Surveillance of influenza B severe hospitalized cases during 10 seasons in Catalonia: Does the lineage make a difference?

Influenza B viruses circulate in two lineages (B/Victoria and B/Yamagata). Although classically affecting children, recently it has shown a high rate of infection and increased hospitalization in the elderly. To describe and analyze the clinical and epidemiological characteristics of severe hospitalized laboratory-confirmed influenza B virus (SHLCI-B) cases in Catalonia associated with mismatch from Influenza B virus strain included in the trivalent influenza vaccine (TIV). SHLCI-B was registered by the influenza sentinel surveillance system of Catalonia (PIDIRAC) during ten surveillance seasons from 2010 to 2020. Variables age, comorbidities, and vaccination status were recorded. Vaccine effectiveness was estimated as (1-OR) for intensive care unit (ICU) admission. Statistical significance was established at p < 0.05. A total of 1159 SHLCI-B were registered, of these 68.2% (791) corresponded to the 2017-2018 season; 21.8% (253) were admitted to ICU and 13.8% (160) were exitus; 62.5% (725) cases occurred in those aged >64 years; most frequent risk factor was cardiovascular disease (35.1%, 407) followed by chronic pulmonary obstructive disease-COPD (24.6%, 285) and diabetes (24.1%, 279). In four seasons, the predominant circulating lineage was B/Victoria, in two seasons the B/Yamagata lineage and four seasons had no IBV activity. Four seasons presented discordance with the strain included within the TIV. Vaccine effectiveness (VE) to prevent ICU admission was 31% (95% confidence interval [CI]: 4%-51%; p = 0.03); being 29% (95% CI: -3% to 51%) in discordant and 43% (95% CI:-43% to 77%) in concordant seasons. Significant differences were observed in the number of affected aged > 64 years (odds ratio [OR] = 2.5; 95% CI: 1.9-3.4; p < 0.001) and in patients with heart disease (OR = 2.40 95% CI: 1.7-3.4; p < 0.001), COPD (OR = 1.6 95% CI: 1.1-2.3; p = 0.01), and diabetes (OR = 1.5 95% CI: 1.1-2.1; p = 0.04) between discordant and concordant seasons. The increase in hospitalization rate in people> 64 years of age and those presenting comorbidities in seasons with circulating influenza B virus belonging to a lineage discordant with the strain included in the TIV and the decrease of VE to prevent ICU admissions evidence the vital need to administer the quadrivalent influenza vaccine regardless of the findings of predominant circulation in the previous season.

Humoral and Cellular Responses to mRNA-1273 and BNT162b2 SARS-CoV-2 Vaccines Administered to Hemodialysis Patients.

RATIONALE & OBJECTIVE: Patients with kidney failure who are receiving maintenance dialysis have a higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and worse clinical outcomes after coronavirus disease 2019 (COVID-19) than the general population. Therefore, immunization against SARS-CoV-2 with effective vaccines is an important component of health-maintenance strategies for these patients. This study evaluated the humoral and cellular responses to messenger RNA (mRNA) SARS-CoV-2 vaccines in this population. STUDY DESIGN: Observational prospective multicenter cohort study. SETTING & PARTICIPANTS: 205 patients treated at 3 dialysis units at the Hospital Clínic of Barcelona (Spain) were vaccinated from February 3 to April 4, 2021, and followed until April 23, 2021. EXPOSURE: Immunization with either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 mRNA vaccine. OUTCOME: Seroconversion, defined as the detection of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG), and the identification of activated CD4+T cells 3 weeks after completing vaccination. Anti-S1-RBD IgG levels were also analyzed as a secondary outcome. ANALYTICAL APPROACH: Univariate and multivariable logistic and multiple linear regression models were used to evaluate the associations between vaccination and study outcomes. RESULTS: We found that 97.7% of 175 vaccinated patients who were seronegative at baseline developed a response (humoral, cellular, or both); 95.4% of these patients seroconverted, while 62% of those tested for cellular immunity had a positive response. Greater age and immunosuppressive treatment were associated with lower antibody levels. LIMITATIONS: Mandatory vaccine administration by health authorities. Anti-S1-RBD IgG levels were reported up to 150U/mL and cellular immune responses were characterized qualitatively. Antibody assay and cellular response assessment may not be comparable with previously published laboratory approaches. CONCLUSIONS: Immunization with mRNA vaccines generated a humoral and cellular immune response in a high proportion of patients with kidney failure receiving maintenance dialysis. These findings as well as the high risk of infection and poor clinical outcomes among these patients make their vaccination a health priority.

Persistent replication of SARS-CoV-2 in a severely immunocompromised patient treated with several courses of remdesivir.

