Deep CNN and LSTM Architecture-Based Approach for COVID-19 Detection

The severe acute respiratory syndrome(SARS-CoV2) led to a pandemic of respiratory disease, namely COVID19. The disease has scaled worldwide and has become a global health concern. Unfortunately, the pandemic not just cost several individuals their lives but also, resulted in many people losing their jobs and life savings. In times like these, ordinary people become fearful of their resources in a world that gives its best resources to the wealthiest beings. Following the pandemic, the world suffered greatly and survival was rather difficult. As a result, numerous analytical techniques were developed to address this issue, with the key one being the discovery that the efficacy of clinically tested vaccines is actually quite poor. When researchers and medical professionals were unable to find a cure, radiologists and engineers created techniques to detect infected chests with the help of X-rays. Our proposed solution involves a CNN + LSTM model which has secured an accuracy of 98% compared to 95% of the trusted VGG-16 architecture. Our model's area under the curve (AUC) scores reached 99.458% while using RMSprop. A crucial feature of image processing till depth is accessible through scanning features from the layers of images using CNN. Our model uses 5 convolution blocks to detect the features. The coordination of activator functions, learning rates, and flattening has enabled accurate in-point predictions. With merely X-rays, models like ours ensure that anyone can easily detect covid-19. The best results obtained were at a learning rate =0.01 with RMSprop and Adam functions. The model has good fortune in detecting any other lung disease which occurs in the near future, as our data collectively rounds up to 4.5 gigabytes of data providing higher precision. © 2023 IEEE.

Gender equity of authorship in pulmonary medicine over the past decade.

BACKGROUND: Gender disparity in authorship broadly persists in medical literature, little is known about female authorship within pulmonary medicine. METHODS: A bibliometric analysis of publications from 2012 to 2021 in 12 journals with the highest impact in pulmonary medicine was conducted. Only original research and review articles were included. Names of the first and last authors were extracted and their genders were identified using the Gender-API web. Female authorship was described by overall distribution and distribution by country/region/continent and journal. We compared the article citations by gender combinations, evaluated the trend in female authorship, and forecasted when parity for first and last authorship would be reached. We also conducted a systematic review of female authorship in clinical medicine. RESULTS: 14,875 articles were included, and the overall percentage of female first authors was higher than last authors (37.0% vs 22.2%, p<0.001). Asia had the lowest percentage of female first (27.6%) and last (15.2%) authors. The percentages of female first and last authors increased slightly over time, except for a rapid increase in the COVID-19 pandemic periods. Parity was predicted in 2046 for the first authors and 2059 for the last authors. Articles with male authors were cited more than articles with female authors. However, male-male collaborations significantly decreased, whereas female-female collaborations significantly increased. CONCLUSIONS: Despite the slow improvement in female authorship over the past decade, there is still a substantial gender disparity in female first and last authorship in high-impact medical journals in pulmonary medicine.

