Evaluation of cellular and humoral immune-responses at different times after SARS-COV-2 vaccination in health care workers cohort

Background. We studied immunological response against SARS-CoV-2 after two doses of vaccine in health care workers (HCW) at our Infectious Disease Unit Methods. We enrolled prospectively HCW without (group A) and with previous infection (group B). We collected peripheral blood at baseline (before the BNT162b2 vaccine), T1 (before the 2nd dose), T2 and T6 (after 1 and 6 months after of 2nd dose). The activation induced cell marker assay (AIM) was performed with CD4 and CD8 Spike peptide megapools (MPs). We evaluated the Stimulation Index (SI) as AIM+ stimulated cells/negative control (positive response SI >= 2). Quantitative antibodies (Abs) to Spike-1 protein (S) and to nucleocapside protein (N) were detected with an electrochemiluminescence immunoassay. We tested at T6 the responses to alpha, beta, gamma, delta and epsilon variants MPs.We used the linear mixed model with random intercept adjusted for age and sex to compare specific times to T0. To assess differences over time between groups the interaction with time was tested. Results. In group A 13/22 (59%) were female vs 5/7 (71%) group B, the mean age 40 vs 38 years, respectively. For CD4+ Spike the overall rate of change over time was significant at T1 (p=0.038) and at T2 (p< 0.001) vs T0 with a decreasing at T6 (p not significant) [Figure 1] with a trend of higher response in group A. In group B the CD8 + Spike reactivity increased at T1(p=0.037) and at T6 (p=0.005) vs T0. The interaction between SI and time was statistically significant at T1 (p=0.033);T2 (p= 0.046) and T6 (p=0.035) (mean values in group B higher than A). For overall population, the anti-S Abs significantly increased at T1 vs T0, T2 vs T0 and at T6 vs T0 [Figure 2A]. The group B at T6 retained a higher anti S response but the rate of change significantly differs between the two group (overall interaction: p< 0.001) [Figure 2B]. At T6 in both groups we found a high CD4+ T cells response to epsilon variant, even if not detected as circulant virus. Conclusion. The humoral response was persistent and increased in previous infected subjects. The CD4+T cells response after vaccination retained a response in uninfected subject, with an increasing trend and with a response to non-circulating variants. The vaccine could help the CD8+ T cells reactivity specific for Spike peptides.

Effect of SARS-CoV-2 Vaccination in a Frailty COVID-19 Cohort: a Real Life Experience in a Northern Italy Hospital

Background. Clinical trial demonstrated that SARS-CoV-2 vaccines have the ability of reduce mortality and morbidity due to COVID-19. The aim of this study is to describe the effect of vaccination in term of mortality, type of ventilation and ICU admission among patients hospitalized for COVID-19 from May to December 2021 in a Ligurian Hospital. Methods. This is a retrospective, single-center study conducted in San Martino Hospital (Genoa, Italy), including patients >= 18 years hospitalized for COVID-19 in Infectious Disease and Emergency Units from 1st May to 31st December 2021. We collected demographical data, multimorbidity and disability score, vaccination time ("vaccinated" all patients hospitalized >= 14 days after first dose or >= 7 days after second/ third dose), therapy for COVID-19, mortality at 7 and 30 days, ICU admission, ventilation type. Characteristics of vaccinated (group A) versus non vaccinated (group B) patients were compared using Chi-squared/Fisher's exact test for categorical variables and t-test /Kruskal-Wallis test for the continuous ones. Cox proportional hazards models for death at 30 days were performed as univariate analysis as well as adjusting for age, Cumulative Illness Rating Scale [CIRS], gender, Remdesivir, Monoclonal antibodies, Tocilizumab use. Results. Overall, 405 patients SARS-CoV-2 infected were enrolled. Data about timing of vaccination were available for 360 patients (89%). We compared clinical characteristics and outcomes of group A (32%) versus group B (68%). In group A patients were older (p< 0.001) and frailer (higher CIRS score and lower Barthel index, p< 0.001) than in group B. Among patients requiring oxygen, 76 (31.5%) in group B vs 26 (22.41%) in group A needed high flow ventilation (p=0.036);33 (13.52%) vs 3 (2.59%) respectively were admitted to ICU (Figure 1). Mortality at 30 days after hospitalization was higher in group A at univariate analysis [HR(95%CI) 1.44(0.82;2.53), p=0.208], lower at multivariate analysis [0.57(0.31;1.02), p=0.059]. Conclusion. The results of this study confirm that SARS-CoV-2 vaccination reduces rate of admission to ICU and 30 days mortality among patients hospitalized for COVID-19. In our cohort mortality among vaccinated patients remains high and we hypothesized this is due to high frailty of evaluated population.

