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2021 ◽  
Vol 12 (1) ◽  
pp. 11-15
Author(s):  
Indira Chowdhury ◽  
Farzana Akonjee Mishu ◽  
Mohammad Masum Alam ◽  
Rubina Yasmin ◽  
Mohammad Matiur Rahman ◽  
...  

Background:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread throughout the world causing a serious health issue. After the swine flu pandemic (also known as H1N1) of 2009-10, WHO had declared Coronavirus disease 2019 (COVID-19) as a global pandemic. This pandemic caused huge losses to the entire world. Most of the patients with mild symptoms were treated at home but patients with difficulty in breathing and various complications were treated at the hospital. Naturally produced antibodies or vaccination can only offer protection. The objective was to compare the antibody status after SARS-CoV-2 infection in hometreated and hospital-treated patients. Methods: This cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology, BIRDEM General Hospital, from July, 2020 to June, 2021. A total of 77 patients (age 18 – 70 years) infected by SARS-CoV-2 were enrolled for this study. Among them, 37 were home treated and 40 were treated in hospital. The study subjects were non-vaccinated. For this study, serum IgG level was measured by the automated analyser. For statistical analysis, the Mann Whitney U test was done. Results:The median value of serum IgG was significantly higher in hospital-treated patients than in hometreated patients (p < 0.001). Hospital treated patients with a history of comorbidity developed more amount of antibody in comparison to home treated patients. Conclusion:Hospital treated patients develop higher antibodies in comparison to home treated patients. BIRDEM Med J 2022; 12(1): 11-15


2021 ◽  
Author(s):  
Victoria Furer ◽  
Tali Eviatar ◽  
Devy Zisman ◽  
Hagit Peleg ◽  
Yolanda Braun-Moscovici ◽  
...  

Abstract BackgroundTreatment with rituximab (RTX) blunts SARS-CoV-2 vaccination-induced humoral response. We sought to identify predictors of a positive immunogenic response to the BNT162b2 mRNA vaccine in patients with autoimmune inflammatory rheumatic diseases (AIIRD) treated with RTX (AIIRD-RTX).MethodsWe analyzed 108 AIIRD-RTX patients and 122 immunocompetent controls immunized with BNT162b2 mRNA vaccine participating in a multicenter vaccination study. Immunogenicity was defined by positive anti-SARS-CoV-2 S1/S2 IgG measured at 2 to 6 weeks after the second vaccine dose. We used a stepwise backward multiple logistic regression to identify predicting factors for a positive immunogenic response to vaccination and develop a predicting calculator, further validated in an independent cohort of AIIRD-RTX patients (n=48) immunized with the BNT162b2 mRNA vaccine.Results AIIRD-RTX patients who mounted a seropositive immunogenic response significantly differed from non-responders by lower number of RTX courses (median (range) 3 (1-10) vs 5 (1-15), p=0.007; lower cumulative RTX dose 6943.11±5975.74 vs 9780.95±7240.12 mg, p=0.033; higher IgG level prior to last RTX course (mean ± SD), 1189.78±576.28 vs. 884.33±302.31 mg/dL, p=0.002, and extended interval between RTX treatment and vaccination, 469.82±570.39 vs 162.08±160.12 days, p=0.0009, respectively. Patients with ANCA-associated vasculitis and inflammatory myositis had a low likelihood of a seropositive immunogenic response compared to patients with rheumatoid arthritis, odds ratio (OR) 0.209, 95% confidence interval (CI) 0.046-0.96, p=0.044 and OR 0.189, 95% CI 0.036-0.987, p=0.048, respectively. Based on these findings, we constructed a calculator predicting the probability of a seropositive immunogenic response following BNT162b2 mRNA vaccination which performed with 90.5% sensitivity, 59.3% specificity, 63.3% positive and 88.9% negative predictive values.ConclusionsThe predicting calculator might guide clinicians for optimal timing of BNT162b2 mRNA vaccination in AIIRD-RTX patients.


Vaccines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 35
Author(s):  
Karen Schreiber ◽  
Christine Graversgaard ◽  
Randi Petersen ◽  
Henning Jakobsen ◽  
Anders Bo Bojesen ◽  
...  