SARS-CoV-2 SEROPREVALENCE AMONG PEOPLE WHO INJECT DRUGS IN BALTIMORE

Background: People who inject drugs (PWID) may be at a greater risk of SARS-CoV-2 infection and COVID-19 due to socio-structural inequities, high-risk behaviors and comorbidities;however, PWID have been underrepresented in case-based surveillance due to lower access to testing. We characterize temporal trends and correlates of SARS-CoV-2 seroprevalence among a community-based sample of current and former PWID. Method(s): A cross-sectional study was conducted among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study-a community-based cohort of adults with a history of injection drug use in Baltimore, Maryland. Participants' first serum sample collected at routine study visits between December 2020 and July 2022 was assayed for antibodies to the nucleocapsid (N) (past infection) and spike-1 (S) (past infection and/or vaccination) proteins using the MSD V-Plex Panel 2 IgG SARS-CoV-2 assay. For each correlate, we estimated adjusted prevalence ratios (PR) via separate Poisson regression models adjusted for calendar time, age, sex and race. Result(s): Of 561 participants, the median age was 59 years (range=28-77), 35% were female, 84% were Black, 36% were living with HIV (97% on ART), and 55% had received >=1 COVID-19 vaccine dose. Overall, anti-N and anti-S prevalence was 26% and 63%, respectively. Prevalence of anti-N increased from 23% to 40% between December 2020-May 2021 and December 2021-July 2022, with greater increases in the prevalence of anti-S from 34% to 86% over the same period (Figure). Being employed (PR=1.53 [95%CI=1.11-2.11]) and never being married (PR=1.40 [0.99-1.99]) were associated with a higher prevalence of anti-N, while female sex (PR=0.75 [0.55-1.02]) and a history of cancer (PR=0.40 [0.17-0.90]) were associated with a lower prevalence of anti-N. Younger age, female sex (PR=0.90 [0.80-1.02]), and homelessness (PR=0.78 [0.60-0.99]) were associated with a lower prevalence of anti-S. Although HIV infection was not associated with anti-N, it was associated with a higher prevalence of anti-S (PR=1.13 [1.02-1.27]). Substance use was not associated with anti-N or anti-S. Conclusion(s): Anti-N and anti-S levels increased over time, suggesting cumulative increases in SARS-CoV-2 incidence of infection and vaccination among PWID;however, disparities in seroprevalence remain. Younger and female PWID and those experiencing homelessness were less likely to be anti-S positive, suggesting programs should aim to improve vaccination coverage in such vulnerable populations.

Hiv Viral Load and Time-to-Covid-19 Vaccination among People Who Inject Drugs

Background: Structural barriers to care among people who inject drugs (PWID) raise concerns about disproportionate access to essential services like COVID-19 vaccination. Given the heightened risk of serious complications resulting from SARS-CoV-2 infection, particularly among people living with HIV (PWH) with unsuppressed viral load, its critical to understand the role of HIV care among other factors associated with timely vaccination. We aimed to assess the role of HIV care on COVID-19 vaccination uptake among PWID. Method(s): We included 960 adult PWUD participating in the ALIVE (AIDS Linked to the Intravenous Experience) longitudinal study in Baltimore, Maryland, who were alive and in follow up as of April 2020. We ed COVID-19 vaccination data from electronic medical records linked to participants via the regional health information exchange. We conducted survival analysis to estimate time from broad vaccine eligibility (April 6, 2021) to completion of the COVID-19 vaccination primary series by HIV status (uninfected, virally suppressed PWH [HIV-RNA< 400 copies/mL], unsuppressed PWH [HIV-RNA >400 copies/mL]) and Cox Proportional Hazards regression to adjust for potential confounding by health status and substance use variables. Result(s): Our sample (N=960) was primarily black (77%) and male (65%) with 31% reporting recent injection drug use. Among 265 people living with HIV (PWH) in our sample (27%), 84% were virally suppressed. As of February 22, 2022, 539 (56%) completed the primary series, 131 (14%) received a single dose of mRNA vaccine and 290 (30%) remained unvaccinated. Compared to PWID without HIV, virally suppressed PWH were significantly more likely to complete the primary series (Adjusted Hazard Ratio [AHR]:1.23,95% Confidence Interval [95%CI]:1.07,1.50), while PWH with higher viral loads were less likely (AHR:0.72,95%CI:0.45,1.16). Sensitivity analyses with a subsample restricted to PWH confirmed significant differences in time to vaccination by viral load status (log-rank p-value: 0.016) and modeling with an origin of Dec. 12, 2020, yielded similar adjusted results. Conclusion(s): Among PWID with HIV, viral suppression is associated with quicker vaccination uptake, likely due to HIV care engagement. Alongside interventions targeting social determinants (e.g. low income, homelessness) and substance use behaviors (e.g. active injecting, stimulant use), targeted improvements along the HIV care continuum and other efforts to engage PWID may bolster vaccine uptake. Figure 1. Kaplan-Meier survival curve demonstrating time-to-vaccination (completion of COVID-19 primary series) in weeks by HIV status accounting for viral load (HIV-, HIV+ [VL <= 400 cells/muL], HIV+ [VL > 400 cells/muL]), including results for Log-rank tests for homogeneity among strata (p-value).

