Reinfection with SARS-CoV-2: outcome, risk factors and vaccine efficacy in a Scottish cohort

Background -- The objective of this study was to investigate how protection against COVID-19 conferred by previous infection is modified by vaccination. Methods -- In a cohort of all 152655 individuals in Scotland alive at 90 days after a positive test for SARS-CoV-2 (confirmed by cycle threshold < 30, or two tests) followed till 22 September 2021, rate ratios for reinfection were estimated with calendar time or tests as timescale. Findings -- Rates of detected and hospitalised reinfection with COVID-19 while unvaccinated were respectively 6.8 (95% CI 6.4 to 7.2) and 0.18 (95% CI 0.12 to 0.25) per 1000 person-months. These rates were respectively 68% and 74% lower than in a matched cohort of individuals who had not previously tested positive. Efficacy of two doses of vaccine in those with previous infection was estimated as as 84% (95 percent CI 81% to 86%) against detected reinfection and 71% (95 percent CI 29% to 88%) against hospitalised or fatal reinfection. The rate of detected reinfection after two doses of vaccine was 1.35 (95% CI 1.02 to 1.78) times higher in those vaccinated before first infection than in those unvaccinated at first infection. Interpretation -- The combination of natural infection and vaccination provides maximal protection against new infection with SARS-CoV-2: prior vaccination does not impair this protection.

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Depression, Anxiety, and Self-directed Violence in Women with Endometriosis: A Retrospective Matched Cohort Study

American Journal of Epidemiology ◽

10.1093/aje/kwaa249 ◽

2020 ◽

Author(s):

Stephanie J Estes ◽

Carrie E Huisingh ◽

Stephanie E Chiuve ◽

Natalia Petruski-Ivleva ◽

Stacey A Missmer

Keyword(s):

Mental Health ◽

Risk Factors ◽

Cohort Study ◽

Disease Diagnosis ◽

Health Claims ◽

Matched Cohort ◽

Calendar Time ◽

Matched Cohort Study ◽

Health Claims Data ◽

Pain Symptoms

Abstract The purpose of this study was to compare the incidence of mental health outcomes in women with and without documented endometriosis identified from the US. In a retrospective matched cohort study using administrative health claims data from Optum’s ClinformaticsTM DataMart from May 1, 2000 through March 31, 2019, women aged 18-50 years with endometriosis (N=72,677) identified by International Classification of Disease diagnosis codes were matched 1:2 on age and calendar time to women without endometriosis (n=147,251), with a median follow-up of 529 days [IQR 195, 1,164]. The rate per 1,000 person-years of anxiety, depression, and self-directed violence among women with endometriosis was 57.1, 47.7, and 0.9, respectively. Compared to women with endometriosis to those without, the adjusted hazard ratio and 95% confidence interval was 1.38 (1.34, 1.42) for anxiety, 1.48 (1.44, 1.53) for depression, and 2.03 (1.60, 2.58) for self-directed violence. The association with depression was stronger among women age <35 years (P, test for heterogeneity<0.01). Risk factors for incident depression, anxiety, and self-directed violence among women with endometriosis included endometriosis-related pain symptoms and prevalence of other chronic conditions associated with pain. The identification of risk factors for mental health conditions among women with endometriosis may improve patient-centered disease management.

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Psychological and Behavioral Predictors of Vaccine Efficacy: Considerations for COVID-19

Perspectives on Psychological Science ◽

10.1177/1745691621989243 ◽

2021 ◽

pp. 174569162198924

Author(s):

Annelise A. Madison ◽

M. Rosie Shrout ◽

Megan E. Renna ◽

Janice K. Kiecolt-Glaser

Keyword(s):

Risk Factors ◽

Side Effects ◽

Vaccine Efficacy ◽

Psychological Factors ◽

Behavioral Interventions ◽

Vulnerable Groups ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Vaccine Response ◽