Background/Purpose: In light of the current COVID-19 pandemic, whether patients with rheumatic musculoskeletal disease (RMD) treated with conventional (cs) or biologic (b) disease-modifying drugs (DMARDs) exhibit an adequate immune response to the currently available SARS-CoV-2 vaccinations remains a major concern. There is an urgent need for more SARS-CoV-2 vaccine efficacy data to inform healthcare providers on the potential need for a booster vaccine. We established the ‘Detection of SARS-CoV-2 antibodies in Danish Inflammatory Rheumatic Outpatients’ study (DECODIR) in March 2021 in order to assess and compare the immunoglobulin G (IgG response) of the SARS-CoV-2 BNT162b2 vaccine (Pfizer, Groton, CT, USA/BioNTech, Mainz, Germany) and mRNA-1273 vaccine (Moderna, Cambridge, MA, USA) administered as part of the national vaccine roll out in patients with RMDs, irrespective of treatment. Patients’ SARS-CoV-2 IgG level was used as proxy to determine vaccination response. Methods: The study is a longitudinal prospective cohort study in which the SARS-CoV-2 antibody response was measured and compared at baseline and at six weeks following vaccination. The study population consisted of patients with rheumatoid arthritis (RA), spondyloarthropathies (SpA), or psoriatic arthritis (PsA) receiving their outpatient treatment at the Danish Hospital for Rheumatic Diseases, Sonderborg. Bloods, patient reported outcome measurements (PROMS), clinical data, and treatment information (cs/bcs/bDMARD) were collected at baseline/6 weeks and documented in the Danish DANBIO registry. Commercially available antibody tests (ThermoFisher, Waltham, MA, USA) were used, and SARS-CoV-2 IgG levels were reported in EliA U/mL. Sufficient IgG response was defined as ≥10 EliA U/mL (manufacturers cut-off). Associations between antibody response, age, gender, disease (RA/PsA/SpA), no treatment or cs/bDMARD treatment, and disease activity were tested using proportional odds regression and bootstrapped tests of medians. Results were reported using mean, median (IqR), and bootstrapped 95% confidence interval (CI) of the median. Results: A total of 243 patients were included. We observed a significant increase in IgG levels (median of <0.7 EliA U/mL at baseline versus 34.5 EliA U/mL at 6 weeks). Seventy-two patients (32%) had an insufficient IgG response. The median IgG level in patients treated with cs/bcs/bDMARD combination therapy was significantly lower compared to patients without any DMARD treatment (12 EliA U/mL vs. 92 EilA U/mL (p < 0.01)). Conclusion: Patients treated with a combination of cs/bcs/bDMARD are at significantly higher risk of an inadequate response to SARS-CoV-2 vaccines as measured by IgG level compared to patients without DMARD treatment. IgG SARS-CoV-2 are only part of the immune response, and further data are urgently needed. At present, our results may inform healthcare providers and policy makers on the decision for the need of a booster vaccine in this particular patient group.


2021 ◽  
Author(s):  
Harold J Manley ◽  
Gideon Aweh ◽  
Caroline M Hsu ◽  
Daniel E Weiner ◽  
Dana Miskulin ◽  
...  

