RESUMEN
Prevention of negative COVID19 infection outcomes and infection/vaccine-acquired immunity is associated with the quality of antibody responses, whose variance by age and sex are poorly understood. Integrated, network approaches, identified sex and age effects in antibody responses and neutralization potential of de novo infection and vaccination throughout the Covid-19 pandemic. Cluster analysis found neutralization values followed SARS-CoV-2 specific receptor binding RIgG, spike SIgG and S and RIgA levels based on COVID19 status. Stochastic behavior tests and other analytical methods revealed sex differences only in persons <40y.o. Serum IgA antibody titers correlated with neutralization only in females 40-60y.o. Network analysis found males could improve IgA responses after vaccination dose 2, unlike >60 y.o. females. Complex correlation analyses found vaccination induced less antibody isotype switching and neutralization in older persons, especially in females. Sex dependent antibody & neutralization behavior decayed fastest in older males and with vaccination. Such sex and age characterization by machine learning can direct studies integrating cell mediated responses to define yet elusive correlates of protection and inform age and sex precision-focused vaccine design.
Asunto(s)
COVID-19RESUMEN
Background: Patients have described symptoms persisting or recurring for weeks after acute COVID-19 illness referred to as post COVID-19 conditions. The objective of this living systematic review is to document the prevalence of post COVID-19 conditions 4-12 weeks (short-term) and >12 weeks (long-term) after COVID-19 diagnosis. Methods: We conducted a systematic review of primary peer-reviewed published literature reporting on the prevalence of the symptoms, sequelae and difficulties conducting usual activities [≥]4 weeks after COVID-19 diagnosis. We adapted a previous search strategy used by the U.K. National Institute for Health and Care Excellence and updated it to search for new research published until January 15, 2021 in Embase, Medline, PsychInfo, and Cochrane Central. Two independent reviewers screened references; one reviewer extracted data and assessed risk of bias and certainty in the evidence while another verified them. Prevalence data from laboratory-confirmed individuals were meta-analyzed, where appropriate, using a random effects model and synthesized separately in the short- and long-term periods after COVID-19 diagnosis; data from clinically-diagnosed populations were synthesized narratively. Results: Of the 2807 unique citations, 36 observational studies met our inclusion criteria. Over 100 post COVID-19 conditions were reported in laboratory-confirmed individuals. Eighty-three percent (95%CI: 65-93%; low certainty) and 56% (95%CI: 34-75%; very low certainty) reported persistence or presence of one or more symptoms in the short- and long-term, respectively. The most prevalent symptoms in both periods included: fatigue, general pain or discomfort, sleep disturbances, shortness of breath and anxiety or depression (point estimates ranging from 22-51%; low to very low certainty). Interpretation: Our data indicate that a substantial proportion of individuals reported a variety of symptoms [≥]4 weeks after COVID-19 diagnosis. Due to low certainty in the evidence, further research is needed to determine the true burden of post COVID-19 conditions.