Nutrition during the preschool years

The preschool years are a period of rapid growth and development, and children are at vulnerable to any amount and duration of nutritional shortfall. Globally, undernutrition remains a leading cause of death in this age group, with the prevalence of obesity rising in parallel. Young children need to be provided with a diet that is sufficiently nutrient dense and qualitatively diverse to meet their micronutrient needs but challenges with food shortage, access, and affordability often make this difficult. In this article, we present the current state of the evidence along with highlighting knowledge gaps on some of these topics. © 2023 Elsevier Ltd. All rights reserved

Antimicrobial Resistance: The Potent Enemy Lurking Behind COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global pandemic due to its high transmissibility and pathogenicity. It is a beta clade zoonotic coron-avirus like severe acute respiratory syndrome coronavirus (SARS-CoV) and middle east respiratory syndrome coronavirus (MERS-CoV). Though no effective medication has been developed against the deadly COVID-19 disease, henceforth old antimicrobial drugs have been repurposed to treat the COVID-19 patients. In this report, a brief account of the used medication and the potential mechanism of antimicrobial drugs against SARS-CoV-2 has been provided. Based on the earlier in-cidences, the antimicrobials are expected to lose the battle against SARS-CoV-2. The vast lacuna in the research and development of vaccines has led to overuse of the already formulated antimicro-bial drugs, which in turn has led to a distressing problem called "Antimicrobial resistance (AMR)". A complete assay of AMR has been given including its cause, mechanism, spread, and conse-quences. The other two interlinked problems, namely environmental deterioration and secondary in-fections, are elaborated. Moreover, to combat the AMR problem, the way forward has been discussed in detail.Copyright © 2021 Bentham Science Publishers.

Policy Driven Epidemiological (PDE) Model for Prediction of COVID-19 in India

The fast spread of COVID-19 has made it a global issue. Despite various efforts, proper forecasting of COVID-19 spread is still in question. Government lockdown policies play a critical role in controlling the spread of coronavirus. However, existing prediction models have ignored lockdown policies and only focused on other features such as age, sex ratio, travel history, daily cases etc. This work proposes a Policy Driven Epidemiological (PDE) Model with Temporal, Structural, Profile, Policy and Interaction Features to forecast COVID-19 in India and its 6 states. PDE model integrates two models: Susceptible-Infected-Recovered-Deceased (SIRD) and Topical affinity propagation (TAP) model to predict the infection spread within a network for a given set of infected users. The performance of PDE model is assessed with respect to linear regression model, three epidemiological models (Susceptible-Infectious-Recovered-Model (SIR), Susceptible-Exposed-Infectious-Recovered-Model (SEIR) and SIRD) and two diffusion models (Time Constant Cascade Model and Time Decay Feature Cascade Model). Experimental evaluation for India and six Indian states with respect to different government policies from 15th June to 30th June, i.e., Maharashtra, Gujarat, Tamil Nadu, Delhi, Rajasthan and Uttar Pradesh divulge that prediction accuracy of PDE model is in close proximity with the real time for the considered time frame. Results illustrate that PDE model predicted the COVID-19 cases up to 94% accuracy and reduced the Normalize Mean Squared Error (NMSE) up to 50%, 35% and 42% with respect to linear regression, epidemiological models and diffusion models, respectively. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Planning, Prioritizing, and Conducting Clinical Research in the Va Learning Healthcare System during the Covid-19 Pandemic

