IMMUNOGENICITY and SAFETY of the CORONOVAC and BNT162B2 COVID-19 VACCINE in PATIENTS with INFLAMMATORY RHEUMATIC DISEASES and HEALTHY ADULTS: COMPARISON of DIFFERENT VACCINES

Background: Having an autoimmune disease was an exclusion criterion in the efficacy and safety phase studies of vaccines against Covid-19 (1-2). In Turkey vaccination frst started with the inactivated CoronaVac, then with the mRNA BNT162b2 vaccine. Although there are studies on vaccine efficacy and safety in adults with infammatory rheumatic disease (IRD), there are still many unknowns (3-4). Objectives: Primary outcome of this study is to determine the seroconversion (SC) rate after CoronaVac and BNT162b2 vaccines in adults with IRD and to compare it with a healthy control group. Secondary outcomes are to evaluate whether there are efficacy differences in the two vaccine types, and to investigate the effects of the biologic agent used in the patient group on the vaccine immunogenicity. Methods: This prospective observational single center study was conducted at the Gazi University Hospital. Patients who were followed up in our outpatient clinic with IRD and who received two doses of either CoronaVac or BNT162b2 vaccines were included. Subjects with two doses one of these vaccine without IRD were included in the healthy control group. Patients who had Covid-19 infection before or during vaccination were excluded. The demographic characters were recorded. The interval between the two doses was 4 weeks. The blood samples of the patient and control groups were taken a minimum of two and a maximum of 12 weeks after the second dose. Anti-S antibodies against SARS-CoV-2 spike proteins were evaluated with the IgG Abbott kit, and a value above 50 arbitrary unit/ml was considered as positive SC. The neutralizing antibody titers were evaluated with the DIA.PRO kit, and cut-off value was above 1 Co/S. Results: The SC rate was slightly lower among patients with IRD versus controls (84% vs 97%, p:0.002). The SC rate was 100% in all participants who received BNT162b2 both in the patient and control group. The IgG antibody level after CoronaVac was signifcantly lower than that of BNT162b2 vaccine (p:0.031) in both patient and healthy controls (p:0.001). Among patients with IRD, those on rituximab (RTX)(12/81, %14.8) had signifcantly less SC rate (5/12, 41.7%) compared to patients on other biologicals (63/69, 91.3%) (p<0.001). Conclusion: This study showed that all patients with BNT162b2 vaccine developed immunogenicity in patients with IRD, while there was a decreased antibody response with CoronaVac vaccine compared to the healthy control group. In particular, the use of RTX signifcantly reduces the SC rate.

Distribution and Clinical Features of Viral Respiratory Infections in Children After Face-To-Face Education in 2021-2022 Winter Period

Objective: Several public health measures were introduced to reduce viral transmission and disease spread at the beginning of the COVID-19 pandemic. These measures had the potential to impact the transmission of other respiratory viruses. In September 2021, schools started face to face in and an increase in viral respiratory infections was observed. This study aims to determine the distribution and clinical features of viral agents in this period when complete face-to-face education was started for the first time in Turkey. Material and Methods: Diagnosis and clinical data of the pediatric patients who were tested for respiratory viral infections between October 1, 2021-January 1, 2022 were retrospectively retrieved from hospital records. Viral agents detected by polymerase chain reaction (PCR) in the nasopharyngeal aspirate samples obtained at the first application of the patients during the pandemic period were investigated. Results: There were 404 patients who were diagnosed with respiratory tract infections and tested for respiratory viruses. The leading viral agents in children who applied to our center between October and December 2021 were COVID-19 (32.7%), multiple viral agents (23.9%), RSV (15.3%) and rhinovirus (8.7%). 43.8% of patients diagnosed with RSV needed hospitalization. Conclusion: Our study shows that after complete face-to-face education and, the viral diversity is observed again in this winter period like before the pandemic. The high rate of hospitalization in RSV cases was remarkable.