Background: SARS-CoV-2 vaccine effectiveness during the Delta period and immunogenicity threshold associated with protection against COVID-19 related hospitalization or death in the dialysis population is unknown. Methods: A retrospective, observational study assessed SARS-CoV-2 vaccine effectiveness and immunogenicity threshold in all adult maintenance dialysis patients without COVID-19 history treated between February 1 and October 2, 2021. All COVID-19 infections, composite of hospitalization or death following COVID-19 and available SARS-CoV-2 anti-spike immunoglobulin (Ig) G values were extracted from electronic medical record. COVID-19 cases per 10,000 days at risk and vaccine effectiveness during pre-Delta and Delta periods were determined. Results: Of 15,718 patients receiving dialysis during the study period, 11,191 (71%) were fully vaccinated, 733 (5%) were partially vaccinated and 3,794 (24%) were unvaccinated. 967 COVID-19 were cases identified: 511 (53%) occurred in unvaccinated patients and 579 (60%) occurred during the Delta period. COVID-19 related hospitalization or death was less likely among vaccinated versus unvaccinated patients for all vaccines (adjusted HR 0.19 [0.12, 0.30]) and for BNT162b2/Pfizer, mRNA-1273/Moderna, and Ad26.COV2.S/Janssen (adjusted HR=0.25 [0.16, 0.40], 0.14 [0.08, 0.22], and 0.34 [0.17, 0.68] respectively). Among those with anti-spike IgG levels, those with IgG level ≥ 7 had significantly lower risk of a COVID-19 diagnosis (HR=0.25 [0.15, 0.42]) and none experienced a COVID-related hospitalization or death. Conclusions: Among maintenance dialysis patients, SARS-CoV-2 vaccination was associated with a lower risk of COVID-19 diagnosis and associated hospitalization or death. Among vaccinated patients, low anti-spike IgG level is associated with worse COVID-19 related outcomes.


2021 ◽  
Author(s):  
Hiroaki Ikezaki ◽  
Ryoko Nakashima ◽  
Kahori Miyoshi ◽  
Yuichi Hara ◽  
Jun Hayashi ◽  
...  

Introduction: The administration of a third vaccine is ongoing in many countries, but the evaluation of vaccine-induced immunity is still insufficient. This study evaluated anti-spike IgG levels in 373 health care workers six months after the BNT162b2 vaccination. Methods: Dynamics of anti-spike IgG levels six months after the 2nd vaccination were assessed in 49 participants (Analysis-1). A cross-sectional assessment of anti-spike IgG level was performed in 373 participants (Analysis-2). Participants positive for anti-nucleocapsid IgG or IgM and receiving immunosuppressants were excluded from Analysis-2. Results: In Analysis 1, the median anti-spike IgG level was lower in the older age group and decreased consistently after the second vaccination regardless of age. In Analysis-2, the anti-spike IgG level was significantly negatively associated with age (r = -0.35, p < 0.01). This correlation remained statistically significant (r = -0.28, p < 0.01) even after adjusting for sex, BMI, smoking habits, alcohol drinking habits, allergies, and the presence of fever or other adverse reactions at the time of the vaccination. Alcohol drinking habit was also associated with the anti-spike IgG level; daily alcohol drinkers had significantly lower anti-spike IgG levels than never alcohol drinkers. Sex, smoking habit, allergy, and fever and other side effects after the vaccination were not associated with anti-spike IgG levels six months after the 2nd vaccination. Conclusions: Six months after the vaccination, the anti-spike IgG level was substantially low among older persons and daily alcohol drinkers.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2864-2864
Author(s):  
Lawrence Liu ◽  
Alicia Yn ◽  
Feng Gao ◽  
Marissa Olson ◽  
Mallory Crain ◽  
...  

