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1.
Journal of Pure and Applied Microbiology ; JOUR
Article in English | Web of Science | ID: covidwho-2100701

ABSTRACT

WHO estimates show that 296 million people were living with chronic hepatitis B infection in 2019 with 1.5 million new infections occurring every year and approximately 290 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma. The prevalence and trends of Hepatitis B and Hepatitis C infections were affected during the pandemic, hence this study aimed to compare the difference in prevalence rates, trends, demographic data, and outcomes of Hepatitis B and Hepatitis C cases in pre-pandemic and pandemic era. The study was carried out in a 1060 bedded tertiary care teaching hospital located 90 kilometers away from Hyderabad, Telangana catering to a majorly rural population from around 200 villages. This study was a retrospective observational study where data of 4 years (March 2018 to Feb 2022) of patients whose samples were sent to Microbiology laboratory and were found to be positive for Hepatitis B surface antigen (HBsAg) or antibodies to Hepatitis C (AntiHCV) were included. The medical records of Hepatitis B and Hepatitis C positive cases were analysed for demographic data like age, sex, address, requesting department, and present status retrieved from the hospital information system. The prevalence rates of Hepatitis B and Hepatitis C infections and trends every year were calculated and compared. Out of the total 39,578 samples tested for Hepatitis B surface antigen, 413 were positive with a seroprevalence of 1.04%. Among the 20,394 samples tested for anti-Hepatitis C antibodies, 53 samples were found to be positive showing a seroprevalence of 0.25%. There was a 23.63% decrease in the number of samples received during the pandemic period demonstrating the impact of COVID-19 on various laboratory testing. Male predominance was observed for both Hepatitis B (65.37%) and Hepatitis C (56.60%) positivity in this study. Hepatitis B was highest in the 61-80 years age group before the pandemic but during the pandemic, Hepatitis B positivity was equally distributed in the 41 to 60 years and 61-80 years age groups. Hepatitis C positive cases were equally distributed in the 41 to 60 years and 61-80 years age groups before the pandemic whereas during the pandemic Hepatitis C positivity was highest among the 41 to 60 years age group. Among the 413 positive cases of Hepatitis B, 315 (76.27%) cases belonged to the rural population and among the 53 Hepatitis C positive cases, 37 (69.81%) cases were from rural areas. The seroprevalence for Hepatitis B surface antigen displayed a decreasing trend in the pandemic era when compared to the pre-pandemic era. Seroprevalence for anti-HCV antibodies showed a small increase in the pandemic era when compared to the pre-pandemic era. Male predominance was observed for both Hepatitis B and Hepatitis C positivity in this study. Hepatitis B was highest in the 61-80 years age group before the pandemic but during the pandemic, Hepatitis B positivity was equally distributed in the 41 to 60 years and 61-80 years age groups. Hepatitis C positive cases were equally distributed in the 41 to 60 years and 61-80 years age groups before the pandemic whereas during the pandemic Hepatitis C positivity was highest among the 41 to 60 years age group. Detailed analysis of these variations in the trends during the pandemic will aid in guiding tertiary care hospitals on the way forward in the retrieval of medical services after the pandemic.

2.
Nurs Womens Health ; 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2095862

ABSTRACT

In 2022, the Centers for Disease Control and Prevention (CDC) updated its Adult Immunization Schedule Recommendations for Ages 19 Years or Older to provide the most current evidence-based recommendations following comprehensive reviews of data related to vaccines. In its report, the CDC highlighted the importance of health care professionals staying up to date on the latest evidence. During the novel coronavirus pandemic, the ability to provide routine vaccinations to the adult population was limited and even halted at times. As in-person health care visits continue to resume, it is imperative for nurses to refocus on and be familiar with the most up-to-date vaccine recommendations. Here, we summarize information on vaccine guidelines, safety, and special considerations for women, and we highlight changes to the 2022 adult immunization schedule. Keeping individuals free of vaccine-preventable diseases is one of the most effective and important public health interventions in health care.