The Impact

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine candidates are being evaluated, with the goal of conferring immunity on the highest percentage of people who receive the vaccine as possible. It is noteworthy that vaccine efficacy depends not only on the vaccine but also on characteristics of the vaccinated. Over the past 30 years, a series of studies has documented the impact of psychological factors on the immune system’s vaccine response. Robust evidence has demonstrated that stress, depression, loneliness, and poor health behaviors can impair the immune system’s response to vaccines, and this effect may be greatest in vulnerable groups such as the elderly. Psychological factors are also implicated in the prevalence and severity of vaccine-related side effects. These findings have generalized across many vaccine types and therefore may be relevant to the SARS-CoV-2 vaccine. In this review, we discuss these psychological and behavioral risk factors for poor vaccine responses, their relevance to the COVID-19 pandemic, as well as targeted psychological and behavioral interventions to boost vaccine efficacy and reduce side effects. Recent data suggest these psychological and behavioral risk factors are highly prevalent during the COVID-19 pandemic, but intervention research suggests that psychological and behavioral interventions can increase vaccine efficacy.

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A multicenter, prospective, observational study to determine association of mesangial C1q deposition with renal outcomes in IgA nephropathy

Scientific Reports ◽

10.1038/s41598-021-84715-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Li Tan ◽

Yi Tang ◽

Gaiqin Pei ◽

Zhengxia Zhong ◽

Jiaxing Tan ◽

...

Keyword(s):

Risk Factors ◽

Iga Nephropathy ◽

Cox Regression ◽

Renal Outcome ◽

Matched Cohort ◽

Negative Group ◽

Renal Survival ◽

Cox Regression Analysis ◽

Renal Outcomes

AbstractIt was reported that histopathologic lesions are risk factors for the progression of IgA Nephropathy (IgAN). The aim of this study was to investigate the relationships between mesangial deposition of C1q and renal outcomes in IgAN. 1071 patients with primary IgAN diagnosed by renal biopsy were enrolled in multiple study centers form January 2013 to January 2017. Patients were divided into two groups: C1q-positive and C1q-negative. Using a 1: 4 propensity score matching (PSM) method identifying age, gender, and treatment modality to minimize confounding factors, 580 matched (out of 926) C1q-negative patients were compared with 145 C1q-positive patients to evaluate severity of baseline clinicopathological features and renal outcome. Kaplan–Meier and Cox proportional hazards analyses were performed to determine whether mesangial C1q deposition is associated with renal outcomes in IgAN. During the follow-up period (41.89 ± 22.85 months), 54 (9.31%) patients in the C1q negative group and 23 (15.86%) patients in C1q positive group reached the endpoint (50% decline of eGFR and/or ESRD or death) respectively (p = 0.01) in the matched cohort. Significantly more patients in C1q negative group achieved complete or partial remission during the follow up period (P = 0.003) both before and after PSM. Three, 5 and 7-year renal survival rates in C1q-positive patients were significantly lower than C1q-negative patients in either unmatched cohort or matched cohort (all p < 0.05). Furthermore, multivariate Cox regression analysis showed that independent risk factors influencing renal survival included Scr, urinary protein, T1-T2 lesion and C1q deposition. Mesangial C1q deposition is a predictor of poor renal survival in IgA nephropathy.Trial registration TCTR, TCTR20140515001. Registered May 15, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074.

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Abstract WP328: A Nurse-Led Initiative Improves Adherence Rates for Stroke Follow-up and Blood Pressure Management

Stroke ◽

10.1161/str.44.suppl_1.awp328 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Darren T Larsen ◽

Helmi L Lutsep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Stroke Prevention ◽

Stroke Risk ◽

Retention Rates ◽

Matched Cohort ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Chi Square Analysis