The Veterans Affairs (VA) Cooperative Studies Program (CSP) and Clinical Science Research and Development (CSRD) are both divisions of the VA Office of Research and Development (ORD) that is responsible for the planning and conduct of clinical trials and epidemiological studies within the VA's learning healthcare system. Since the outbreak of the COVID-19 pandemic in the United States, the VA has been facing some new and evolving challenges in clinical research, especially in planning, prioritizing, and conducting new clinical research projects aimed at preventing and/or treating SARS CoV-2 infection/ COVID-19 disease. In considering clinical research projects, different stakeholders of the VA research enterprise assess needs using numerous parameters: (1) CSP and CSRD leadership: VAMC network infrastructure, financial support, available funding, and enterprise-wide impact. (2) Clinical researchers: clinical perspectives and needs, as they relate to study design and operations, in the context of an ever-evolving epidemiological picture and disease knowledgebase. (3) VA research Coordinating Center(s): the challenges that reside in aspects of trial design and planning, in an effort to account for frequent changes in the COVID-19 epidemiology, and its impact on project feasibility/participant recruitment, choice of study endpoints, safety of healthcare providers, research personnel, and study participants. Notwithstanding these evolving challenges, the VA ORD stood up the VA CoronavirUs Research and Efficacy Studies (VA CURES) network in a coordinated effort to develop a master protocol framework that could efficiently utilize the VA's clinical research infrastructure to address the COVID-19 pandemic. The VA CURES framework has been serving as the umbrella structure encompassing numerous COVID-19 clinical research activities. Both CSP and CSRD have an established clinical research infrastructure, including Coordinating Centers, a Network Of Enrollment Dedicated Sites (NODES) and over 150 VA Medical Centers across the United States, with a clear and streamlined process of submission and review of research proposals (Letters of Intent;LOI), subsequent trial planning leading up to scientific review and, once approved, conduct of research projects. In this session, we will present the VA clinical research infrastructure and share its mobilization in this pandemic. Furthermore, we will share lessons learned in conducting research in emergency situations and how the research infrastructure pivoted and adapted to fulfill its mission of providing the best healthcare to Veterans. The following four areas will be the focus of this session: the VA ORD leadership perspective: Infrastructure/support/funding/priorities;clinical research perspectives: Study design in the face of evolving epidemiological picture;trial design and planning: Protocol drafting/timelines/shifting priorities/feasibility/ VAMC networks;organizing and operationalizing the VA CURES umbrella/platform: CURES-1, and CURES-2.

Impact of COVID-19 on IT Business

Our purpose in this study is to gain a better understanding of COVID-19's effects on the IT industry by doing empirical research on a variety of issues that have influenced current Indian IT enterprises. We were inspired to develop this concept because COVID-19 has had a significant influence on many firms, and this will help business owners identify the causes that are causing them to close their doors due to financial losses. Specifically, machine learning algorithms will aid in the classification of data into several categories in which organizations operate, and companies will be able to forecast whether they will profit or suffer a drop in income based on this information. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Association Between SARS-CoV-2 Viral Load and Patient Symptoms and Clinical Outcomes Using Droplet Digital PCR

Background. Droplet digital PCR (ddPCR) has been shown to be more sensitive and precise in the quantification of SARS-CoV-2 when compared to traditional quantitative RT-PCR. Multiple studies have explored associations between SARS-CoV-2 viral load and patient outcomes;however, few have used ddPCR technology. Here we investigated the associations between viral load measured using ddPCR and clinical presentation and outcomes. Methods. We performed a retrospective observational study of individuals who tested positive for COVID-19 at the VA San Diego between August 2020 and December 2021. SARS-CoV-2 viral load from nasopharyngeal swabs was determined using ddPCR. Baseline demographics, past medical history, clinical course, and laboratory data were ed from the chart. Results. A total of 696 individuals were included, 86% (n=603) of whom were male. The average age was 50-years-old [range: 19-98]. Three-quarters of individuals (76%, n=528) were unvaccinated at diagnosis. Frequency of comorbidities are shown in Table 1. The majority of individuals developed symptoms with 75% (n=516) reporting respiratory symptoms, 47% (n=317) fever, 34% (n=230) GI symptoms, and 23% (n=161) loss of taste and/or smell. A total of 24% of veterans were evaluated only in the emergency department, 21% (n=149) were admitted to the hospital;9% (n=60) required ICU level of care, 33% of these (n=20) required intubation, and 16 individuals died during hospitalization. SARS-CoV-2 log10 viral load was not associated with age, and only a weak correlation was seen with time from onset of symptoms (r2=-0.1, p=0.04). No association was observed between viral load and peak CRP, ferritin, d-dimer, or nadir absolute lymphocyte count. Mean viral load was significantly higher in veterans reporting fever (5.0 vs 5.4, p=0.02) and respiratory symptoms (4.7 vs 5.3, p=0.01). Interestingly, vaccinated veterans also had higher viral loads(5.8 vs 5.0, p< 0.0001). Conclusion. Fever and respiratory symptoms were associated with higher viral loads as expected. The association of vaccination with higher viral load may reflect selection bias for infections in the delta wave. Future work will include multivariate analyses to adjust for medical history and timing of sampling.