3.
China Biotechnology ; JOUR(5):117-123, 42.
Article in Chinese | Scopus | ID: covidwho-2090951

ABSTRACT

Objective: Hepatitis B virus core protein HBc was used as vector to construct virus-like particles expressing novel coronavirus spike protein receptor binding domain RBD, and their immunogenicity was identified, which provides a new idea for the development of COVID-19 vaccines. Methods: The amino acid coding sequence 78 and 81 of hepatitis B virus core protein HBc (1-183 aa) were inserted into novel coronavirus spike protein receptor binding domain RBD and ligated by flexible linker (G4S) 3. After sequence optimization, the fusion gene was cloned into prokaryotic expression vector pET-28a (+) and transformed into expression strain Rosetta. After induced expression in self-inducing medium, the virus-like particles (VLPs) were purified by sucrose density gradient centrifugation. VLPs were detected and identified by SDS-PAGE, Western blot and transmission electron microscope. BALB/c mice were immunized subcutaneously with the prepared VLPs in equal proportion with adjuvant. The specific antibodies in the serum of the mice were analyzed by ELISA to verify the immune effect of HBc-RBD VLPs. Results: Escherichia coli can express partially soluble VLPs in self-inducing medium. VLPs could be observed by transmission electron microscope after purification by sucrose density gradient centrifugation. Mice immunized with HBc-RBD VLPs produced specific antibodies against RBD antigen. Conclusion: VLPs displaying RBD antigen were successfully expressed in prokaryotic expression systems, and their immunogenicity was preliminarily verified by mouse experiment, which provides a new direction for the research and development of novel coronavirus vaccines. © 2022, China Biotechnology Press. All rights reserved.

4.
Clin Mol Hepatol ; 28(4): 890-911, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2080100

ABSTRACT

BACKGROUND/AIMS: Data of coronavirus disease 2019 (COVID-19) vaccine immunogenicity among chronic liver disease (CLD) and liver transplant (LT) patients are conflicting. We performed meta-analysis to examine vaccine immunogenicity regarding etiology, cirrhosis status, vaccine platform and type of antibody. METHODS: We collected data via three databases from inception to February 16, 2022, and reported pooled seroconversion rate, T cell response and safety data after two vaccine doses. RESULTS: Twenty-eight (CLD only: 5; LT only: 18; both: 2; LT with third dose: 3) observational studies of 3,945 patients were included. For CLD patients, seroconversion rate ranged between 84% (95% confidence interval [CI], 76-90%) and 91% (95% CI, 83-95%), based predominantly on neutralizing antibody and anti-spike antibody, respectively. Seroconversion rate was 81% (95% CI, 76-86%) in chronic hepatitis B, 96% (95% CI, 93-97%) in non-alcoholic fatty liver disease, 85% (95% CI, 75-91%) in cirrhosis and 85% (95% CI, 78-90%) in non-cirrhosis, 86% (95% CI, 78-92%) for inactivated vaccine and 89% (95% CI, 71-96%) for mRNA vaccine. The pooled seroconversion rate of anti-spike antibody was 66% (95% CI, 55-75%) after two doses of mRNA vaccines and 88% (95% CI, 58-98%) after third dose among LT recipients. T cell response rate was 65% (95% CI, 30-89%). Prevalence of adverse events was 27% (95% CI, 18-38%) and 63% (95% CI, 39-82%) among CLD and LT groups, respectively. CONCLUSION: CLD patients had good humoral response to COVID-19 vaccine, while LT recipients had lower response.


Subject(s)
COVID-19 , Liver Diseases , Liver Transplantation , Humans , COVID-19 Vaccines , Immunogenicity, Vaccine , COVID-19/prevention & control , Antibodies, Neutralizing , Vaccines, Inactivated , Antibodies, Viral
5.
Intern Med ; 2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2079923

