney is not routinely performed. We report a case of successful KT from a deceased donor who died from severe COVID-19 respiratory illness whose donor kidney and aorta were probed for virus using in situ hybridization (ISH) and quantitative reverse transcriptionpolymerase chain reaction (qRT-PCR). Method(s): A 30-year-old female was admitted to the hospital with severe COVID-19 pneumonia with a positive RT-PCR test for SARS-CoV-2 on nasopharyngeal swab. With clinical worsening, she was placed on extracorporeal membrane oxygenation, but developed hypoxic brain injury and progressed to brain death. Renal function was stable during her hospital course with serum creatinine concentration of 0.7 mg/dL. SARS-CoV-2 RT-PCR on bronchoalveolar lavage and nasopharyngeal samples tested again three days prior to donation was negative. A 55-year-old male recipient with an end-stage renal disease secondary to hypertension was transplanted with the left kidney from the above donor. The donor kidney was studied using pre-implantation surgical biopsy tissues to investigate the presence of SARS-CoV-2 RNA. Aorta tissue with the kidney was also studied given high expression of angiotensin-converting enzyme 2 receptors in vasculature. Result(s): ISH analyses did not show any positive signal for SARS-CoV-2 RNA in the donor kidney sample compared to a SARS-CoV-2 positive lung control. All samples tested by qRT-PCR were also negative for SARS-CoV-2. We found no evidence of SARS-CoV-2 mRNA in the donor kidney and aorta. The recipient has been free of COVID-19 related signs or symptoms and tested negative for SARSCoV- 2 by nasopharyngeal swab RT-PCR on days 20, 30, and 90 following KT. After an initial period of delayed graft function requiring hemodialysis, the recipient now has excellent renal recovery over 6 months following the transplant, and the most recent creatinine is 1.3 mg/dL. Conclusion(s): Taken together with recent observations of successful KT outcomes from mild or asymptomatic COVID-19 donors, we believe that the transmission risk of SARS-CoV-2 through KT is likely to be very low. Use of deceased donors who died after severe COVID-19 can be considered for KT. Larger scale studies are needed to confirm our findings.

17.
American Journal of Transplantation ; 22(Supplement 3):702, 2022.
Article in English | EMBASE | ID: covidwho-2063424

ABSTRACT

Purpose: In contrast to high morbidity and mortality of COVID-19 infection (COVIDi) in adult kidney transplant (KT) recipients, these sequelae appear to be muted in the pediatric KT population. Long-term effects of COVIDi in pediatric KT recipients (pKTR), specifically those with absent or mild symptoms, have not been characterized. Thus, we aimed to investigate the impact of subclinical COVIDi on allograft outcomes, specifically allosensitization, and viremias in pKTR. Method(s): This retrospective 1:1 case-control study investigated COVIDi in pKTR transplanted between January 2016 to November 2021 at our center. Each pKTR with COVIDi, was matched with a control patient (by time of KT). Using laboratory values between March 1, 2020 and December 1, 2021, data was collected following COVIDi to baseline include donor specific antibodies (DSA), panel reactive antibodies (PRA), allograft rejection, and development or intensification of viremias. Descriptive statistics were utilized as well as two-sample t-tests, chi square, and logistic regression for tests of significance. Result(s): 22 patients in our cohort of 135 pKTR experienced subclinical COVIDi. 4 patients (18%) had an increase in BK viremia after COVIDi. Of these cases, 75% resulted in a >100-fold increase in BK viral load, compared to controls experiencing no more than a 5-fold increase. Following COVIDi, the proportion of pKTR with PRA>0 significantly increased compared to controls (p=0.03). Additionally, 2 patients with COVIDi developed de novo DSA versus none in the controls (p=0.078). Conclusion(s): Fortunately, acute morbidity and mortality associated with COVIDi in pKTR is muted compared to adults. However, COVIDi has long-term consequences for the pKTR with marked BK viremia and sensitization, potentially compromising allograft function. Pronounced BK viremia combined with increased risk for sensitization requires delicate adjustments of immunosuppression and anti-viral therapies to optimize patient and graft outcomes. The importance of avoiding these complications of COVIDi could lend additional support to vaccination before and after transplant in the pKTR population. (Table Presented).

18.
Clin Infect Dis ; 2022 Oct 10.
Article in English | MEDLINE | ID: covidwho-2062883

ABSTRACT

BACKGROUND: The recombinant protein-based vaccine, NVX-CoV2373, demonstrated 89.7% efficacy against COVID-19 in a phase 3, randomized, observer-blinded, placebo-controlled trial in the United Kingdom. The protocol was amended to include a blinded crossover; data to the end of the placebo-controlled phase are reported. METHODS: Adults aged 18-84 years received two doses of NVX-CoV2373 or placebo (1:1) and were monitored for virologically confirmed mild, moderate, or severe COVID-19 (onset from 7 days after second vaccination). Participants who seroconverted to immunoglobulin G (IgG) against the nucleocapsid protein and did not meet criteria for symptomatic COVID-19 were classified as having asymptomatic disease. Secondary outcomes included anti-spike (S) IgG responses, wild-type virus neutralization, and T-cell responses. RESULTS: Of 15185 participants, 13989 remained in the per-protocol efficacy population (6989 NVX-CoV2373, 7000 placebo). At a maximum of 7.5 months (median, 4.5 months) postvaccination, there were 24 cases of COVID-19 among NVX-CoV2373 recipients and 134 cases among placebo recipients, a vaccine efficacy of 82.7% (95% CI: 73.3-88.8). Vaccine efficacy was 100% (17.9-100.0) against severe disease and 76.3% (57.4-86.8) against asymptomatic disease. High anti-S and neutralization responses to vaccination were evident, together with S-protein-specific induction of interferon-γ secretion in peripheral blood T cells. Incidence of serious adverse events and adverse events of special interest were similar between groups. CONCLUSIONS: A two-dose regimen of NVX-CoV2373 conferred a high level of ongoing protection against asymptomatic, symptomatic, and severe COVID-19 through >6 months postvaccination. A gradual decrease of protection suggests that a booster dose may be indicated.