Impact of COVID-19 on IT Business

Our purpose in this study is to gain a better understanding of COVID-19's effects on the IT industry by doing empirical research on a variety of issues that have influenced current Indian IT enterprises. We were inspired to develop this concept because COVID-19 has had a significant influence on many firms, and this will help business owners identify the causes that are causing them to close their doors due to financial losses. Specifically, machine learning algorithms will aid in the classification of data into several categories in which organizations operate, and companies will be able to forecast whether they will profit or suffer a drop in income based on this information. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Factors Contributing to SARS-CoV-2 Vaccine Hesitancy in Kidney Transplant Candidates

Purpose: SARS-CoV-2 infection in kidney transplant recipients is associated with an increased risk of severe disease and mortality relative to other patient populations, with mortality reported to be as high as 30% early in the pandemic. It has been demonstrated that vaccination against SARS-CoV-2 after transplantation is less effective as when administered prior to immunosuppression administration. To reduce the risk of poorer outcomes associated with immunosuppression, it is advisable that transplant candidates complete a SARS-CoV-2 vaccine series prior to transplantation. SARS-CoV-2 vaccine hesitancy contributes to under-vaccination in the transplant candidate population. We describe candidate perspectives associated with vaccine hesitancy in kidney transplant candidates. Method(s): Vaccination status of actively listed kidney transplant candidates at our center was reviewed in January 2022. The infectious disease nurse practitioner performed counseling telephone visits with all available candidates not vaccinated against SARS-CoV-2 to uncover their perspectives around vaccination and determine reasons for vaccine refusal/hesitancy. Result(s): Of the 233 candidates actively listed for kidney transplant, 23 (9.8%) were found to be unvaccinated against SARS-CoV-2. Of the 23 patients, 20 (87%) were successfully contacted for telephone interview. Thirteen (65%) candidates described safety concerns as their primary reason for vaccine hesitancy. The most common concerns shared by unvaccinated candidates were a lack of trust in the development of SARS-CoV-2 vaccines, speed of development and general lack of safety data. Five (38%) of the 13 candidates expressed additional concern about the effect of vaccines could have on their native kidney function. One candidate expressed fear that vaccine will increase HLA sensitization, making it more difficult for organ matching. Three candidates stated they did not need the vaccine, citing isolation, healthy diet and prior infection as protective factors. Three candidates cited medical reasons. These included recent monoclonal antibody treatment for SARS-CoV-2 infection (2) and lymphadenopathy (1). Conclusion(s): For patients awaiting kidney transplant, the primary reason contributing to vaccine hesitancy is concern regarding vaccine safety. For some, concerns are specific to diagnosis and status as a transplant candidate. Transplant centers should continue to address vaccine hesitancy in order to provide accurate information and targeted patient education around vaccine safety and benefit to aid patients in making decisions based on available scientific data.