ABSTRACT

Objective One of the therapeutic goals for chronic infection with hepatitis B virus is the clearance of hepatitis B surface antigen (HBsAg) from the blood, as a high load of HBsAg has been proposed to induce antigen-specific immunotolerance. To achieve HBsAg reduction, Pegylated interferon and nucleos (t) ide analogs are used to treat chronic hepatitis B. Following the coronavirus disease 2019 (COVID-19) outbreak, the SARS-CoV-2 infection has rapidly spread worldwide, and vaccination with mRNA COVID-19 vaccines has been conducted since 2021 in Japan. We experienced three clinical cases in which HBsAg levels rapidly decreased after injection of the COVID-19 vaccine without any incentive. Method To examine whether the vaccine administration was involved in the HBsAg reduction, the number of patients with chronic hepatitis B showing a change in the HBsAg levels during the period before the commencement of the COVID-19 vaccination program in Japan (i.e. until the end of 2020; pre-vaccination-program period) was compared to the number of those who showed a change in HBsAg levels after the initiation of the program (i.e. 2021 onwards; post-vaccination-program period). Results The number of patients whose HBsAg levels was reduced by >50% per year was prominent after the initiation of the vaccination program. Although the involvement of vaccination in HBsAg reduction was not statistically proven (p =0.0532), the result suggests that the administration of COVID-19 vaccines may have been involved in HBsAg reduction in patients with chronic hepatitis B. Conclusion COVID-19 vaccines may be involved in HBsAg reduction.

6.
Intern Med ; 2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2079921

ABSTRACT

An 81-year-old man underwent rituximab-containing chemotherapy for chronic lymphocytic leukemia (CLL). Thirteen years after his last chemotherapy, he was diagnosed with hepatitis B virus (HBV) reactivation. He was then treated with entecavir, and improvement was seen in his liver injury. He developed diffuse large B cell lymphoma (DLBCL) after improvement in his hepatitis. Despite chemotherapy, he contracted the coronavirus disease 2019 (COVID-19) and died of COVID-19. We suspect that HBV reactivation was triggered by DLBCL. When HBV reactivation occurs a long time after chemotherapy has concluded, the onset of DLBCL should be considered.

7.
Dig Liver Dis ; 2022 Oct 17.
Article in English | MEDLINE | ID: covidwho-2068870

ABSTRACT

BACKGROUND AND AIMS: COVID-19 mRNA vaccines were approved to prevent severe forms of the disease, but their immunogenicity and safety in cirrhosis is poorly known. METHOD: In this prospective single-center study enrolling patients with cirrhosis undergoing COVID-19 vaccination (BNT162b2 and mRNA-1273), we assessed humoral and cellular responses vs healthy controls, the incidence of breakthrough infections and adverse events (AEs). Antibodies against spike- and nucleocapsid-protein (anti-S and anti-N) and Spike-specific T-cells responses were quantified at baseline, 21 days after the first and second doses and during follow-up. RESULTS: 182 cirrhotics (85% SARS-CoV-2-naïve) and 38 controls were enrolled. After 2 doses of vaccine, anti-S titres were significantly lower in cirrhotics vs controls [1,751 (0.4-25,000) U/mL vs 4,523 (259-25,000) U/mL, p=0.012] and in SARS-CoV-2-naïve vs previously infected cirrhotics [999 (0.4-17,329) U/mL vs 7,500 (12.5-25,000) U/mL, (p<0.001)]. T-cell responses in cirrhotics were similar to controls, although with different kinetics. In SARS-CoV-2-naïve cirrhotics, HCC, Child-Pugh B/C and BNT162b2 were independent predictors of low response. Neither unexpected nor severe AEs emerged. During follow-up, 2% turned SARS-CoV-2 positive, all asymptomatic. CONCLUSION: Humoral response to COVID-19 vaccines appeared suboptimal in patients with cirrhosis, particularly in SARS-CoV-2-naïve decompensated cirrhotics, although cellular response appeared preserved, and low breakthrough infections rate was registered.

8.
Journal of Acute Disease ; 11(4):161-164, 2022.
Article in English | EMBASE | ID: covidwho-2066827

ABSTRACT

Rationale: The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far. This case report describes the clinical course of a patient with autoimmune hepatitis (AIH) who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit. Patient's Concern: A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months. Diagnosis: AIH and Covid-19 with features of cytokine storm syndrome. Interventions: Intravenous furosemide, mannitol, syrup lactulose, steroids (prednisolone 40 mg), azathioprine 1 mg/kg body weight, rifaximin, vitamin K, and blood products. Outcomes: The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support, sustained low-efficiency hemodialysis, and resuscition. Lessons: The dramatic release of cytokines and the inflammatory-immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.

