Epidemiology and types of oral cancer

Oral cancer is a subset of head and neck cancer and usually refers to different neoplastic conditions that impact any tissue within the oral cavity. Evidence shows that these malignancies are associated with different complications over the affected patients. The present literature review will discuss the epidemiology and types of oral cancer based on evidence from relevant studies within the literature. Estimates show that oral cancer is a common condition with high prevalence rates globally. However, we have identified several factors across the different relevant investigations, including smoking, alcohol intake, age, socioeconomic status, immunocompromised state, and genetics. This might explain the inconsistent findings regarding the prevalence and mortality rates of the conditions among worldwide studies. Moreover, squamous cells carcinoma is the commonest type of oral cancer. However, other types might also be identified as adenocarcinoma, sarcoma, melanoma, and lymphoma. These lesions can also be found at different places within the mouth cavity, including lips, tongue, and salivary glands. Therefore, healthcare authorities should plan adequate interventional strategies targeting the risk factors to properly control the disease and reduce its burden.

The antibody response of haematological malignancies to COVID-19 infection and vaccination

SummaryCancer patients with COVID-19 have reduced survival. While most cancer patients, like the general population, have an almost 100% rate of seroconversion after COVID-19 infection or vaccination, patients with haematological malignancies have lower seroconversion rates and are far less likely to gain adequate protection. This raises the concern that patients with haematological malignancies, especially those receiving immunosuppressive therapies, may still develop the fatal disease when infected with COVID-19 after vaccination. There is an urgent need to develop Guidelines to help direct vaccination schedules and protective measures in oncology patients, differentiating those with haematological malignancies and those in an immunocompromised state.

Latent tuberculosis and COVID-19 disease

Since the start of the COVID-19 pandemic in 2020, there has been chaos in the world. With the COVID-19 cases rising, many other medical diseases have been ignored and not prioritized. One of these crucial diseases is Tuberculosis (TB). TB is a highly infectious bacterial respiratory disease. Every year there are millions of cases that are registered all around the world. TB is seen in two forms, an active and a latent form. In both of the states, the individual with TB is immunocompromised. This is of great importance, as COVID-19 is known to readily infect individuals in an immunocompromised state more than those with a healthy immune system. Although a little investigation about coexisting infections with COVID-19 and TB is conducted, it is important to consider many factors that can be beneficial to help treat these patients with both conditions effectively and promptly. A few of these factors are pathophysiological relation, diagnostic measurements, effects of each condition on the other, and approaches to treatment. Through a literature review of available information, we summarized the knowledge regarding the correlation between Latent TB infection and COVID-19 infection. The main objective of this publication is to provide a brief overview of how the two conditions overlap with one another. The article also provides a clinical review of how to approach these two conditions in a scenario where an individual is found to be infected with both Latent TB and COVID-19.

Assessment of correlations between risk factors and symptom presentation among defined at-risk groups following a confirmed COVID-19 diagnosis

This study analyzes the specific linkages between symptoms within individual COVID patients belonging to at-risk groups. The goal was to determine how strongly linked patient symptoms are within these at-risk groups to find any associations between factors such as comorbidities and COVID symptoms. In this study, de-identified patient data from the N3C database was utilized in order to link representative immunocompromised states with specific symptoms, and non-immunocompromised state with the same, to determine if the strength of the correlation changes for these at-risk groups. Multiple autoimmune disorders resulting in immunocompromised state were analyzed, to determine if severity of immune response and inflammatory action plays a role in any potential differences. An exploratory approach using statistical methods and visualization techniques appropriate to multidimensional data sets was taken. The identified correlations may allow pattern analysis in disease presentation specific to a given population, potentially informing pattern recognition, symptom presentation, and treatment approaches in patients with immune comorbidities.

Fetal Complications in COVID-19 Infected Pregnant Woman: A Systematic Review and Meta-Analysis

Background Pregnancy is an immunocompromised state and, for this reason, a pregnant woman is at a higher risk of getting infected as compared with a healthy individual. There is limited data available regarding the impact of COVD-19 on pregnancy; however, the case of miscarriage due to placental infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in second trimester has already been reported. Methods We searched for all published articles in PubMed, Science Direct, Cochrane, Scopus, and Embase. The literature search produced 167 relevant publications; 67 manuscripts were further excluded because they did not satisfy our inclusion criteria. Out of the remaining 100 articles, 78 were excluded after full text screening. Therefore, a total of 22 articles were eligible for review in our study. Results Overall, these 22 studies included a total of 7,034 participants: 2,689 (38.23%) SARS-CoV-2 positive pregnant women, of which 2,578 (95.87%) were laboratory confirmed and 111 (4.13%) were clinically diagnosed. Among the positive patients, there were 174 (6.47%) cases of abortion, of them 168 (96.55%) were spontaneous abortions and 6 (3.45%) were missed. Most patients either reported mild symptoms of fever, cough, fatigue, and anosmia or they presented asymptomatic. Conclusion Additional investigation and rigorous research are warranted to confirm placental pathology mechanisms concerning COVID-19 to protect maternal and fetal health.