Antibody Response and Molecular Graft Surveillance in Kidney Transplant Recipients Following Sars-CoV-2 Vaccination

Purpose: Preliminary studies suggest that kidney transplant recipients (KTRs) show diminished humoral responses to SARS-CoV-2 vaccination. Although reports of allograft rejection after SARS-CoV-2 vaccination have been rare, there is no recommended framework for monitoring for potential vaccine-related allograft injury. Here, we describe an approach for longitudinal assessment of immunogenicity and safety of SARS-COV-2 vaccination in KTRs. Method(s): KTRs eligible for SARS-CoV-2 vaccination were identified through medical records, beginning March 12, 2021. Baseline and weekly blood samples were collected for SARS-CoV-2 spike protein antibody titers, dd-cfDNA and gene expression profiling (GEP) for 12 weeks. Donor specific antibody (DSA) testing was performed at baseline, 2 weeks after completion of vaccine doses and at week 12. Antibody response was defined as a 10-fold increase in total binding IgG titers. Result(s): 49 KTRs were identified for analysis. Patient demographics are shown in Table 1. Ten patients (20.4%) demonstrated a spike antibody response post- vaccination. Of responders, 80% (n=8) had a history of COVID-19. The odds ratio for the association of a history of COVID-19 with vaccine response was 18.3 (95% CI 3.2, 105.0, p=0.0005). Median dd-cfDNA levels did not differ between pre- and postvaccination (0.23% versus 0.21% respectively). There was no significant difference between pre- and post-vaccination GEP scores (9.85 versus 10.4 respectively). No patients developed clinically significant DSA, eGFR decline or allograft rejection following vaccination. Conclusion(s): Quantitative antibody responses were strongly associated with a diagnosis of prior SARS-CoV-2 infection. Stability of eGFR, dd-cfDNA, GEP profiles and lack of allosensitization reinforce the safety profile of SARS-CoV-2 vaccination in KTRs. Further studies are needed to better understand immunogenicity in SARSCoV- 2 naive individuals, including whether cellular responses are protective in the absence of humoral responses.

Kinetics of dd-cfDNA in Kidney Transplant Recipients Following Sars-CoV-2 Vaccination Booster Administration

Purpose: Evolving data suggests booster vaccine doses enhance the immunogenicity of SARS-CoV-2 vaccines in solid organ transplant recipients with higher IgG responses, neutralizing antibodies titers, and greater SARS-CoV-2-specific T-cell counts. Currently, there is no recommended framework for monitoring potential vaccine-related immunological graft injury. Here, we describe kinetics of dd-cfDNA pre- and post-booster vaccination in kidney transplant recipients (KTRs). Method(s): Electronic medical records were reviewed to identify KTRs that received a SARS-CoV-2 booster vaccine dose in 2021 and were monitored with dd-cfDNA pre- and post-vaccination. dd-cfDNA was collected as part of standard of care assessment. Pre-booster dd-cfDNA levels were defined as the most recent result prior to booster administration. Post-vaccination results were collected up to 30 days post-booster administration. Result(s): 116 KTRs were identified for analysis. Patient demographics are summarized in Table 1. Median time from transplant to SARS-CoV-2 booster administration was 463 days (IQR 333-787.25, Table 1). Pre-booster dd-cfDNA levels were established a median of 9 days (IQR 2.25 - 16) pre-booster. The median level of dd-cfDNA pre-booster was 0.17% (IQR 0.12% - 0.25%). There was no significant difference in median levels of dd-cfDNA up to 30 days post-booster administration (Kruskal Wallis test with multiple comparisons, all p values >0.99, Figure 1). No adverse clinical events or acute rejection episodes were reported within 30 days of SARS-CoV-2 booster administration in this cohort. Conclusion(s): Median dd-cfDNA levels were not impacted by SARS-CoV-2 booster administration, suggesting that patterns of subclinical injury that may potentiate inflammation, allosensitization or allograft rejection are unlikely in this setting. The stability of dd-cfDNA demonstrated here further reinforces the safety profile of SARS-CoV-2 vaccine booster administration in KTRs.