9.
Vaccines (Basel) ; 10(10)2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2066626

ABSTRACT

Maintenance hemodialysis (MHD) patients have impaired immunological responses to pathogens and vaccines. In this study, we compared the humoral response to HBV and COVID-19 vaccines in a cohort of MHD patients. Demographic and clinical characteristics of vaccine responders and non-responders were also compared, and the association between the humoral responses to both vaccines was evaluated. The cohort included 94 MHD patients who were vaccinated at least once for HBV and twice for COVID-19. Among the 94 patients, 28 (29.8%) did not develop protective titers to HBV. Hypertension, coronary heart disease, and heart failure were more common in non-responders. Among MHD patients, 85% had positive IgG anti-spike SARS-CoV-2 levels 6 months after two doses of BNT162b2 (Pfizer/Biotech) vaccine. Age and immunosuppressive therapy were the main predictors of humoral response to COVID-19 vaccine. We did not find any association between non-responders to HBV and non-responders to COVID-19 vaccine. There was no difference in IgG anti-spike titers between HBV responders and non-responders (505 ± 644 vs. 504 ± 781, p = 0.9) Our results suggest that reduced humoral response to hepatitis B is not associated with reduced response to COVID-19 vaccine. Different risk-factors were associated with poor immune response to HBV and to COVID-19 vaccines.

10.
Przegl Epidemiol ; 76(2): 243-254, 2022.
Article in English | MEDLINE | ID: covidwho-2067623

ABSTRACT

OBJECTIVE: Aim of the study was the assessment of hepatitis B epidemiological situation in Poland in 2019 compared to previous years, taking into consideration the impact of the COVID-19 pandemic during that time. MATERIAL AND METHODS: Data for 2020 included in individual reports on hepatitis B and HBV infections recorded by sanitary and epidemiological stations at EpiBaza, i.e. in the electronic epidemiological surveillance system on infectious diseases, were analyzed. In the assessment of the epidemiological situation, data published in the annual bulletins: "Infectious diseases and poisonings in Poland in 2020" and "Vaccinations in Poland in 2020" were also used. Data on deaths were obtained from the Statistics Poland (GUS). RESULTS: In 2020, 2,854 cases of hepatitis B were reported, which corresponds to the incidence of 2.59 per 100,000 population, lower by 65.1% than in 2019. 14 cases of acute hepatitis B were reported, constituting 1.4% of all registered cases. The incidence of acute hepatitis B was 0.04 per 100,000 population and was lower by 67% compared to 2019 and lower by 71% compared to the median for the years 2014-2018. There were no cases of acute disease in the age group 0-29 years. A total of 978 chronic and unknown hepatitis B cases (UNK) were registered and the diagnosis rate was 2.56 per 100,000 population, lower by 64.2% than in 2019. Compared to the median diagnosis rate of chronic hepatitis B in 2014-2018, a decrease of 70.4% was observed. In the age group 0-19 years, there was no case reported. In 2020, 24 people died due to hepatitis B, including 22 from chronic hepatitis B. CONCLUSIONS: The COVID-19 pandemic resulted in a significant reduction in the number of HBV tests performed and, consequently, a reduction in the number of diagnosed infections. A decrease in the number of detected infections was observed from the second quarter of 2020, i.e. from the beginning of the COVID-19 pandemic, although already in the first quarter of 2020 the number of registered hepatitis B cases was lower than in the same period in 2019. No acute cases were reported among people who were vaccinated against hepatitis B during childhood. Vaccination with three doses of hepatitis B vaccine in children in the second year of life was only slightly lower than in 2019, which proves the stability of the implementation of the preventive vaccination program, despite the limited access to primary health care during the pandemic.