COVID-19 Clinical Manifestations & Concerns among the Kingdom of Saudi Arabia's 937 Health Hotline Callers in Jeddah

The on-going COVID-19 pandemic has highlighted telehealth as a crucial tool in delivering high quality healthcare with increased efficiency. In the Kingdom of Saudi Arabia this has been evidently clear with the establishment of the robust Ministry of Health 937 COVID-19 hotline. The objectives of our study are to describe the clinical patterns of COVID-19, identify the most common concerns of the 937 hotline callers and to identify the associations between the clinical presentation of COVID-19 and risk factors of the patients.through an Analytic Cross-Sectional study design. Results : The average age was 36.8 ± 15.7 years, 61.1% were males and 38.9% were females. 69.3% were Saudi and 30.7% were non-Saudis. 82.5% employed, whilst 17.5% were unemployed.The most commonly reported symptoms were fever, followed by fatigue and cough respectively. With 41.8%, 28.2% and 23.2% of participants reporting those symptoms respectively. The most significant predictors of developing shortness of breath due to COVID-19 was chronic lung disease OR=5.7pvalue >0.01, chronic kidney disease, OR = 4.8 p value >0.02 and immunocompromised state OR = 19 >0.01. 82% of all calls to the hotline were related to COVID-19 testing, and 11% of all calls resulted in the caller receiving medical counselling and/or treatment without having to make a physical visit to a healthcare provider. Conclusion : A well-designed telehealth program can mitigate the need for a physical visit to the emergency room or clinic and as such reduce the load on front-line healthcare workers, reducing transmission and improving outcomes during infectious disease epidemics. It can also provide valuable insights into the presentation and risk factors of a new disease to aid in the prevention, diagnosis, management and control of the disease.

LB9. Longitudinal antibody dynamics in children infected with SARS-CoV-2 through 6 months post-infection

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection elicits antibodies (Abs) that bind several viral proteins such as the spike entry protein and the abundant nucleocapsid (N) protein. We examined convalescent sera collected through 6 months (~24wks) post-SARS-CoV-2 infection in children to evaluate changes in neutralization potency and N-binding. Methods Outpatient, hospitalized, and community recruited volunteers < 18 years with COVID-19 were enrolled in a longitudinal study at Seattle Children’s Hospital. Analysis includes symptomatic and asymptomatic children with laboratory-confirmed SARS-CoV-2 infection who provided blood samples at approximately 4wks (range: 2-18wks, IQR:4-8wks) and 24 wks (range: 23-35wks, IQR:25-27wks) after diagnosis. We measured neutralizing Ab using an in-house pseudoneutralization assay and anti-N binding Ab using the Abbott Architect assay. Results Of 32 children enrolled between April 2020 and January 2021, 27 had no underlying immunocompromised state and 25 of these 27 children had symptomatic disease. Ten of 27 had a > 2-fold decrease neutralization titers between 4 and 24wks (most were < 10-fold); 12 had < 2-fold change; and 5 had neutralization titers that increased > 2-fold over time (Fig. 1A). All but one of these 27 children had detectable neutralizing activity at 24wks. Anti-N Abs were assessed for 25 children at 4wks and 17 children at 24wks (data pending for 14 samples); all children with paired samples had a > 1.75-fold Abbott index reduction at 24wks, and 5 children had no detectable anti-N Abs by 24wks (Fig. 2A). An additional 5 children with symptomatic disease had complicating immunosuppression or multiple blood transfusions; 2 had decreasing neutralizing titers, 2 increased, and 1 had no change (Fig. 1B). Anti-N Abs were undetectable for one child by 24wks (data pending for 4 samples) (Fig. 2B). No participants received COVID-19 vaccine. Figure 1. Pseusoneutralization titers in children over time. Figure 2. Nucleocapsid-binding antibody titers in children over time. Conclusion We show neutralizing Abs wane to a small degree over 24wks post-SARS-CoV-2 infection and remain detectable in most children. In contrast, anti-N Abs decreased, becoming undetectable in some children by 24wks. These findings add to understanding of the natural history of SARS-CoV-2 immunity in children. * This study was supported by CDC BAA75D301-20-R-67897 Disclosures Jesse Bloom, PhD, Flagship Labs 77 (Consultant)Moderna (Consultant) Janet A. Englund, MD, AstraZeneca (Consultant, Grant/Research Support)GlaxoSmithKline (Research Grant or Support)Meissa Vaccines (Consultant)Pfizer (Research Grant or Support)Sanofi Pasteur (Consultant)Teva Pharmaceuticals (Consultant)