The Impact of Monoclonal Antibody Against Sars-CoV2 and Vaccination on Outcomes in Kidney Transplant Recipients with COVID-19

Purpose: Solid organ transplant recipients are at high risk of morbidity and mortality from coronavirus disease 2019 (COVID-19) with mortality rates as high as 30% reported in the early pandemic period. COVID-19 vaccine efficacy in the immunosuppressed population is lower than the general population. Early studies suggest that monoclonal antibody (MAB) treatment against the SARS-CoV-S spike protein may decrease hospitalizations and emergency department (ED) visits. Herein, we report our single center experience with use of MAB for COVID-19 treatment in kidney transplant recipients. Method(s): We performed a retrospective chart review of all kidney transplant recipients who developed COVID-19 from March 17, 2020 to January 26, 2022 at our transplant center. Date of diagnosis, vaccine status, MAB treatment, hospitalization and patient outcome was reviewed. Result(s): Two hundred ninety-one kidney transplant recipients had positive testing for SARS-CoV-2 in the period reviewed. 120 (41%) patients received MAB treatment. One patient death, not COVID related, was excluded from analysis. Of those who received MAB treatment, 99.2% survived compared to 82.4% of those who did not (p=0.00), Figure 1. Hospitalization was lower in those who received MAB (18.3% vs 60.8%, p=0.00). Completion of vaccine series, defined as 2 doses of mRNA or 1 dose of Janssen vaccine prior to infection, was also associated with better survival (98.6% vs 80.3%, p=0.00), Figure 1. Hospitalization rate was lower in those who completed vaccination prior to infection with SARS-CoV-2 (27.1% vs 59.2%, p = 0.00). The combination of MAB therapy and completion of vaccination also decreased hospitalization compared to those who received MAB but did not complete vaccines series (14% vs 26.8%, Table 1). Subgroup analysis of 143 patients infected from December 2021 to Jan 26, 2022 which may have reflected the Omicron surge was performed (Table 2). Treatment with MAB was associated with a reduction in hospitalization (11.6%) compared to 44.6% in those who did not receive MAB. Conclusion(s): MAB treatment for COVID-19 and prior vaccination were associated with improved survival and decreased risk of hospitalization in kidney transplant recipients.

Antibody Response and Cellular Phenotyping in Kidney Transplant Recipients Following Sars-CoV-2 Vaccination

Purpose: Correlates of protection for SARS-CoV-2 vaccines are not well-established in kidney transplant recipients(KTRs). Studies have highlighted the importance of neutralizing antibodies(Abs), however data suggests T cell responses may play a secondary role in preventing reinfection. We performed a longitudinal assessment of immunogenicity, T and B cell response in KTRs following SARS-CoV-2 vaccination. Method(s): KTRs eligible for SARS-CoV-2 vaccination from 3/12/21 were enrolled. Baseline and weekly blood samples were collected for routine lab, SARS-CoV-2 spike protein Ab titers and cellular phenotyping for 12 weeks. Ab response was defined as a 10-fold increase in total binding IgG titers. To determine if T cell responses were induced by vaccination, we considered the proportion of activated non-naive CD4+ and CD8+ T cells post-vaccination. Result(s): 49 KTRs were enrolled ( Demographics -Table 1). 10 patients (20.4%) mounted an Ab response following vaccination. A history of COVID-19 was associated with an increased likelihood of developing an Ab response (OR: 18.3, 95% CI 3.2, 105.0, p=0.0005). For non-naive CD8+ T cells, a subset co-expressing CD38+Ki67+ was induced 1 week after the 1st immunization in some SARS-CoV- 2-naiive patients (P=0.12 versus P=0.14 for SARS-CoV-2-experienced adults, Fig 1A/B). For non-naive CD4+ T cells, induction of a subset co-expressing CD38+Ki67+ was observed at 1 week after the 1st immunization for SARS-CoV-2-naive participants (P = 0.09 for SARS-CoV-2-naive, P=0.03 for SARS-CoV-2-experienced adults, Fig 1C/D). For CD8+ and CD4+ T cells, dose 2 stimulated weak induction of the CD38+Ki67+ subset in the SARS-CoV-2-naive patients only (Fig 1A-D). Conclusion(s): Quantitative Ab responses were strongly associated with prior SARS-CoV-2 infection. Activated CD4+ and CD8+ T cell responses were evident in most patients irrespective of history of COVID-19. Further studies are needed to determine whether these activated CD4+ and CD8+ T cell responses were antigenspecific or confer immunity. (Table Presented).