A Strategy to Detect Emerging Non-Delta SARS-CoV-2 Variants with a Monoclonal Antibody Specific for the N501 Spike Residue.

Efforts to control SARS-CoV-2 have been challenged by the emergence of variant strains that have important implications for clinical and epidemiological decision making. Four variants of concern (VOCs) have been designated by the Centers for Disease Control and Prevention (CDC), namely, B.1.617.2 (delta), B.1.1.7 (alpha), B.1.351 (beta), and P.1 (gamma), although the last three have been downgraded to variants being monitored (VBMs). VOCs and VBMs have shown increased transmissibility and/or disease severity, resistance to convalescent SARS-CoV-2 immunity and antibody therapeutics, and the potential to evade diagnostic detection. Methods are needed for point-of-care (POC) testing to rapidly identify these variants, protect vulnerable populations, and improve surveillance. Antigen-detection rapid diagnostic tests (Ag-RDTs) are ideal for POC use, but Ag-RDTs that recognize specific variants have not yet been implemented. Here, we describe a mAb (2E8) that is specific for the SARS-CoV-2 spike protein N501 residue. The 2E8 mAb can distinguish the delta VOC from variants with the N501Y meta-signature, which is characterized by convergent mutations that contribute to increased virulence and evasion of host immunity. Among the N501Y-containing mutants formerly designated as VOCs (alpha, beta, and gamma), a previously described mAb, CB6, can distinguish beta from alpha and gamma. When used in a sandwich ELISA, these mAbs sort these important SARS-CoV-2 variants into three diagnostic categories, namely, (1) delta, (2) alpha or gamma, and (3) beta. As delta is currently the predominant variant globally, they will be useful for POC testing to identify N501Y meta-signature variants, protect individuals in high-risk settings, and help detect epidemiological shifts among SARS-CoV-2 variants.

Clinical Impact of Vaccine Development.

The discovery and development of immunization has been a singular improvement in the health of mankind. This chapter reviews currently available vaccines, their historical development, and impact on public health. Specific mention is made in regard to the challenges and pursuit of a vaccine for the human immunodeficiency virus as well as the unfounded link between autism and measles vaccination.

Patients Hospitalized with pH1N1 Influenza in an Academic Community Medical Center.

BACKGROUND: The emergence of a novel strain of pandemic influenza (pH1N1) in 2009 presented significant challenges to health care facilities worldwide. In our academic community medical center in suburban Philadelphia, we noted our first pH1N1 diagnosis in September 2009. We sought to assess the impact of pH1N1 disease on our hospitalized patient population. METHODS: We prospectively collected clinical and epidemiological data on 29 consecutive patients that were admitted to our hospital with a primary or secondary diagnosis of influenza from October 1-November 30, 2009. Data were obtained through care of the patients and chart review. RESULTS: Prominent symptoms on admission included fever, hypoxia, cough, myalgias, and diarrhea, with leukocytosis and neutrophilia. Pre-existing medical conditions included asthma, pregnancy, immunosuppressive therapy, and sickle cell disease. All but 5 of the patients were under 60 years of age. Three patients had culture-documented bacterial or mycoplasma infections. All but two of the patients received oseltamivir. Six required admission to the intensive care unit but only one patient died. CONCLUSIONS: Our population of hospitalized patients with novel pH1N1 influenza demonstrated many of the features that have been associated with pH1N1 disease in other populations. Most of the patients were women and none of the patients died directly as a complication of influenza. We observed a cluster of patients with a tetrad of features comprising a history of asthma, obesity, female gender, and African-American race. Individuals with this constellation of factors should be specifically targeted for pH1N1 vaccination.

Use of antibacterial agents in renal failure.

This article provides background information on the pharmacokinetics of antibacterial agents in patients who have normal and impaired renal function. Tables are provided to allow quick determination of appropriate dosages for varying degrees of renal failure. The use of serum levels; newer strategies for cefazolin, vancomycin and aminoglycoside dosing; methods of dialysis and associated antibiotics dosage adjustments, and antibiotic toxicity in renal failure are reviewed.

Use of antibacterial agents in renal failure.

This article provides background information on the pharmacokinetics of antibacterial agents in patients who have normal and impaired renal function. Tables are provided to allow quick determination of appropriate dosages for varying degrees of renal failure. The use of serum levels; newer strategies for cefazolin, vancomycin and aminoglycoside dosing; methods of dialysis and associated antibiotics dosage adjustments, and antibiotic toxicity in renal failure are reviewed.

Use of antibacterial agents in renal failure.

This article provides background information on the pharmacokinetics of antibacterial agents in patients with normal and impaired renal function. Tables are provided to allow quick determination of appropriate dosages for varying degrees of renal failure. The use of serum levels, newer strategies for cefazolin, vancomycin, and aminoglycoside dosing, methods of dialysis and associated antibiotics dosage adjustments, and antibiotic toxicity in renal failure are reviewed.