Subject(s)
COVID-19 , Communicable Diseases , Hepatitis B, Chronic , Hepatitis B , Adolescent , Age Distribution , COVID-19/epidemiology , Child , Child, Preschool , Communicable Diseases/epidemiology , Disease Outbreaks , Hepatitis B/epidemiology , Hepatitis B/prevention & control , Hepatitis B Vaccines/therapeutic use , Hepatitis B, Chronic/epidemiology , Hepatitis B, Chronic/prevention & control , Humans , Incidence , Infant , Infant, Newborn , Pandemics , Poland/epidemiology , Registries , Rural Population , Urban Population , Young Adult
11.
Current Issues in Pharmacy and Medical Sciences ; 35(2):75-79, 2022.
Article in English | EMBASE | ID: covidwho-2065356

ABSTRACT

The level of immunization of children and adolescents under the Protective Vaccination Program in Ukraine is lower than in Poland, and, due to the outbreak of the war in Ukraine, many people now live in conditions that are often unsanitary. Centers for refugees are also places of increased risk of outbreaks of infectious diseases. This risk is increased by the low percentage of the vaccinated, limited access to healthcare (including diagnostics) and overcrowding. The paper presents the state of vaccination in Ukraine against poliomyelitis, measles, diphtheria, tetanus and pertussis, the most important problems in the field of infectious diseases, as well as the resulting risks and the need to prevent them.

12.
Front Pediatr ; 10: 888686, 2022.
Article in English | MEDLINE | ID: covidwho-2065607

ABSTRACT

Objectives: The hepatitis B vaccine comprises hepatitis B surface antigen (HBsAg) produced by transgenic yeast cells. There are few serious adverse events (SAE) reports after Hepatitis B vaccination. Methods: The authors searched the Chinese legal documents database for all SAE with Hepatitis B vaccination from January 2010 to January 2022. Results: All seven patients received yeast-derived recombinant hepatitis B vaccine. Three cases of myocarditis (death), 2 cases of interstitial pneumonia (death), and 2 cases of encephalitis. The mean time of onset of SAE was 8.3 ± 4.3 h after vaccination. Conclusion: The mechanism of vaccine-induced myocarditis may come from immune protein reactions. Based on the experience of Hepatitis B vaccine adverse events, we present new insights into the mechanism of myocarditis caused by the COVID-19 vaccine.

13.
Front Med (Lausanne) ; 8: 770124, 2021.
Article in English | MEDLINE | ID: covidwho-2065530

ABSTRACT

Hepatitis B virus (HBV) reactivation associated with various therapeutic interventions is an important cause of morbidity and mortality in patients with current or resolved HBV infection. Because no curative treatment for HBV infection is yet available, there are many individuals at risk for HBV reactivation in the general population. Populations at risk for HBV reactivation include patients who are currently infected with HBV or who have been exposed to HBV in the past. HBV reactivation and its potential consequences is a concern when these populations are exposed to anti-cancer chemotherapy, immunosuppressive or immunomodulatory therapies for the management of various malignancies, rheumatologic diseases, inflammatory bowel disease, or solid-organ or hematologic stem cell transplantation. Accordingly, it has become important to understand the basics of HBV reactivation and the mechanisms by which certain therapies are more susceptible to HBV reactivation. This review aims to raise the awareness of HBV reactivation and to understand the mechanisms and the risks of HBV reactivation in various clinical settings.

14.
Gut ; 71(Suppl 3):A91-A92, 2022.
Article in English | ProQuest Central | ID: covidwho-2064235

ABSTRACT

P80 Figure 1This ongoing project will enable our team to identify those requiring blood tests and potential treatment. As we continue we expect an increase in patient numbers to our CNS clinics. One major limitation is limited access to regional hospital laboratory results. Another limitation is staff being available to review files, responses to letters and chasing blood tests or results.Public Health England (2017). Hepatitis C in the UK – 2017 Report.Working to Eliminate Hepatitis C as a Major Public Health Threat. London: PHE.Thursz M. (2017). The fight against hepatitis C has not yet been won: here’s what we have to do. Huffington Post;10 August 2017.Vine LJ et al. Diagnosis and management of hepatitis C. British Journal of Hospital Medicine;2015;76:11, 625–630.World Health Organization (2016). Combating Hepatitis B and C to Reach Elimination by 2030. Geneva: WHO.

