Map Design for Public Health Emergencies: a Novel Conceptual Framework for Thematic Content Selection

Public health emergencies always lead to serious consequences which affect a lot on human health and socioeconomic progress. It is essential that governments and regional health commissions guide the public toward self-protection and better arranged social production during epidemic outbreaks and spreads. According to the need of risk communication and information disclosure, existing studies for COVID-19 maps and visualization applications are conducive to predicting the future trend of the pandemic, mitigating the harmful effect on public wellbeing by leading to effective intervention and policy measures. However, unsettled tasks remain on comprehensive organization of risk information, effective expression of data for public requirement, and systematic theoretical framework as a standard of map design for public health emergencies. To close the research gaps, this paper proposes a conceptual framework with a three-dimensional spatiotemporal-logic structure as a theoretical foundation for map thematic content selection, which is also a good basis for determining the effective visualization approaches of map design. It enhances the validity and legibility of the map expression by leading maps' thematic content couple with features and processes of an epidemic. Then, using the COVID-19 outbreak in Shenzhen, China, as an example, this paper illustrates how to apply the conceptual framework for selecting the thematic content of COVID-19 maps, and explains the specific ways to transform epidemic data into objects for cartographic representation with proper principles and modes. To our knowledge, this paper is the very first study to bring the thematic content of maps for public health emergencies to the fore, and it is thus believed to shed fresh lights into thematic map design.

Neutralization potency of monoclonal antibodies recognizing dominant and subdominant epitopes on SARS-CoV-2 Spike is impacted by the B.1.1.7 variant.

Interaction of the SARS-CoV-2 Spike receptor binding domain (RBD) with the receptor ACE2 on host cells is essential for viral entry. RBD is the dominant target for neutralizing antibodies, and several neutralizing epitopes on RBD have been molecularly characterized. Analysis of circulating SARS-CoV-2 variants has revealed mutations arising in the RBD, N-terminal domain (NTD) and S2 subunits of Spike. To understand how these mutations affect Spike antigenicity, we isolated and characterized >100 monoclonal antibodies targeting epitopes on RBD, NTD, and S2 from SARS-CoV-2-infected individuals. Approximately 45% showed neutralizing activity, of which ∼20% were NTD specific. NTD-specific antibodies formed two distinct groups: the first was highly potent against infectious virus, whereas the second was less potent and displayed glycan-dependant neutralization activity. Mutations present in B.1.1.7 Spike frequently conferred neutralization resistance to NTD-specific antibodies. This work demonstrates that neutralizing antibodies targeting subdominant epitopes should be considered when investigating antigenic drift in emerging variants.

Impact of the B.1.1.7 variant on neutralizing monoclonal antibodies recognizing diverse epitopes on SARS-CoV-2 Spike (preprint)

The interaction of the SARS-CoV-2 Spike receptor binding domain (RBD) with the ACE2 receptor on host cells is essential for viral entry. RBD is the dominant target for neutralizing antibodies and several neutralizing epitopes on RBD have been molecularly characterized. Analysis of circulating SARS-CoV-2 variants has revealed mutations arising in the RBD, the N-terminal domain (NTD) and S2 subunits of Spike. To fully understand how these mutations affect the antigenicity of Spike, we have isolated and characterized neutralizing antibodies targeting epitopes beyond the already identified RBD epitopes. Using recombinant Spike as a sorting bait, we isolated >100 Spike-reactive monoclonal antibodies from SARS-CoV-2 infected individuals. {approx}45% showed neutralizing activity of which {approx}20% were NTD-specific. None of the S2-specific antibodies showed neutralizing activity. Competition ELISA revealed that NTD-specific mAbs formed two distinct groups: the first group was highly potent against infectious virus, whereas the second was less potent and displayed glycan-dependant neutralization activity. Importantly, mutations present in B.1.1.7 Spike frequently conferred resistance to neutralization by the NTD-specific neutralizing antibodies. This work demonstrates that neutralizing antibodies targeting subdominant epitopes need to be considered when investigating antigenic drift in emerging variants.

COVID-19 impact on hepatitis b prevention programs in clinics serving at-risk populations

