Should we vaccinate the better seroconverters or the most vulnerable? Game changing insights for COVID-19 vaccine prioritization policies

Background With the rapid rise in COVID 19 cases incomparable to the number of vaccinations available, there has been a demand to prioritize the older age groups receiving the vaccine as they have more risk of morbidity and mortality and thus better outcome from vaccination. Main body Some studies showed a lower seroconversion rate in older group patients; thus, we discuss the necessity to reprioritize vaccinations to younger age groups who have better seroconversion rates, but we may face some ethical dilemma that could hinder our hypothesis. Decreased seroconversion rates in adults are attributable to immuno-senescence which involves a decrease in humoral and cellular-mediated immunity with age. Despite this fact, there remains some ethical dilemma that can hinder widespread vaccination of younger generations, the most important of which is the unknown long-term effects of COVID-19 vaccines due their fast-tracking under the pressure of the pandemic. Short conclusion Prioritizing children vaccination against COVID-19 seems an interesting strategy that can help in containing the pandemic. Resolving some ethical dilemma needs to be done before implementing such strategy.

Herpes Zoster Radiculopathy in a Systemic Lupus Erythematosus Patient – A Case Report

Background:Motor neuropathy is an extremely rare herpes complication, with a mere prevalence of 0.5–5%. The case of segmental zoster paresis of limbs, resulting from motor radiculopathy, is especially limited, with cervical and thoracic segments being the least frequent.Setting:Neurology outpatient clinic. CaseDescription:We report a case of a 16-year-old female who presented sudden-onset right upper extremity weakness, a week after her herpes zoster lesions first appeared. As she was diagnosed with systemic lupus erythematosus (SLE) 4 months prior, she routinely consumed steroids and azathioprine. Initial examinations revealed multiple vesicles along right C5-C6 roots dermatome accompanied by upper right extremity weakness (manual muscle test [MMT] 3) corresponding to the myotome of C5-C6 roots. An electromyography assessment uncovered results relevant to motor root neuritis in C5-C6. Magnetic resonance imaging of the cervical radix with contrast showed no abnormality. Thus, she received acyclovir, gabapentin and physiotherapy.Results:A follow-up visit after 2 weeks revealed an improvement of the weakness along C5-C6 myotome (MMT 4). A month later, all motor functions were restored with hypoesthesia and hypoalgesia sensory sequelae along C5-C6 dermatome.Conclusion:Herpes zoster radiculopathy, though rare, can occur after the onset of characteristic rash. Since cellular-mediated immunity holds crucial roles in varicella zoster virus activation, SLE and immunosuppression therapy is pertinent to this rare motoric complication of herpes. The prognosis is good. Acyclovir, gabapentin and physiotherapy treatments resulted in satisfactory recovery.

Integrating between-host transmission and within-host immunity to analyze the impact of varicella vaccination on zoster

Varicella-zoster virus (VZV) causes chickenpox and reactivation of latent VZV causes herpes zoster (HZ). VZV reactivation is subject to the opposing mechanisms of declining and boosted VZV-specific cellular mediated immunity (CMI). A reduction in exogenous re-exposure ‘opportunities’ through universal chickenpox vaccination could therefore lead to an increase in HZ incidence. We present the first individual-based model that integrates within-host data on VZV-CMI and between-host transmission data to simulate HZ incidence. This model allows estimating currently unknown pivotal biomedical parameters, including the duration of exogenous boosting at 2 years, with a peak threefold to fourfold increase of VZV-CMI; the VZV weekly reactivation probability at 5% and VZV subclinical reactivation having no effect on VZV-CMI. A 100% effective chickenpox vaccine given to 1 year olds would cause a 1.75 times peak increase in HZ 31 years after implementation. This increase is predicted to occur mainly in younger age groups than is currently assumed.

Evaluation of Humoral Immunity toMycobacterium tuberculosis-Specific Antigens for Correlation with Clinical Status and Effective Vaccine Development

Although tuberculosis remains a major global health problem, Bacille Calmette-Guérin (BCG) is the only available vaccine. However, BCG has limited applications, and a more effective vaccine is needed. Cellular mediated immunity (CMI) is thought to be the most important immune response for protection againstMycobacterium tuberculosis(Mtb). However, the recent failure of a clinical trial for a booster BCG vaccine and increasing evidence of antibody-mediated immunity prompted us to evaluate humoral immunity to Mtb-specific antigens. Using Enzyme-Linked ImmunoSpot and Enzyme-Linked ImmunoSorbent Assays, we observed less correlation of both CMI and IgG titers with patient clinical status, including serum concentration of C reactive protein. However, IgA titers against Mtb were significantly correlated with clinical status, suggesting that specific IgA antibodies protect against Mtb proliferation. In addition, in some cases, IgA antibody titers were significantly associated with the serum concentration of total albumin, which supports the idea that humoral immunity can be influenced by the nutritional status. Based on these observations, we propose that the induction of humoral immunity should be included as an option in TB vaccine development strategies.