15.
Gut ; 71(Suppl 3):A72, 2022.
Article in English | ProQuest Central | ID: covidwho-2064228

ABSTRACT

P54 Figure 1ConclusionUnsurprisingly, there were 1.5 times more fibroscan cases in the pre-covid year (1633 in 2019 compared to 1058 in 2021), indicating the negative impact of COVID-19 in the diagnosis of chronic liver diseases. In addition, NAFLD had a higher rate of advanced fibrosis compared to hepatitis B with the possibility of more sequential HBV follow-up, late referral of NAFLD or impact of fasting state on steatohepatitis.We need to evaluate the interval and indications of repeat fibroscan in each etiology due to no significant variation of LSM value despite different fibroscan intervals. We also need to improve the fibroscan access in district hospitals and other specialities regarding external referral data.

16.
Gut ; 71(Suppl 3):A29-A30, 2022.
Article in English | ProQuest Central | ID: covidwho-2064224

ABSTRACT

Chronic hepatitis B (CHB) patients require long term medical care, with regular monitoring blood tests and ultrasound scans. The COVID-19 pandemic disrupted outpatient services and many patients fell ‘out of sync’ with their routine care;missing scans, blood tests and running out of medication as a result. Telephone appointments are now routine in outpatient care, and fewer patients attend for F2F appointments than pre-pandemic. We developed a virtual patient forum for patient engagement and service evaluation.Patients were invited to take part in a virtual patient group during routine telephone appointments. Further information was sent by email with a link to virtual meeting. Meetings were scheduled in weekday evenings to allow those who are currently working to attend, with a duration of 1–1.5 hours. Feedback surveys were sent out via email, and notes from the meeting were sent to patient participants for approval.Results3 sessions were held virtually between November 2021 – June 2022. A total of 14 patient interactions across 3 sessions (Male n=5, Female n= 3). A doctor chaired the sessions and a nurse specialist was also in attendance. Topics raised varied but there was repeated discussion regarding treatment, patient support and disease information. Diagnosis was highlighted as particularly difficult;patients suggested increasing available resources. Patients on treatment reported difficulties obtaining repeat prescriptions, uncertainty about long-term implications of taking medication and requested more information on treatment and new therapies.Post feedback surveys were distributed within 1 week of the sessions and had a 78% completion rate. All respondents reported sessions were useful to them. Additional comments mentioned the utility of speaking to other CHB patients (n=5,) the value of being able to “contribute in a way which helps services develop/improve” (n=3,) having an avenue to “express concerns” (n=2) and opportunity to hear about treatment developments (n=2).Patient expectations of the sessions were as follows;wanting to engage with other patients (n=8,) engaging with the clinical team (n=5,) raising concerns/issues (n=4) and a desire for more information about CHB (n=4.) All patients stated the sessions met their expectations, and that they would be interested in attending similar sessions in future.ConclusionsVirtual patient groups were effective in our patient cohort for gathering feedback on service delivery and formulating goals for future work and service improvement. Patients respond positively to the opportunity to share their opinions, and this enables effective collaboration necessary to drive change.

17.
American Journal of Transplantation ; 22(Supplement 3):863, 2022.
Article in English | EMBASE | ID: covidwho-2063466

ABSTRACT

Purpose: Vaccination rates in solid organ transplant candidates (SOTc) remains suboptimal. We report the effect of a dedicated Infectious Disease Pre-transplant (IDPT) clinic visit on vaccine uptake in SOTc. Method(s): We evaluated all SOTc referred to the IDPT from January 2020 to February 2021 at Henry Ford Transplant Institute in Detroit, MI. Patients were followed up until October 2021. Sociodemographic data, comorbidities, vaccination status for influenza, pneumococcus, hepatitis B, Tdap, zoster and COVID-19 were determined from electronic medical records and the Michigan Care Improvement Registry that includes vaccination records. Vaccine uptake at baseline and 3 and 6 months after IDPT visit were evaluated. Result(s): A total of 183 SOTc were evaluated in IDPT. Median age was 57 years, mean Charlson Comorbidity Index was 4.1. Other characteristics are summarized (Table 1). Vaccine uptake improved post IDPT for all vaccines (Table 2), most notably for hepatitis B (53.4%), zoster (40.4%) and pneumococcal vaccine (33.4%). COVID vaccine uptake post visit was 80.3%. Conclusion(s): IDPT clinic visits steadily improved vaccine uptake in SOTc at our institution. Implementation of an Infectious Diseases visit as a requirement for all SOTc can provide opportunities to optimize vaccine completion before transplantation.