Is the Presence of a Typical Triad of COVID-19 Symptoms (Cough, Dyspnea, and Fever) Enough to Make a Decision About Diagnostic Testing? From the Perspective of an Emergency Department

Objective: The aim of this study is to show the consistence between the recommended guidelines regarding the triad of symptoms-cough, dyspnea, and fever-and the diagnosis of COVID-19. Methods: A prospective observational study conducted at a tertiary emergency department between April 2, 2020 and May 15, 2020 in Turkey. Detailed patient history, main presenting complaints and imaging findings were recorded. For COVID-19 confirmation, nasopharyngeal RT-PCR was used. The relationship between complaints and COVID-19 test results were analyzed. Results: Of the 1226, suspected COVID-19 patients, 127 were positive, 471 were negative, and 628 were discharged without any tests. The most common presenting complaints of the COVID-19 positive patients were throat pain (25.2%), dyspnea (15%), cough (22%), malaise and fatigue (11.8%), and fever (8.7%). There was no statistically significant difference between the positive and negative test groups as they had fever (chi(2), p = 0.30), cough (chi(2), p = 0.67) and dyspnea (chi(2), p = 0.14). Conclusion: Considering that it is difficult to diagnose COVID-19 in emergency settings, testing decision and diagnosis should not depend only on classical symptoms;otherwise, patients with atypical and rare symptoms may be missed. Instead, patient history, clinical status, and radiological findings should be considered together.

Comparison of the Clinical and Radiological Features of COVID-19 and Other Viral Pneumonias

Objective: The aim of the study is to compare the differences between COVID-19 pneumonia and other viral pneumonia (OVP) in terms of demographic, clinical and radiological features. Methods: This retrospective cohort study was conducted in Gazi University Hospital between 11 March and 24 May 2020. Patients, admitted to the hospital with suspected COVID-19 infection aged >18 years and those who had pneumonia on chest computed tomography (CT) scan were evaluated. SARS-CoV-2 RT-PCR and multiplex PCR, for other respiratory viruses, were performed. Patients with a positive SARS-CoV-2 PCR were included in "COVID-19 pneumonia" group and those who had a positive result for any other respiratory viruses and two consecutive negative results for SARS-CoV-2 were included in the "OVP" group. Two groups were compared in terms of clinical, laboratory and chest CT findings. Results: Of the 63 patients included in the study, 45 had COVID-19 pneumonia and 18 had OVP. Cough, nasal congestion, sputum production and leukocytosis were more common in the OVP group while leukopenia was more common in the COVID-19 pneumonia (p<0.05). The distribution pattern of parenchymal lesions on chest CT was more likely to be predominantly peripheral and posterior in COVID-19 pneumonia compared to OVP. Bilateral involvement was also more frequent in COVID-19 group compared to OVP (p<0.05). Conclusion: Distinguishing COVID-19 pneumonia from OVP with clinical and laboratory findings is difficult. Chest CT findings such as peripheral and posterior distribution of the parenchymal lesions and bilateral involvement may help to differentiate COVID-19 pneumonia from OVP.

Retrospective evaluation of the prevelance and seasonal distribution of Coronaviridae positivity before the COVID-19 pandemic (2016-2020)

Introduction: Coronaviruses are the agents of viral respiratory infections and cause severe respiratory infections, especially in the elderly, those with chronic disease and immunocompromised patients. The aim of this study was to determine the positive and common types of Coronaviridae family in patients admitted to our hospital in the four-year period before the COVID-19 pandemic (2016-2020) and to investigate the distribution of coronavirus positivity by age groups, months, seasons and years. Materials and Methods: Between February 2016 and January 2020, clinical samples of 1164 female (45%) and 1428 (55%) male patients were sent to the molecular virology laboratory from the various clinics of Gazi University, Faculty of Medicine Hospital due to symptoms of acute respiratory tract infection. Coronaviridae family positivity was investigated retrospectively in clinical samples of 2592 patients aged 0-101 years. Nucleic acid extraction from the clinical samples was performed with the 'EZ1 Virus Mini Kit'. For viral DNA amplification, it was performed by multiplex Real-Time PCR method using 'FTD Respiratory Pathogen 21' test. Statistical analysis of the distribution of coronavirus positivity by age groups, months, seasons and years was done by SPSS 20.0 computer program. Results: Two hundred and twenty-nine (8.8%) of the clinical samples were found to be positive for any Coronavirus type. The most common type of Coronavirus was found to be CoV-229E with 52% (119/229). The distribution of other coronavirus types including CoV-HKU1, CoV-OC43 and CoV-NL63 was determined as 19.2% (44/229), 17.4% (40/229) and 14% (32/229) respectively, and the most common type of Coronavirus changed from year to year. Single Coronavirus positivity was found to be 48.1%, its association with other viruses was 51.9%. The highest coinfection of Coronavirus was found in Rhinovirus (35.3%) and influenza A virus (19.3%). Patients over 60 years of age were found to have a higher rate (30.6%) positivity compared to other age groups (p< 0.05). The highest rate of Coronavirus positivity was observed in January (17.4%) and the lowest rate in June (1.7%). It was observed that the highest rate of positivity (44.2%) was in winter and the lowest rate (8.2%) was in summer (p< 0.05). Coronaviruses were found to be detected at higher rates in winter with seasonal variation (p< 0.05). Conclusion: Since it is not possible to diagnose viral respiratory tract infections based on clinical findings, viral respiratory panel and Multiplex real time PCR test is a fast and useful method in routine diagnosis for early diagnosis and treatment and to prevent unnecessary use of antibiotics. Coronaviridae family positivity is seen in patients over 60 years of age and in seasonal variation, with higher rates in winter.