Background and Issues Aggressive management of vascular risk factors reduces stroke rates. It is unknown whether structured nurse-led follow up increases adherence rates for stroke patients after hospital discharge. Purpose The purpose of this program is to improve secondary stroke risk factor management by instituting a nurse-led initiative called Stroke Therapy, Education, Prevention (STEP). Methods The pilot STEP program was based on protocols used for other stroke prevention trials. This nurse-led program includes inpatient initiation and outpatient maintenance of pharmacologic and lifestyle goals for stroke patients. Eligible patients have a non-disabling ischemic stroke or TIA and are without insurance restrictions and live within a distance allowing return to clinic for follow up. Prior to discharge, the STEP nurse completes patient education, and reviews outpatient goals. The STEP nurse makes phone contact with the patient 7-10 days after discharge to review medication compliance and reinforce education. At 30 days post discharge patients are seen in clinic by the STEP nurse where a resting blood pressure (BP) is measured. If the patient does not meet targets (<140 SBP or <130 SBP for DM) medications are adjusted by a stroke neurologist. We undertook a retrospective chart review of a consecutive cohort of patients matched to STEP eligibility criteria to determine whether the program improved retention rates and BP management. Chi-Square analysis was used to compare visit adherence and percentage achieving goal BPs at 30 days. Results In the STEP group 25/32(78%) patients completed the 30 day follow up compared to 14/32 (44%) patients in the historical matched cohort (p=0.0048). Target BP was achieved in 13/25(52%) STEP patients and 5/14 (36%) matched cohort patients (p=0.32) returning to clinic. Overall, target BP was achieved in 13/32 (41%) and 5/32 (16%) respectively (p=0.026). Conclusions In conclusion, follow up adherence and BP management in the group as a whole was better in the nurse-led model and is recommended for secondary stroke prevention. Long term follow up with this model may further increase in-target rates of BP control and other stroke risk factors.

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Basic Predictive Risk Factors for Cytokine Storms in COVID-19 Patients

Frontiers in Immunology ◽

10.3389/fimmu.2021.745515 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sergey G. Shcherbak ◽

Anna Yu Anisenkova ◽

Sergei V. Mosenko ◽

Oleg S. Glotov ◽

Alexander N. Chernov ◽

...

Keyword(s):

Risk Factors ◽

Lymphocyte Count ◽

Absolute Lymphocyte Count ◽

Early Warning Score ◽

Positive Test ◽

City Hospital ◽

Cytokine Storm ◽

Positive Test Result ◽

Test Result ◽

D Dimer

ObjectiveA critical role in coronavirus disease 2019 (COVID-19) pathogenesis is played by immune dysregulation that leads to a generalized uncontrolled multisystem inflammatory response, caused by overproduction of proinflammatory cytokines, known as “a cytokine storm” (CS), strongly associated with a severe course of disease. The aim of this study is to identify prognostic biomarkers for CS development in COVID-19 patients and integrate them into a prognostic score for CS-associated risk applicable to routine clinical practice.Materials and MethodsThe authors performed a review of 458 medical records from COVID-19 patients (241 men and 217 women aged 60.0 ± 10.0) who received treatment in the St. Petersburg State Budgetary Institution of Healthcare City Hospital 40 (City Hospital 40, St. Petersburg), from Apr. 18, 2020 to Nov. 21, 2020. The patients were split in two groups: one group included 100 patients with moderate disease symptoms; the other group included 358 patients with progressive moderately severe, severe, and extremely severe disease. The National Early Warning Score (NEWS) score was used alongside with clinical assessment, chest computed tomographic (CT) scans, electrocardiography (ECG), and lab tests, like ferritin, C-reactive protein (CRP), interleukin (IL)-6, lactate dehydrogenase (LDH), and D-dimer.ResultsThe basic risk factors for cytokine storms in COVID-19 patients are male gender, age over 40 years, positive test result for replicative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, absolute lymphocyte count, dynamics in the NEWS score, as well as LDH, D-dimer, ferritin, and IL-6 levels. These clinical and instrumental findings can be also used as laboratory biomarkers for diagnosis and dynamic monitoring of cytokine storms. The suggested prognostic scale (including the NEWS score dynamics; serum IL-6 greater than 23 pg/ml; serum CRP 50 mg/L or greater; absolute lymphocyte count less than 0.72 × 109/L; positive test result for replicative coronavirus (SARS-CoV-2) RNA; age 40 years and over) is a useful tool to identify patients at a high risk for cytokine storm, requiring an early onset of anti-inflammatory therapy.

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SARS-CoV-2 Serology Status Detected by Commercialized Platforms Distinguishes Previous Infection and Vaccination Adaptive Immune Responses

10.1101/2021.03.10.21253299 ◽

2021 ◽

Author(s):

Raymond T. Suhandynata ◽

Nicholas J. Bevins ◽

Jenny T. Tran ◽

Deli Huang ◽

Melissa A. Hoffman ◽

...