19.
Cardiology in the Young ; 32(Supplement 2):S40-S41, 2022.
Article in English | EMBASE | ID: covidwho-2062094

ABSTRACT

Background and Aim: With the progressive spread of the coronavi-rus among the youngest and the need for a safe resumption of physical activity, several protocols have been proposed for healed athletes. The aim of the present study is to evaluate the presence of cardio-respiratory complications in the pediatric population after mild or asymptomatic SARS-CoV-2 infection. Method(s): From January 2021 the protocols of the Italian Sports Medical Federation were applied to all the children and adoles-cents who came to our observation for return-to-play after covid infection. The protocols take into account the severity of the infection. In case of mild or asymptomatic infection echocardiogram, electrocardiogram, treadmill ECG test and pul-monary function tests were performed. Result(s): From January 2021 to November 2021, 169 children and adolescents (mean age 14+3 ys;male = 92) with previous SARS-CoV-2 infection were evaluated according to the protocols in force after an average time of 48 + 13 days from SARS-CoV-2 swab negativity. 60,3% of the subjects (N = 102) reported an asymptomatic infection;39,7 % reported a mild symptomatic infection. Results of lung function test have exceeded the limit of 80% of the theoretical value in all patients. No subject presented evidence of cardiovascular function impairment. Conclusion(s): The data obtained showed that, in the pediatric pop-ulation, mild coronavirus infection does not cause cardiorespira-tory complications in the short and medium term. This reinforce the evidence from preliminary studies that return to play after Coronavirus infection seems to be safe and must be strongly recommended. It will therefore be possible to assess the possibility of lightening or even suspending these evaluations in the cases of mild coronavirus infection in the pediatric age groups.

20.
American Journal of Transplantation ; 22(Supplement 3):597, 2022.
Article in English | EMBASE | ID: covidwho-2063338

ABSTRACT

Purpose: To investigate the effect of mycophenolate mofetil (MMF) on SARSCoV- 2 vaccination response in kidney transplant recipients using the standard immunosuppressive regimen of tacrolimus (TAC) and MMF. Method(s): A randomized controlled trial in immunologically low risk kidney transplant recipients was performed (EudraCT nr.: 2014-001372-66). Patients were randomized to standard TAC/MMF or TAC monotherapy (TACmono) from 9 months onwards, without steroids. Antibody based immune responses to SARS-CoV-2 vaccination (mRNA-1273 or BNT162b2) were investigated in a central laboratory, as part of the RECOVAC Antibody study (EudraCT nr.: 2021-283 001520-18), 4-8 weeks after the second vaccination. Measurement involved the presence of antibodies against the receptor binding domain (RBD) of the SARS-CoV-2 S-protein (IgG anti-RBD antibody) using the Sanquin anti-SARS-CoV-2 RBD IgG ELISA assay. Patients were classified as non-responders (<=50 BAU/mL), low-responders (50-300 BAU/ mL) and responders (>300 BAU/mL). Result(s): Between 2015 and 2018, 79 recipients were randomized to TAC/MMF (n=41) and TACmono (n=38). At the outbreak of the COVID-19 pandemic in early 2020, 67 patients were alive with a functioning graft (TAC/MMF n=35, TACmono n=32). In 27 patients antibody responses could be established: Ten patients were excluded from the analyses due to symptomatic COVID-19 infection and 1 due to a positive nucleocapsid test, possibly from an asymptomatic infection. The rest did not participate in the vaccination study, because of ChAdOx1-S, age >80 years or lack of informed consent. Mean age was 64 (43-75) years, median time after transplantation 4.2 (3.0-6.5) years and eGFR was 53 (36-105) ml/min/1.73m2. TAC trough levels were 6.6 (+/-0.3) mug/L in both groups, and MMF dose was 1000 mg daily (range 500- 2000) in TAC/MMF. Median SARS-CoV-2 Spike S1-specific IgG antibody levels were 37.3 BAU/ml in TAC/MMF (5 non, 7 low, 1 responder) and 715.6 BAU/ml in TACmono (1 non, 6 low, 7 responders, p =0.004, figure 1). Of note is that antibody levels of >1000 BAU/ml, as a presumed threshold for protection against Omicron (B.1.1.529), was reached in 1/13 TAC/MMF and 7/14 TACmono patients (p=0.03). Conclusion(s): In this controlled study mycophenolate mofetil on top of tacrolimus severely hampered serological COVID-19 vaccination response.

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