Abstract Background: Up to 70% of allogeneic stem cell transplant (alloSCT) recipients who are cytomegalovirus (CMV) seropositive experience CMV reactivation and up to a third are complicated by end-organ disease. Letermovir, an antiviral agent targeting CMV, is FDA-approved for prophylaxis of CMV reactivation in CMV seropositive recipients of alloSCT. 1-4 In CMV seropositive recipients, letermovir use up to week 14 after alloSCT has demonstrated a significantly lower incidence of clinically significant CMV infection (csCMVi) and an overall mortality benefit as far as 24 weeks after transplant. 5-8 However, data on csCMVi beyond 24 weeks is lacking. Additionally, more information is needed on letermovir use in patients who had prior alloSCT, are CMV seronegative, have a detectable CMV viral load but without csCMVi, and/or are high risk*. Methods: This is a single-center, retrospective, comparative cohort analysis of 524 patients who received alloSCT at Barnes-Jewish Hospital from January 2016 to June 2019. Of those, 191 patients were excluded because both the recipient and donor were seronegative for CMV. Patient information was obtained from the electronic medical record systems after IRB approval of the protocol. Gray's sub-distribution methods (while account for death as competing risk) were used to calculate the incidence of csCMVi and to assess the effect of letermovir on csCMVi. Univariate and multivariate Cox proportional hazards models were fitted for the effect of letermovir on overall survival (OS), and time-dependent Cox model was used to determine the effect of csCMVi on OS. Results: Out of 333 patients, 149 received letermovir. The median follow-up period was 13.38 months (0.033 to 63.8 months). A univariate analysis demonstrated that csCMVi was associated with worse OS (HR 2.173, 95% CI 1.602-2.948). Among those who received letermovir, there were reductions in csCMVi for the overall cohort and for high-risk patients at 100 days, 180 days, and 365 days after alloSCT. In seropositive recipients receiving seropositive alloSCT (CMV +/+), there were reductions in csCMVi at days 100, 180, and 365 after transplant. In seropositive recipients receiving seronegative alloSCT (CMV +/-), there was a reduction in csCMVi at 100 days after transplant. There was a reduction in CMV-related mortality at day 180 post-transplant (p=0.03) but not at day 365 (p=0.46). Additionally, for the overall cohort, the letermovir group showed worse OS from days 180-365 (HR 1.938, 95% CI 1.143-3.285). In CMV seronegative patients receiving seropositive SCT (CMV -/+), no difference in csCMVi was detected at days 100, 180, and 365. A landmark analysis of Day 100 IgG level effect on csCMVi incidence demonstrated that lower IgG level (&lt;485) is associated with higher csCMVi rates after Day 100 (p=0.004). Day 100 CD4 level was not found to be predictive of csCMVi (p=0.744). Conclusion: Letermovir prophylaxis reduces csCMVi overall and in high risk and CMV seropositive patients. We observed a reduction in CMV-related mortality at 180 days after transplant with letermovir prophylaxis. A worsening of OS after day 180 and a trend towards worse non-relapse mortality was surprising and may be related to a higher degree of immunosuppression associated with post-transplant cyclophosphamide (PTCy) use, haploidentical SCT, thymoglobulin use, prior SCTs, and CMV high-risk* patients. Additionally, letermovir was stopped at day 100 at which point survival worsens and the incidence of csCMVi precipitously increases. Our results suggest that there may be additional benefit to extending letermovir therapy past day 100 in the high-risk groups, haploidentical SCT group, patients with low IgG levels at day 100, and subclinical CMV viremia. *High risk patients were defined as those receiving haploidentical, mismatched related, mismatched unrelated, umbilical cord blood, T-cell depleted graft stem cell transplants or immunosuppression with methylprednisolone &gt; 1 mg/kg or 2 or more immunosuppressants. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.


2021 ◽  
Vol 12 ◽  
Author(s):  
Nina Nurarifah ◽  
Herwindo Pudjo Brahmantyo ◽  
Shinta Oktya Wardhani ◽  
Djoko Heri Hermanto ◽  
Putu Moda Arsana

BackgroundConvalescent plasma therapy is expected to be a promising alternative to supportive therapy during the SARS-CoV-2 pandemic outbreak. Altered immune response in repetitive convalescent plasma donors has not been widely studied. This case series was reported to analyze the patterns of immune responses and the factors that might influence them in repetitive convalescent plasma donors and increase awareness of COVID-19 survivors to donate their convalescent plasma.Cases IllustrationThere were five repetitive donors who were eligible as convalescent plasma donor requirements. It was found two donors who showed increment of anti-SARS-CoV-2 IgG level after donation and two others who showed persistent anti-SARS-CoV-2 IgG level more than two months after recovered.DiscussionThere was a difference in immune response in survivors who have the probability of being exposed to same antigens with survivors who did not, where the group of survivors who are at risk of exposure to antigens after recovery could trigger anamnestic immune response that can increase antiSARS-CoV-2 IgG levels. The other factor that influence the prolongation of anti-SARS-CoV-2 IgG levels are the possibility of neutralizing antibodies in plasma upregulation.ConclusionImmunological phenomenon in SARS-CoV-2, both in survivors and convalescent plasma donors, have not been widely observed and studied. From the case series discussed above, it can be concluded that convalescent plasma donation does not yet have strong evidence of decreasing levels of specific antibodies against SARS-CoV-2 and plasmapheresis procedure is safe to be done without reducing the protective effect of donor antibody post-plasma donation.