Keyword(s):

Immune Response ◽

Immune Responses ◽

Neutralizing Antibodies ◽

Natural Infection ◽

Adaptive Immune Response ◽

Antibody Assay ◽

Adaptive Immune Responses ◽

Adaptive Immune ◽

Previous Infection ◽

A Cell

AbstractBackgroundThe severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 110 million individuals and led to 2.5 million deaths worldwide. As more individuals are vaccinated, the clinical performance and utility of SARS-CoV-2 serology platforms needs to be evaluated.MethodsThe ability of four commercial SARS-CoV-2 serology platforms to detect previous infection or vaccination were evaluated using a cohort of 53 SARS-CoV-2 PCR-positive patients, 89 SARS-CoV-2-vaccinated healthcare workers (Pfizer or Moderna), and 127 SARS-CoV-2 negative patients. Serology results were compared to a cell based SARS-CoV-2 pseudovirus (PSV) neutralizing antibodies assay.ResultsThe Roche S-(spike) antibody and Diazyme neutralizing antibodies (NAbs) assays detected adaptive immune response in 100.0% and 90.1% of vaccinated individuals who received two-doses of vaccine (initial and booster), respectively. The Roche N-(nucleocapsid) antibody assay and Diazyme IgG assay did not detect adaptive immune response in vaccinated individuals. The Diazyme Nabs assay correlated with the PSV SARS-CoV-2 ID50 neutralization titers (R2= 0.70), while correlation of the Roche S-antibody assay was weaker (R2= 0.39). Median PSV SARS-CoV-2 ID50 titers more than doubled in vaccinated individuals who received two-doses of the Moderna vaccine (ID50: 597) compared to individuals that received a single dose (ID50: 284).ConclusionsThe Roche S-antibody and Diazyme NAbs assays robustly detected adaptive immune responses in SARS-CoV-2 vaccinated individuals and SARS-CoV-2 infected individuals. The Diazyme NAbs assay strongly correlates with the PSV SARS-CoV-2 NAbs in vaccinated individuals. Understanding the reactivity of commercially available serology platforms is important when distinguishing vaccination response versus natural infection.SummaryThe Roche S (spike protein)-antibody and Diazyme neutralizing-antibodies (NAbs) assays were evaluated for their clinical utility in the detection of SARS-CoV-2 related adaptive immune responses by testing SARS-CoV-2 PCR-confirmed patients, SARS-CoV-2-vaccinated individuals, and SARS-CoV-2-negative individuals. Commercial serology results were compared to results generated using a cell-based SARS-CoV-2 pseudovirus (PSV) NAbs assay and previously validated SARS-CoV-2 commercial serology assays (Roche N (nucleocapsid protein) antibody and Diazyme IgG). We demonstrate that the Roche S-antibody and Diazyme NAbs assays detected adaptive immune response in SARS-CoV-2 vaccinated individuals and the presence of SARS-CoV-2 PSV NAbs. The Roche S-antibody assay had an observed positive percent agreement (PPA) of 100% for individuals who received two doses of the Pfizer or Moderna vaccine. By contrast, the Roche N assay and Diazyme IgG assay did not detect vaccine adaptive immune responses. Our findings also indicate that the Diazyme NAbs assay correlates strongly with the levels of SARS-CoV-2 ID50 neutralization titers using the PSV Nab assay in vaccinated individuals.

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COVID-19 risk factors amongst 14,786 care home residents: An observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays, and vaccination status in Wales (UK) between 1st September 2020 and 1st May 2021.