554. Clinical Impact of Monoclonal Antibody Therapy with SARS-CoV-2 Infection

Background The novel coronavirus SARS-CoV2 is the causative agent for COVID-19 responsible for the ongoing global pandemic. The spike protein on its surface binds to the angiotensin-converting enzyme 2 receptor helps to enter human cells. Neutralizing antibodies to this protein can be protective and helpful in alleviating symptoms. Monoclonal antibodies (mAb) have been utilized in the U.S. under an emergency use authorization by the FDA, including bamlanivimab (BAM) and casirivimab-imdevimab (CAR/IMD). We report our experience of using COVID mAb. Methods We conducted a retrospective chart review of patients that received CAR/IMD or BAM between December 1st, 2020, and May 15th, 2021. Medical records were reviewed to determine demographic and clinical information as well as tolerability and effectiveness of mAb. Results 463 patients with mild to moderate symptoms of SARS-CoV2 received mAb: 355(176 Men) BAM, 108(53 Men) CAR/IMD. The median BMI was 31 (17.4 to 62.5), 85% Caucasian, 4% Asian, 3% African American, 4% Hispanic, 4% others. The average duration of symptoms was 3.4 days and included cough (74%), malaise (71%), Headache (28%), dyspnea (28%), rhinorrhea (25%), fever (20%), diarrhea (18%), and anosmia (14%). Risk factors included hypertension (65%), diabetes mellitus (32%), coronary artery disease (22%), asthma (16%), COPD (9%), CHF (9%), CKD (8%), active malignancy (6%), and immunocompromised state (7%). Those who received BAM were older (p=0.000) and have underlying dementia and congestive heart failure (p=0.025 and 0.034, respectively). 27 patients (2 CAR/IMG, 25 BAM) got admitted to the hospital due to worsening of their respiratory status and were treated for COVID-19. 4 patients in the BAM group and 0 in the CAR/IMD group died. 2 patients developed a mild allergic reaction to CAR/IMD, no other side effects were reported in both groups. 37 patients (19 CAR/IMD, 18 BAM) received mRNA COVID vaccine prior. Overall mortality rate was 0.8%. There was no significant difference between BAM and CAR/IMR in terms of hospitalization (p= 0.104) or mortality (p=0.268). Conclusion Treatment with BAM versus CAR/IMR was well tolerated and resulted in similar outcomes in terms of hospitalization or mortality. Disclosures All Authors: No reported disclosures

190. Epidemiology of COVID-19 Breakthrough Infections in Dallas County, Texas, 2021

Background From March 2020 through May 2021, Dallas County reported a total of 304,056 cases of COVID-19, including 4,073 deaths. During the month of December 2020, a post-holiday surge of cases led to peak daily average case rates of over 50 cases per 100,000. COVID-19 cases and deaths have since declined substantially following the rollout of COVID-19 vaccine delivery. As of June 8, 2021, about 1,831,588 Dallas County residents have received at least one COVID-19 vaccine dose and 910,067 are fully vaccinated. Recent county integration of immunization and case databases enabled identification and analysis of COVID-19 breakthrough infections. Methods A COVID-19 breakthrough infection was defined as a positive test (PCR or antigen) collected from an individual ≥ 14 days after receiving the full series of an FDA-authorized COVID-19 vaccine. Nationally, 10,262 vaccine breakthrough infections had been reported from 46 US states and territories, through April 2021. Vaccine breakthrough cases were reviewed and medical records abstracted to collect demographic information, clinical characteristics, and medical conditions. Data analysis was performed using R, version 4.0.2 (2020). Results Of the 700 vaccine breakthrough cases reported in Dallas County residents as of June 8, 2021, 304 (43%) were male and 396 (57%) female, with an average age of 53 years. The majority of the vaccine breakthrough cases were White (42%); 25% were Hispanic/Latino; and 20% were Black. Almost all breakthrough cases were confirmed with PCR testing, with 451 (64%) cases receiving the Pfizer vaccine. Of breakthrough cases, 49% were symptomatic; 52% (358) had underlying conditions including: tobacco use, obesity, or immunocompromised state; 68 (10%) were hospitalized; and 11 (1.6%) died. Whole genome sequencing was performed on 51 cases, with 14 (27.5%) variants identified, including: eight B.1.1.7, two B.1.429 and one P.1 variants. Conclusion Despite the high levels of vaccine efficacy documented in US vaccine trials, COVID-19 breakthrough infections, though currently uncommon, do occur and are important to investigate. Ongoing close public health surveillance of variants is needed to discern changes in patterns of vaccine efficacy and characteristics of populations at greatest risk of severe disease from COVID-19. Disclosures All Authors: No reported disclosures

Herpes simplex esophagitis in an immunocompetent host: a case report

ABSTRACT Esophagitis caused by Herpes Simplex virus is a well-recognized opportunistic infection in the immunocompromised or severely ill host. However, it is uncommon in otherwise immunocompetent host. It usually responds well to a course of acyclovir. We report a case of young female without any other immunocompromised state who presented with severe dysphagia. She was diagnosed endoscopically and later with histopathology and recovered well after a course of acyclovir.