2021 ◽  
Vol 2021 (11-12) ◽  
Author(s):  
Warren Connolly ◽  
Jonathan O’Keeffe ◽  
Cathal ÓBroin ◽  
Rosa Mc Namara ◽  
Jonathan Dean ◽  
...  

ABSTRACT Our patient, a nursing home resident, was reviewed by our frailty outreach service in November 2020. She initially was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in September 2020 during an outbreak in her nursing home. On this occasion, she again tested positive for SARS-CoV-2. Our case report describes the resident’s poor immune response indicated by a low IgG level after her initial COVID infection as well as reinfection with a ‘non-variant’ SARS-CoV-2 lineage (B.1.177). The case describes the importance of integration of community and secondary care. The nursing home received close monitoring and nurse supervision for the detection of potential deterioration of the patient. Exit-seeking behaviour by nursing home residents was limited effectively. The issues of low immune response to COVID-19 in older people and the emergence of variants of concern will continue to pose a threat to this susceptible group.


2021 ◽  
Author(s):  
Ynolde E Leys ◽  
Magdalene Nwokocha ◽  
Jerome P Walker ◽  
Tiffany R Butterfield ◽  
Velesha Frater ◽  
...  

The Caribbean region is lacking an assessment of the antibody response and side effects experienced after AstraZeneca COVID-19 vaccination (AZD1222). We examined SARS-CoV-2 spike receptor binding domain (RBD) IgG levels and reported side effects in a Jamaican population after AZD1222 vaccination. Median RBD IgG levels for persons without evidence of previous SARS-CoV-2 infection were 43.1 bIU/mL after 3-7 weeks post first dose, rising to 100.1 bIU/mL 3-7 weeks post second dose, and falling 46.9 bIU/mL 16-22 weeks post second dose. The median RBD IgG level 2-8 weeks after symptom onset for unvaccinated SARS-CoV-2 infected persons of all disease severities was 411.6 bIU/mL. Common AZD1222 side effects after first dose were injection site pain, headache and chills. Most persons reported no side effects after second dose. AZD1222 is widely used across the English-speaking Caribbean and the study provides evidence for its continued safe and effective use in vaccination programs.


2021 ◽  
Author(s):  
Lysiane Duniere ◽  
Justin B Renaud ◽  
Michael A Steele ◽  
Caroline S Achard ◽  
Evelyne Forano ◽  
...  

Colostrum quality is of paramount importance in the management of optimal ruminant growth and infectious disease prevention in early life. Live yeast supplementation effect during the last month of gestation was evaluated on ewes colostrum composition. Two groups of ewes (n=14) carrying twin lambs were constituted and twins were separated into groups (mothered or artificially-fed) 12h after birth. Nutrient, oligosaccharides (OS), IgG and lactoferrin concentrations were measured over 72h after lambing, and bacterial community was described in colostrum collected at parturition (T0). Immune passive transfer was evaluated through IgG measurement in lamb serum. In both groups, colostral nutrient, OS concentrations and IgG concentrations in colostrum and lamb serum decreased over time, (p < 0.01) except for lactose, which slightly increased (p < 0.001) and lactoferrin which remained stable. Bacterial population was stable over time with high relative abundances of Aerococcaceae, Corynebacteriaceae, Moraxellaceae and Staphylococcaceae in T0-colostrum. No effect of supplementation was observed in nutrient and lactoferrin concentrations. In supplemented ewes, colostral IgG level was higher at T0 and a higher level of serum IgG was observed in lambs born from supplemented mothers and artificially-fed, while no effect of supplementation was observed in the mothered lambs groups. Using a metabolomic approach, we showed that supplementation affected OS composition with significantly higher levels of colostral Neu-5Gc compounds up to 5h after birth. No effect of supplementation was observed on bacterial composition. Our data suggest that live yeast supplementation offsets the negative impact of early separation and incomplete colostrum feeding in neonate lambs.


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