10.1101/2021.09.30.21264338 ◽

2021 ◽

Author(s):

Joe Hollinghurst ◽

Robyn Hollinghurst ◽

Laura North ◽

Amy Mizen ◽

Ashley Akbari ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Hospital Admissions ◽

Care Home ◽

Vaccination Status ◽

Care Homes ◽

Positive Test ◽

Care Providers ◽

Specialist Care ◽

Individual Level

Objectives: Determine individual level risk factors for care home residents testing positive for SARS-CoV-2. Study Design: Longitudinal observational cohort study using individual-level linked data. Setting: Care home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021. Participants: 14,786 older care home residents (aged 65+). Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. Methods: We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 polymerase chain reaction (PCR) test. We included time dependent covariates for the estimated community positive test rate of COVID-19, hospital admissions, and vaccination status. Additional covariates were included for age, positive PCR tests prior to the study, sex, frailty (using the hospital frailty risk score), and specialist care home services. Results: The multivariable logistic regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year of age), community positive test rate (OR 1.13 [1.12,1.13] per percent increase in positive test rate), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09] respectively) were associated with a decreased odds of a positive test. Conclusions: Our findings suggest care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Furthermore, minimising potential COVID-19 infection for care home residents admitted to hospital should be prioritised.

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V2-Specific Antibodies in HIV-1 Vaccine Research and Natural Infection: Controllers or Surrogate Markers

Animals ◽

10.3390/ani9080526 ◽

2019 ◽

Vol 9 (8) ◽

pp. 526 ◽

Cited By ~ 6

Author(s):

Duerr ◽

Gorny

Keyword(s):

Vaccine Efficacy ◽

Natural Infection ◽

Vaccine Trial ◽

Clinical Findings ◽

Hiv Vaccine ◽

Model Systems ◽

Potential Contribution ◽

Vaccine Research ◽

Specific Antibodies ◽

Hiv 1

Most human immunodeficiency virus (HIV) vaccine trials have lacked efficacy and empirical vaccine lead targets are scarce. Thus far, the only independent correlate of reduced risk of HIV-1 acquisition in humans is elevated levels of V2-specific antibodies identified in the modestly protective RV144 vaccine trial. Ten years after RV144, human and non-human primate vaccine studies have reassessed the potential contribution of V2-specific antibodies to vaccine efficacy. In addition, studies of natural HIV-1 infection in humans have provided insight into the development of V1V2-directed antibody responses and their impact on clinical parameters and disease progression. Functionally diverse anti-V2 monoclonal antibodies were isolated and their structurally distinct V2 epitope regions characterized. After RV144, a plethora of research studies were performed using different model systems, immunogens, protocols, and challenge viruses. These diverse studies failed to provide a clear picture regarding the contribution of V2 antibodies to vaccine efficacy. Here, we summarize the biological functions and clinical findings associated with V2-specific antibodies and discuss their impact on HIV vaccine research.

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Risk factors for pregnancy-associated venous thromboembolism: a review

Journal of Perinatal Medicine ◽

10.1515/jpm-2013-0207 ◽

2014 ◽

Vol 42 (4) ◽

Cited By ~ 15

Author(s):

Barry Kevane ◽

Jennifer Donnelly ◽

Mary D’Alton ◽

Sharon Cooley ◽

Roger J.S. Preston ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Molecular Mechanisms ◽

Case Control Studies ◽

Search Terms ◽

Specific Risk ◽

Pubmed Database ◽

Multiplicative Effect ◽

Incident Rate ◽

Rate Ratios

AbstractTo critically evaluate current understanding of risk factors for pregnancy-associated venous thromboembolism (VTE) and to describe underlying molecular mechanisms.A literature search was undertaken using the national library of medicine PubMed database. The search terms used were “pregnancy” and “venous thromboembolism”. Following exclusion of unsuitable data sources, studies were identified that described specific risk factors for pregnancy-associated VTE and suggested possible underlying molecular mechanisms. Adjusted odds ratios and incident rate ratios for these specific risk factors were identified in each study and tabulated.A series of mainly retrospective cohort and case control studies over the past two decades have reported specific risk factors for pregnancy-associated VTE. Recent published literature has highlighted the interaction between commonly occurring risk factors, particularly the potential for a multiplicative effect on overall VTE risk, and have led to improvements in our understanding of the molecular mechanisms underlying these risk factors.Mortality from pregnancy associated VTE continues despite prevention strategies. A detailed understanding of specific risk factors, their interactions and underlying molecular mechanisms is required to identify women at highest risk and to guide development of thromboprophylaxis strategies.

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