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Background: A significant portion of individuals with SARS-CoV-2 infection have persistent COVID-19 symptoms after recovery. Symptoms may be new or persistent from the initial illness, which could cause both psychological and physical difficulty to the patients. These symptoms are collectively known as "long COVID-19 syndrome". There is limited information about this syndrome in the Thai population. Objectives: We aimed to describe and evaluate the risk for post COVID-19 symptoms among hospitalized COVID-19 patients in a university hospital. Methods: A prospective descriptive study was conducted on symptomatic COVID-19 patients admitted in Ramathibodi Hospital from July 1 to September 10, 2021. All surviving COVID-19 patients received a telephone assessment every month until 3 months after discharge and electronic medical records were reviewed. Information collected included symptoms, severity, treatment, duration of symptom, complication of COVID-19 and treatment. The New York Heart Association (NYHA) functional classification was used to categorized severity of dyspnea. Results: Among 253 evaluable patients, 57.3% were female and the mean age was 59.3 years old. Of these, 66% and 24.1% had moderate (pneumonia and SpO2 90%) and severe COVID-19 (pneumonia with severe respiratory distress and SpO2 90%), respectively. Almost all patients were inadequately vaccinated (unvaccinated 53.3%, partially vaccinated 41.9%). Overall, complete resolution of symptoms before 1 month after onset were noted in 47 patients (18.5%) and 72 (28.5%) patients had at least one persistent symptom at three months. The most common symptom is sleep disturbance (11.9%);29.2% remain in NYHA II and 0.8% in NYHA III and IV each. Female gender (OR 1.94;[95% CI 1.09-3.48], p=0.024), history of receiving dexamethasone (OR 1.04;[95% CI 1.01-1.08], p=0.004) and length of hospitalization (OR 1.04;[95% CI 1.00-1.08], p=0.034) were associated with being in NYHA II. Additionally, 5.9% had bacterial infection, and most were urinary tract infection and pneumonia, respectively. The risk factor associated with post-COVID-19 bacterial infection is bed ridden status (OR 23.3;[95% CI 5.79-93.72], p=<0.001). Conclusions: A significant number of COVID-19 patients had residual COVID-19 symptoms and still not fully functional at least 3 months after recovery. A major limitation of this study is obtaining information by telephone interview since hospital visit were not encouraged to limit mobility of people during pandemic, which may have led to a recall bias.
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Purpose: An additional dose of the COVID-19 vaccine following a primary series is recommended for solid organ transplant recipients. However, a comparison of the immunogenicity and safety of an additional dose of COVID-19 vaccine among different platforms has not been investigated. Method(s): Eligible adult KT recipients were randomized using a stratified (by a previous vaccine regimen) block randomization approach to receive either ChAdOx1 nCoV-19 vaccine (AstraZeneca);V group, or mRNA vaccine (Pfizer-BioNTech or mRNA-1273);M group. Two weeks later, humoral immunity (HMI) was evaluated by anti-RBD IgG level, and percentages of neutralizing antibody inhibition using surrogate viral neutralization test (%SVNT), and cell-mediated immunity (CMI) was investigated by the ELISpot assays. Result(s): A total of 85 KT recipients were included. Of those, 62% were male with the median (IQR) age of 50 (43-59) years. The median (IQR) duration after transplantation was 46 (26-82) months. Twenty-six (34%) and 51 (66%) of those received two-dose of CoronaVac followed by one dose of ChAdOx1 nCoV-19 vaccine and two-dose of ChAdOx1 nCoV-19 vaccine, respectively. Of all, 42 and 43 patients were assigned to V and M groups, respectively. At two weeks after an additional dose, KT recipients in the M group elicited a greater trend of the median (IQR) anti-RBD antibody levels compared to those in the V group (51.8 [5.1-591] vs. 28.5 [2.9-119.3] BAU/mL,p=0.18), which resulted in significantly higher seroconversion rate (anti-RBD antibody > 7.1 BAU/mL) in M group than those in V group (83%vs.51%, p<0.01). Additionally, sVNT positivity rate (%SVNT > 35%) were also significantly greater in M group (58%vs32%, p=0.03). However, there was no difference in S1-specific T cell and RBD-specific B cell responses between M and V groups (230 [41-420] vs. 268 [118-510] SFUs/106 PMBCs, p=0.65 and 2 [0-10] vs. 2 [0-13] SFUs/106 PMBCs, p=0.60). Adverse events were mild and similar between groups (p=NS). Conclusion(s): KT recipients who received an additional dose of mRNA COVID-19 vaccine could elicit HMI greater than a viral vector COVID-19 vaccine along with comparable CMI and safety profile.
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BACKGROUND AND AIMS: Patients with end-stage kidney disease (ESKD) are at risk of coronavirus disease 2019 infection and its associated complications. A previous study demonstrated that patients with ESKD on dialysis generated suboptimal humoral immune response (HIR) and lower seroconversion rate after two-dose inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination as compared to healthy individuals. In this study, we examined HIR of the additional dose of ChAdOx1 nCoV-19 vaccine following a standard two-dose inactivated wholevirus SARS-CoV-2 vaccination in patients on dialysis, and compared to those of healthy controls. METHOD: We recruited 59 patients with ESKD [31 patients on haemodialysis (HD) and 28 on peritoneal dialysis (PD)) and 16 healthy controls who received two doses of inactivated SARS-CoV-2 vaccine (V2) from Ramathibodi hospital and Banphaeo General Hospital, Bangkok, Thailand, from July 2021 to September 2021. All participants were administered a third dose of the ChAdOx1nCoV-19 vaccine (V3) with a 6-week interval between the V2 to V3. HIR was measured 2 weeks after V2 and V3 using SARS-CoV-2 immunoglobulin G (IgG) assay, which detects antibodies against the S1 receptor-binding domain (RBD) of the SARSCoV- 2 spike protein. Median anti-RBD IgG titer and seroconversion rate, defined as anti-RBD IgG titre ≥ 7.1 BAU/mL, were compared among ESKD patients and to those of healthy controls using the Kruskal-Wallis H test and the chi-squared test, respectively. RESULTS: Baseline characteristics of patients on HD, PD and healthy controls are shown in Table 1. Demographic characteristics and baseline laboratory parameters were comparable between the HD and PD groups, except for a lower mean serum albumin level in the PD group (P<.001). None of the healthy controls were immunocompromised or receiving immunosuppressive therapies. At 2 weeks after V3, the median anti-RBD IgG titres were significantly increased in all groups compared to those levels after V2 (85[33-412] versus 1566 [861-3083] BAU/mL for patients on HD, 81 [15-144] versus 913 [293-1359] BAU/mL for patients on PD and 250 [92-603] versus 2210 [1531-2782] BAU/mL for healthy controls;P < .001 for all groups). Comparing antibody levels between groups after V3, patients on PD generated significantly lower anti-RBD IgG titer than patients on HD (P = .02) and healthy controls (P < .01) (Figure 1A). The seroconversion rate of the HD and PD groups improved from 94% and 82% after V2 to 100% after V3 in both groups (P = .16 and P = .03, respectively) (Figure 1B). All patients on dialysis who had anti- RBD IgG < 7.1 BAU/mL after V2 (7/59 patients) seroconverted after the additional dose of ChAdOx1 nCoV-19 vaccine. CONCLUSION: We suggest that an additional ChAdOx1 nCoV-19 vaccine after a primary two doses inactivated SARS-CoV-2 vaccination could improve seroconversion rate and magnitude of humoral immune response in patients on dialysis. The durability of the immune response to this vaccination regimen requires further study. (Table Presented).