Retrospective Evaluation of the Prevelance and Seasonal Distribution of Coronaviridae Positivity Before the COVID-19 Pandemic (2016-2020)

Introduction: Coronaviruses are the agents of viral respiratory infections and cause severe respiratory infections, especially in the elderly, those with chronic disease and immunocompromised patients. The aim of this study was to determine the positive and common types of Coronaviridae family in patients admitted to our hospital in the four-year period before the COVID-19 pandemic (2016-2020) and to investigate the distribution of coronavirus positivity by age groups, months, seasons and years. Materials and Methods: Between February 2016 and January 2020, clinical samples of 1164 female (45%) and 1428 (55%) male patients were sent to the molecular virology laboratory from the various clinics of Gazi University, Faculty of Medicine Hospital due to symptoms of acute respiratory tract infection. Coronaviridae family positivity was investigated retrospectively in clinical samples of 2592 patients aged 0-101 years. Nucleic acid extraction from the clinical samples was performed with the 'EZ1 Virus Mini Kit'. For viral DNA amplification, it was performed by multiplex Real-Time PCR method using 'FTD Respiratory Pathogen 21' test. Statistical analysis of the distribution of coronavirus positivity by age groups, months, seasons and years was done by SPSS 20.0 computer program. Results: Two hundred and twenty-nine (8.8%) of the clinical samples were found to be positive for any Coronavirus type. The most common type of Coronavirus was found to be CoV-229E with 52% (119/229). The distribution of other coronavirus types including CoV-HKU1, CoV-OC43 and CoV-NL63 was determined as 19.2% (44/229), 17.4% (40/229) and 14% (32/229) respectively, and the most common type of Coronavirus changed from year to year. Single Coronavirus positivity was found to be 48.1%, its association with other viruses was 51.9%. The highest coinfection of Coronavirus was found in Rhinovirus (35.3%) and influenza A virus (19.3%). Patients over 60 years of age were found to have a higher rate (30.6%) positivity compared to other age groups (p< 0.05). The highest rate of Coronavirus positivity was observed in January (17.4%) and the lowest rate in June (1.7%). It was observed that the highest rate of positivity (44.2%) was in winter and the lowest rate (8.2%) was in summer (p< 0.05). Coronaviruses were found to be detected at higher rates in winter with seasonal variation (p< 0.05). Conclusion: Since it is not possible to diagnose viral respiratory tract infections based on clinical findings, viral respiratory panel and Multiplex real time PCR test is a fast and useful method in routine diagnosis for early diagnosis and treatment and to prevent unnecessary use of antibiotics. Coronaviridae family positivity is seen in patients over 60 years of age and in seasonal variation, with higher rates in winter.

The COVID-19 pandemic: Role of the medical virology laboratory

The SARS-CoV-2, agent of the Coronavirus disease 2019 (COVID-19), is a member of the Coronaviridae family leading to severe acute respiratory illness. It is enveloped RNA virus. WHO declared the outbreak of Covid-19 as a pandemic on 11 February 2020. After the emergence of the outbreak in the world and in our country, COVID-19 virology laboratory has been designed and diagnostic tests have been established for the early diagnosis of the SARS-CoV-2. The routine diagnosis of COVID-19 is achieved by the detection of viral RNA in clinical samples using the nucleic acid amplification tests like real-time polymerase chain reaction (PCR). The rapid diagnosis during the early phases of the infection is critically important for the isolation of the patients and for the development of preventive measures to control the infection in the community. In this context, after the emergence of the pandemic, different diagnostic techniques (real-time PCR tests, rapid antibody tests, and ELISA tests) have been used for the early diagnosis of COVID-19 in our hospital. In this paper, we want to emphasize the role and importance of the medical laboratories for the diagnosis of SARS-CoV-2, for tracking of the patients, and for epidemiologic studies during COVID-19 pandemic.