18.
Chest ; 162(4):A663, 2022.
Article in English | EMBASE | ID: covidwho-2060662

ABSTRACT

SESSION TITLE: Challenging Cases of Hemophagocytic Lymphohistiocytosis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Worsening respiratory disease is the most common complication of severe COVID-19. However, when patients develop multi-organ dysfunction, clinicians must have a high index of suspicion for rare syndromes such as hemophagocytic lymphohistiocytosis (HLH). CASE PRESENTATION: A 39-year-old male smoker presented with 1 week of shortness of breath and malaise. Initial physical examination revealed T 37.3 C, pulse 85 min-1, respiratory rate 18 breaths min-1, SPO2 96% and clear breath sounds without labored respirations. Chest X-ray showed bilateral patchy airspace opacities in the mid and lower lung fields. A SARS-COV2 PCR test was positive. The patient was prescribed antibiotics and discharged home. Subsequently, the patient's symptoms worsened and he presented 1 week later with SPO2 90% (O2 10 L/min via nasal cannula). He was admitted to the hospital with COVID-19 pneumonia and began remdesivir, barcitinib, systemic steroids, albuterol and IV antibiotics. On admission his complete blood count and complete metabolic panel were unremarkable. After 3 weeks of hospitalization, he developed multi-organ failure with acute liver injury, acute kidney injury, shock, pancytopenia and worsening hypoxemia leading to endotracheal intubation and mechanical ventilation. CT chest imaging showed bilateral ground glass opacities in the lungs with superimposed consolidation (figure 1). Blood cultures remained sterile, HIV, hepatitis B and C viral serologies were negative. Serum viral polymerase chain reaction detected Herpes Simplex Virus-1 (HSV-1) and Epstein Barr Virus (EBV) infections. Trans-jugular liver biopsy confirmed HSV-1 hepatitis and showed sub-massive hemorrhagic necrosis of the liver (figure 2). Bone marrow biopsy demonstrated phagocytic histiocytes engulfing red blood cells and platelets consistent with HLH (figure 3). The patient began HLH targeted therapy with anakinra and high dose steroids. Despite this, the patient continued to deteriorate, developed refractory shock and subsequently expired. DISCUSSION: HLH is a rare disease of the immune system in which a genetic or infectious trigger causes uncontrolled T cell activation. T cell activation triggers macrophage activation, cytokine storm and macrophage phagocytosis of erythrocytes, leukocytes, platelets and precursors in the bone marrow and other tissues. If the syndrome is unrecognized, it can quickly lead to multi-organ failure and death. EBV is the most common infectious trigger of HLH;however, infection with HSV-1 and SARS-COV-2 viruses have been identified as rare and independent causes. CONCLUSIONS: This case illustrates the high index of suspicion providers should have for HLH in patients with severe COVID-19 who develop multi-organ injuries. Once HLH is suspected, prompt initiation of HLH-94 protocol with etoposide and dexamethasone may be lifesaving. For those patients with liver failure, other agents (e.g. anakinra) may be provided. Reference #1: Ramos-Casals M, Brito-Zerón P, López-Guillermo A, et al.: Adult haemophagocytic syndrome. Lancet 2014;383:1503–1516 Reference #2: Risma K, Jordan MB: Hemophagocytic lymphohistiocytosis: updates and evolving concepts. Curr Opin Pediatr 2012;24:9–15 Reference #3: Trottestam H, Horne A, Aricò M, et al.: Chemoimmunotherapy for hemophagocytic lymphohistiocytosis: long-term results of the HLH-94 treatment protocol. Blood 2011;118:4577–4584 DISCLOSURES: No relevant relationships by Erin Biringen No relevant relationships by Christine Brennan No relevant relationships by Joann Hutto No relevant relationships by Daniel Puebla Neira