Background: Prevention of hepatitis B virus (HBV) infection includes vaccination of susceptible individuals, testing and linkage to care of persons at risk for chronic hepatitis B (CHB) There are about 1 million persons living with CHB in the United States, and 32 states reported increased incidence of acute HBV infection in 2017 In July 2019, to address the public health burden of HBV infection, the Department of Health and Human Services Office of Minority Health (OMH) funded six grantees (health department, federally qualified health center, academic institutions, and non-profit organizations) to develop comprehensive hepatitis B prevention programs, targeting at-risk populations who are disproportionately impacted by hepatitis B The objective of this analysis was to evaluate the impact of COVID-19 on the OMH grantees' delivery of hepatitis B services to at-risk populations Methods: The six OMH grantees collected data from electronic health records during a 3-week period in June 2020 for two defined timeperiods;pre-pandemic from 12/1/2019 - 2/29/2020 and early-pandemic from 3/1/2020 - 5/31/2020 All patient visits to the clinics during pre-pandemic and early-pandemic were included Data was organized into the number of people tested for hepatitis B, number of hepatitis B vaccine doses given, number of telemedicine visits, and number of in-person clinic visits Data from all grantees were combined for this analysis Descriptive statistics were performed to evaluate the impact of the COVID-19 pandemic on the delivery of hepatitis B services Results: Following the pre-pandemic period, there was a decrease in the number of in-person visits from 35,095 to 17,054 (63 5% decrease) and an increase in the number of telemedicine visits from 12 to 29,686 (211,566 7% increase) (Table 1) The overall number of patient visits increased from 35,107 to 46,740 (33 1% increase) The number of people tested for HBV decreased from 5,145 to 1,988 (70 5% decrease), and the number of HBV vaccine doses administered decreased from 2,432 to 999 (69 6% decrease) Conclusion: Prior to the COVID-19 pandemic, the six OMH grantees made progress on establishing hepatitis B prevention programs Grantees are utilizing telemedicine to provide healthcare during the COVID-19 pandemic, yet, hepatitis B services provided have been reduced substantially Innovative approaches to delivering hepatitis B vaccinations and testing are needed in the era of COVID-19(Table Presented).

[Pathological changes of the spleen in ten patients with coronavirus disease 2019(COVID-19) by postmortem needle autopsy].

Objective: To study the pathological changes of the spleen in patients with COVID-19 and to analyze the relationship between the weakened immune system and splenic lesions. Methods: Postmortem needle autopsies from the spleen were carried out on 10 patients who died from COVID-19 in Wuhan. Routine hematoxylin and eosin (HE) staining was used to observe the pathological changes. The changes of lymphocytes were studied further with immunohistochemistry.RT-PCR was used to detect 2019-nCoV RNA in the spleen. In addition,the Epstein-Barr virus (EBV) was detected by in situ hybridization, and coronavirus particles were detected by transmission electron microscopy in 2 cases. Results: There were 7 males and 3 females, with an average age of 68.3 years.Of the 10 cases, 4 had cancer history and another 4 had other underlying diseases respectively.Cough, fever, malaise and dyspnea were the main clinical symptoms.The time from onset to death was 15-45 days.Ten cases patients had normal or slight increase in peripheral blood leukocyte count in the early stage of the disease, 6 cases had significant increase before death. Five patients' peripheral blood lymphocyte count decreased in the early stage of the disease, and 10 patients' peripheral blood lymphocyte count decreased significantly before the disease progressed or died. Seven cases were treated with corticosteroid (methylprednisolone ≤40 mg/d, not more than 5 days). Histopathological examination showed that the cell composition of the spleen decreased, white pulp atrophied at different levels, meanwhile lymphoid follicles decreased or absent;in addition, the ratio of red pulp to white pulp increased with varying degrees. In 7 cases, more neutrophil infiltration was found, and in 5 cases, scattered plasma cell infiltration was found. Macrophage proliferation and hemophagocytic phenomena in a few cells were found in a case. Meanwhile, necrosis and lymphocyte apoptosis were detected in 2 cases, small artery thrombosis and spleen infarction in 1 case, and fungal infection in 1 case. The results of immunohistochemistry showed that the T and B lymphocyte components of the spleen in all cases decreased in varying degrees. CD20(+) B cells were found to accumulate in the lymphoid sheath around the splenic artery in 8 cases. However, CD20 and CD21 immunostaining in 2 cases showed that the number of white pulp was almost normal, and splenic nodules were atrophic. CD3(+), CD4(+) and CD8(+)T cells were decreased. In 9 cases,CD68(+) macrophages were no significant changes in the distribution and quantity. While more CD68(+) cells were found in the medullary sinuses of 1 case (related to fungal infection). Few CD56(+) cells were found. EBV was negative by in situ hybridization. RT-PCR was used to detect the nucleic acid of 2019-nCoV. One of 10 cases was positive, 39 years old,who was the youngest patient in this group, and the other 9 cases were negative. Coronavirus particles were found in the cytoplasm of macrophage under electron microscope in 2 cases. Conclusions: The death of COVID-19 occurs mainly in the elderly, and some cases have no underlying diseases. Spleen may be one of the organs directly attacked by the virus in some patients who died from COVID-19. T and B lymphocyte in the spleen decrease in varying degrees, lymphoid follicles are atrophied, decreased or absent, and the number of NK cells do not change significantly. And the pathological changes of the spleen are not related to the use of low dose corticosteroid, which may be related to the direct attack of virus and the attack of immune system on its own tissues.