The impact of air pollution on COVID-19 severity among infected individuals in a population of italian MS patients

Introduction: Studies have found associations between air pollution and pneumonia and air pollution is an established risk factors for common COVID-19 complications including pneumonia. Additionally, air pollutants have been identified as possible risk factors for MS onset and relapses. To our knowledge, only one study explored the impact of air pollution on Covid-19 severity specifically among MS patients but has only focused on PM2.5 exposures. Aim(s): We aim to evaluate the association between long-term exposure to air pollution and COVID-19 severity, described as developing pneumonia in a population of COVID-19-positive MS patients. Method(s): Data on COVID-19 infection among MS patients were extracted from an Italian web-based platform (Musc-19). A casecontrol study was designed including patients with and without pneumonia at a case-control ratio of 1:2 and 615 patients were included. The included patients were asked to provide information on the geographical area where they had spent most time in the previous 5 years. When this information was missing, the address of the MS center was used as a proxy and evaluated in sensitivity analysis. Air quality was assessed as annual average particulate matter (PM2.5 and PM10) and Nitrogen Dioxide (NO2) ground-level concentrations derived from air quality model results as provided by the 'Copernicus Atmospheric Monitoring Service', and evaluated as categorical exposures (terciles). The association between pollutants and COVID-19 pneumonia was studied using logistic regression models, also adjusting for confounders (age, sex, BMI, comorbidities, EDSS, MS type, duration and treatments). Result(s): Detailed exposure was obtained for 491 patients, of whom 34% had pneumonia. Higher concentrations of air pollutants were associated with increased odds of developing COVID-19 pneumonia in both unadjusted and adjusted models (Adjusted models estimates: PM2.5: 2nd vs 1st tercile OR(95% CI)=2.09 (1.20;3.65), 3rd vs 1st tercile OR(95% CI)=2.26(1.29;3.96);PM10: 2nd vs 1st tercile OR(95% CI)=1.83(1.05;3.20), 3rd vs 1st tercile OR(95% CI)=2.12(1.22;3.68);NO2: 3rd vs 1st tercile OR(95% CI)=2.12(1.21;3.69)). Results remained consistent in the sensitivity analysis. Conclusion(s): Higher long-term concentrations of PM2.5, PM10 and NO2 were associated with COVID-19 pneumonia among MS patients. Urgent measures to reduce air pollution should be adopted especially to protect the most vulnerable population.

The impact of PM2.5 on COVID-19 severity among Italian MS patients

Introduction: Studies have pointed out that air pollution longterm exposure may play a role in the severity and prognosis of SARS-CoV-2 infections. Additionally, air pollution has been associated to MS prevalence and course. However, the role of air pollution in COVID-19 severity has never been explored specifically among MS patients. Aims: To explore the association between air pollution assessed by PM2.5 levels and COVID-19 severity among MS patients. Methods: Demographic and clinical characteristics as well as data about Covid-19 severity were extracted from an Italian webbased platform (Musc-19 project) containing clinician-reported data from 118 Italian MS centers. PM2.5 ground-level concentrations were derived from air quality model results, as provided by the 'Copernicus Atmospheric Monitoring Service' (CAMS). Ordered logistic regression models were used to assess the association between PM2.5 (continuous and in tertiles) and Covid-19 prognosis (defined on three levels as mild course, hospitalization, and intensive care unit (ICU) admission or death) while controlling for possible confounders. Results: PM2.5 concentrations were available for 1517 MS patients, of whom 1321(87%) were classified as mild Covid-19 cases, 172(11%) were hospitalized and 24(2%) were admitted to ICU or died. Higher concentrations of PM2.5 were associated with increased odds of developing a worst Covid-19 prognosis (10-unit increase in PM2.5: OR(95% CI)=1.76(1.16-2.67) p-value=0.008;3rd vs 1st tertile: OR(95% CI)=1.74(1.17-2.59) p-value=0.006). Results remained consistent when we included only the Covid-19 cases confirmed by a nasopharyngeal swab (N=1087). Conclusions: Higher concentrations of PM2.5 are associated with Covid-19 severity among MS patients. Further studies are needed to evaluate the impact of other air pollutants, but urgent measures to reduce air pollution must be surely adopted.

Digital work engagement among Italian neurologists

Background and aims: In 2018 we surveyed the use of social media and digital devices among Italian neurologists. In the present study, we evaluated whether major changes had occurred in a short time-frame and indirectly assessed the impact of the Sars-COV-2 virus and the related COronaVIrus Disease 19 (COVID-19) pandemic. Methods: Online survey (September 2020 to January 2021) to collect information on attitude toward digital health of members of the Italian Society of Neurology (SIN). The outline of the survey was the same as the prior study. Results: One hundred and nine neurologists participated in the survey. Some major changes were found compared to 2018: fewer participants reported using the tablet (23% versus 43%;p < 0.001) and Facebook (18% versus 32%;p = 0.006) for professional purposes. More participants reported that social media had worsened the doctor-patient relationship, and were against a friendship with their patients in social media. There was a trend towards higher use of WhatsApp (92% versus 82%;p = 0.018), and a significant reduction in active involvement in personal websites, blogs, or online forums. Conclusions: Dramatic changes in the attitudes towards social media have occurred in Italy in a very short timeframe, probably due to the concurrent pandemic and its impact on daily practice, and the dissemination of online misinformation.