19.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S95-S96, 2022.
Article in English | EMBASE | ID: covidwho-2058186

ABSTRACT

Background Global health interest continues to rise among pediatric trainees including those entering pediatric fellowships. While global health opportunities are being incorporated into many pediatric fellowship programs, there remains a paucity of global health training in pediatric gastroenterology, hepatology, and nutrition (GHN) fellowships. In a 2014 survey by Jirapinyo et al. only 17% of responding GHN fellowships offered global health training activities. A 2018 survey by Crouse et al. showed that 34% of responding GHN fellowships offered global health electives, and none had formal global health tracks. We believe that creating a formalized global health track for GHN fellows will not only appeal to the increasing interest among applicants, but also provide a firm knowledge base on GHN topics specific to a more global level, build international collaborations, and contribute a unique perspective in our field. We aim to describe our experience with the development and implementation of a novel global health track in a pediatric GHN fellowship. Methods Planning commenced January 2021. A multidisciplinary team was assembled bringing together experts in different areas including those in other subspecialties involved in global health fellowship training. The team involved in development included GHN program director, GHN division chief, pediatric emergency medicine global health fellowship director, director of the pediatric infectious disease fellowship tropical and global medicine track, and Baylor international pediatric AIDS initiative (BIPAI) chief medical officer. Input was also received on certain aspects of the curriculum from the pediatric viral hepatitis program director, dieticians, a radiologist, an ultrasound technologist, and the pediatric point-of-care ultrasound fellowship program director. Existing clinical niche track curriculum developed within the GHN department at Texas Children's Hospital were used as a guide for the structure and different aspects to be incorporated into the track including, but not limited to, clinical activities, procedural opportunities, research, education, and teaching. Results A comprehensive, multifaceted global health curriculum was developed, and implementation began in July 2021. Clinical activities include participation in pediatric and adult viral hepatitis clinics, nutrition focused clinics, and tropical medicine clinic. Global health electives abroad were explored but deferred given travel restrictions during the COVID-19 pandemic. For procedural opportunities an ultrasound curriculum was developed including point of care ultrasound training as well as more focused training in liver, biliary, and gastrointestinal disease. A fellowship research project was developed in conjunction with the Baylor International Pediatric AIDS Initiative (BIPAI) network in sub-Saharan Africa with mentorship both from faculty in the GHN department as well as the BIPAI network locally and abroad. The project is public health focused examining hepatitis B screening rates and prevalence among people living with HIV in sub-Saharan Africa. Education includes attendance of lectures given in different departments as well as cross departmental within the institution, and global lectures attended virtually. Other educational activities include review of a global health focused GHN topics and assembly of a library of resources including recent seminal papers for current and future fellows to use for review. Last, completion of the Diploma in Tropical Medicine and the Certificate of knowledge in Clinical Tropical Medicine and Travelers' Health Examination. Teaching opportunities include involvement in general global health education for US-based medical students and residents interested in pursuing careers in global health, and teaching residents and faculty on topics such as viral hepatitis, malnutrition, and diarrhea. Conclusion We have developed to our knowledge the first formal global health track in pediatric GHN fellowship that is feasible to integrate into the 2nd and 3rd year and omplete in the available time frame. Participation in the global health track by the first fellow is still in process and improvements are being made based on experience. A multidisciplinary team including support within the fellowship program and experts in global health training is essential to the success of a pediatric GHN global health track. International relationships either previously established by the fellow, within the department, or the institution are also necessary for the success of the track. We believe that this track will help to equip future gastroenterologists to pursue a career with a focus in global health. Future directions include recruiting future fellows to complete the curriculum within our institution, formal evaluation by fellows participating in the curriculum, and securing ongoing funding. We also hope to incorporate global health electives abroad when feasible.

20.
Medical Letter on Drugs and Therapeutics ; 63(1637):177-184, 2021.
Article in English | EMBASE | ID: covidwho-2057493
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