Microbiological response of SARS-CoV-2 to remdesivir in immunocompromised patients has not been evaluated. We present the case of a severely immunocompromised patient with persistent replication of SARS-CoV-2, who required different courses of remdesivir. Short courses of remdesivir might be insufficient in immunocompromised patients due to prolonged viral clearance.

Evaluación del riesgo suicida y caracterización de factores asociados en estudiantes de medicina colombianos / Assessment of suicide risk and characterization of associated factors in Colombian medical students

Objetivo: estimar la prevalencia de riesgo suicida en estudiantes de medicina colombianos y caracterizar factores de riesgo conocidos en dicha población. Metodología: estudio de tipo corte transversal en estudiantes de medicina de diez universidades colombianas. El riesgo suicida se estimó con la escala de Plutchik. Se utilizó un cuestionario autoaplicado, realizando muestreo por conveniencia. El análisis estadístico se realizó con SPSS 5.0. Resultados: 243 sujetos, con edad entre 15-27 años, 64,5 % eran mujeres, 16 % cursaban internado; 3,3 % tuvo autopercepción de mal rendimiento académico, 16 % reportó antecedente personal y 23 % antecedente familiar de enfermedad mental; 18,8 % tenían consumo de licor mayor al social. La prevalencia general de riesgo suicida fue de 49,4 %, se encontró asociación entre el riesgo suicida y el antecedente personal de enfermedad mental (p= 0,000; OR= 3,01 IC: 1,60-5,63) y la autopercepción de mal rendimiento académico (p= 0,001; OR= 2,32 IC: 2,008-2,696). Conclusión: este estudio refuerza la necesidad de la búsqueda activa del riesgo suicida en estudiantes de medicina.

Objective: to estimate the prevalence of suicide risk in Colombian medical students and to characterize known risk factors in this population. Methodology: cross-sectional study in medical students from ten Colombian universities. Suicide risk was estimated on the Plutchik scale. A self-applied questionnaire was used, sampling for convenience. Statistical analysis was performed with SPSS 5.0. Results: 243 subjects, aged 15-27 years, 64.5% were women, 16% were in boarding school; 3.3% had poor academic self-perception, 16% reported personal history and 23% family history of mental illness; 18.8% had consumption of liquor greater than social. The overall prevalence of suicidal risk was 49.4%, an association was found between suicidal risk and personal history of mental illness (p= 0.000; OR= 3.01 CI: 1.60-5.63) and self-perception of poor academic performance (p= 0.001; OR= 2.32 CI: 2.008-2.696). Conclusion: This study reinforces the need for active suicide risk research in medical students.

Sensitivity and specificity of immunoglobulin G titer for the diagnosis of mumps virus in infected patients depending on vaccination status.

The aim of the study was to evaluate the usefulness of serological detection of mumps IgM and titration of IgG in patients with acute parotitis according to their vaccination status. The detection of mumps virus RNA in saliva by RT-PCR was used as reference. 116 patients (109 of them previously vaccinated) with mumps RT-PCR-negative results and 21 (19 vaccinated) with mumps RT-PCR-positive results were studied. Mumps-specific IgM and IgG were assayed by EIA (Enzygnost, Dade Behring, Germany). IgM results were expressed as positive or negative. For IgG, several cut-offs were calculated using receiver operating characteristic (ROC) curves. Seven RT-PCR-positive and five RT-PCR-negative patients showed IgM-positive results (sensitivity 33.3% and specificity 95.7%). Among vaccinated patients, the sensitivity and specificity of IgM were 26.3% (5/19) and 99.1% (108/109). For IgG, a titer of 5,000 in all the patients showed a sensitivity of 76.2% (16/21) and a specificity of 83.6% (97/116). In vaccinated patients, the corresponding figures for this cut-off were 84.2% (16/19) and 83.5% (91/109), respectively. Although IgM detection against mumps is highly specific, its sensitivity is very low in immunized subjects. In this group, the titration of IgG could serve as an additional diagnostic tool.

[Diagnostic performance of specific IgM detection and genomic amplification in rubella]. / Estudio del rendimiento diagnóstico de la detección de IgM específica y de la amplificación genómica de rubéola.

Nowadays, most exanthematic diseases for which a vaccine is available affect young adults. A large percentage of these cases prove to be rubella. The aim of this study is to assess the performance of specific IgM and RT-PCR for the diagnosis of rubella infection. Fifty-nine patients with clinically suspected measles or rubella, and with available serum, whole blood, urine and pharyngeal exudate specimens were studied. RT-PCR in pharyngeal exudate was found to be the most effective marker at the start of the disease (mean, 2.5 days). IgM detection yielded a larger percentage of positive results (76.2%), but at a later time (3.7 days).

Estudio del rendimiento diagnóstico de la detección de IgM específica y de la amplificación genómica de rubéola / Diagnostic performance of specific IgM detection and genomic amplification in rubella

En la actualidad la mayoría de los casos de enfermedades exantemáticas prevenibles por inmunización afectan a jóvenes. Además, una elevada proporción de estos casos se confirman como rubéola. El objetivo de este estudio es evaluar el rendimiento de la IgM específica y una técnica de reacción en cadena de la polimerasa en tiempo real (RT-PCR) en el diagnóstico de la infección por virus de la rubéola. Se estudiaron 59 pacientes bajo sospecha clínica de sarampión o rubéola de los cuales se disponía de muestras de suero, sangre completa, orina y exudado faríngeo. Se comprobó que la RT-PCR en exudado faríngeo fue el marcador diagnóstico más eficaz en los primeros días de la enfermedad (2,5 días de media). Sin embargo, la detección de IgM mostró un mayor rendimiento (76,2%), aunque más tardíamente (3,7 días) (AU)

Nowadays, most exanthematic diseases for which a vaccine is available affect young adults. A large percentage of these cases prove to be rubella. The aim of this study is to assess the performance of specific IgM and RT-PCR for the diagnosis of rubella infection. Fifty-nine patients with clinically suspected measles or rubella, and with available serum, whole blood, urine and pharyngeal exudate specimens were studied. RT-PCR in pharyngeal exudate was found to be the most effective marker at the start of the disease (mean, 2.5 days). IgM detection yielded a larger percentage of positive results (76.2%), but at a later time (3.7 days) (AU)

[Comparison of serological procedures used for the diagnosis of viral exanthema in laboratories participating in the measles elimination plan]. / Comparación de los procedimientos serológicos de los laboratorios del Plan para la Eliminación del Sarampión en el diagnóstico de exantemas víricos.

OBJECTIVE: The comparison of serological methods used by the laboratories participating in the Network for the Elimination of Measles to diagnose measles virus infection as well as differential diagnosis with other exanthematic diseases are compared. MATERIALS AND METHODS: One panel of 20 serum samples including measles (12), rubella (4), parvovirus B19 (2) and dengue (2) infections was established. All cases were diagnosed by detection of specific IgM. The panel was sent to the laboratories of the Network. The results were compared with those obtained at the reference laboratory. RESULTS AND DISCUSSION: Regarding measles, IgM response from 20 laboratories (19 by ELISA and 1 by indirect immunofluorescence) was obtained, with an agreement of 91.5%. Related to rubella IgM, replay from 6 laboratories, using ELISA, was received, with an agreement of 98.7%. With respect to parvovirus B19 IgM, response from 10 laboratories (8 by ELISA and 2 by indirect immunofluorescence) was obtained, with an agreement of 94.6%. Results about dengue virus were not reported by any laboratory. CONCLUSION: Some laboratories from the network should review the methods used for the diagnosis of measles and other exanthematic diseases. The results reassert the need for a reference laboratory to support confirmation of the results.

Use of whole blood dried on filter paper for detection and genotyping of measles virus.

PCR, and two different ELISAs were used to detect measles virus on blood dried on filter paper samples from Equatorial Guinea. Sensitivity was 40% by PCR, 57.1% by indirect ELISA and 86.7% by micro chain capture ELISA. Genotype B3 was found in two positive samples by PCR.

Simultaneous detection of measles virus, rubella virus, and parvovirus B19 by using multiplex PCR.

We describe here a multiplex reverse transcription-PCR (RTMNPCR) assay designed to detect and differentiate measles virus, rubella virus, and parvovirus B19. Serial dilution experiments with vaccine strains that compared cell culture isolation of measles in B95 cells and rubella in RK13 cells showed sensitivity rates of 0.004 50% tissue culture infective dose (TCID(50)) for measles virus and 0.04 TCID(50) for rubella virus. This RTMNPCR can detect as few as 10 molecules for measles virus and rubella virus and one molecule for parvovirus B19 in dilution experiments with plasmids containing inserts of the primary reaction amplification products. Five pharyngeal exudates from measles patients and 2 of 15 cerebrospinal fluid samples from measles-related encephalitis were found to be positive for measles virus by this RTMNPCR. A total of 3 of 27 pharyngeal exudates from vaccinated children and 2 pharyngeal exudates, plus one urine sample from a case of congenital rubella syndrome, were found to be positive for rubella virus by RTMNPCR, whereas 16 of 19 sera from patients with erythema infectiosum were determined to be positive for parvovirus B19 by RTMNPCR. In view of these results, we can assess that this method is a useful tool in the diagnosis of these three viruses and could be used as an effective surveillance tool in measles eradication programs.