Higher Risk Of Severe COVID-19 Research Articles

Breast cancer (BC) and severe COVID-19 (C-19) outcomes: a matched analysis.

Patients with cancer receiving anticancer treatment have a higher risk of severe COVID-19 (C-19) outcomes. We examine the association between breast cancer (BC), recent treatment (systemic therapy, surgery, radiation), and C-19 outcomes. Retrospective matched cohort study using the Optum® de-identified C-19 Electronic Health Record dataset (2007-2022). Patients with C-19 were categorized into: no cancer, BC with recent treatment, and BC without recent treatment and matched based on age, C-19 diagnosis date, and comorbidity score. We evaluated 30-day mortality, mechanical ventilation, intensive care unit (ICU) stay, and hospitalization. A composite outcome including all outcomes was analyzed. Multivariable logistic regression models were used. 2200 matched triplets (1:1:10) of patients with BC recently treated, BC not recently treated, and no cancer were included. Rates of adverse outcomes improved in 2021 compared to 2020. Compared to patients without cancer, those with BC recently treated had a similar risk of adverse outcomes, while patients with BC not recently treated had a lower risk of ICU stay and hospitalization. Using the composite variable, BC recently treated had similar outcomes (OR = 1.02; 95%CI 0.93-1.11) to patients without cancer, while BC patients not recently treated had better outcomes (OR = 0.66; 95%CI 0.59-0.74). Among patients with BC, chemotherapy within 3months was associated with a higher risk of hospitalization (OR = 2.30; 95%CI 1.76-2.99) and composite outcome (OR = 2.11; 95%CI 1.64-2.72). Patients with BC have a similar risk of adverse C-19 outcomes compared to patients without cancer. Among patients with BC, recent chemotherapy was associated with a higher risk of hospitalization.

Interim Effectiveness of Updated 2023-2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19-Associated Hospitalization Among Adults Aged ≥18 Years with Immunocompromising Conditions - VISION Network, September 2023-February 2024.

In September 2023, CDC's Advisory Committee on Immunization Practices recommended updated 2023-2024 (monovalent XBB.1.5) COVID-19 vaccination for all persons aged ≥6 months to prevent COVID-19, including severe disease. As with past COVID-19 vaccines, additional doses may be considered for persons with immunocompromising conditions, who are at higher risk for severe COVID-19 and might have decreased response to vaccination. In this analysis, vaccine effectiveness (VE) of an updated COVID-19 vaccine dose against COVID-19-associated hospitalization was evaluated during September 2023-February 2024 using data from the VISION VE network. Among adults aged ≥18 years with immunocompromising conditions, VE against COVID-19-associated hospitalization was 38% in the 7-59 days after receipt of an updated vaccine dose and 34% in the 60-119 days after receipt of an updated dose. Few persons (18%) in this high-risk study population had received updated COVID-19 vaccine. All persons aged ≥6 months should receive updated 2023-2024 COVID-19 vaccination; persons with immunocompromising conditions may get additional updated COVID-19 vaccine doses ≥2 months after the last recommended COVID-19 vaccine.

Absence of short-term changes in knowledge and attitudes among household contacts of COVID-19 cases during the post-acute phase of the pandemic in Catalonia and Navarre, Spain.

To evaluate short-term changes in knowledge and attitude towards COVID-19 and preventive measures during the post-acute phase of the pandemic in Spain. A survey was performed in Catalonia and Navarre between May-2022 and July-2023 in household contacts of COVID-19 cases. Knowledge and attitude were assessed at baseline and at three months, using a Likert scale. Responses were grouped according to correct or incorrect. At baseline, 172 subjects were contacted, 118 (69%) of which completed a follow-up interview three months later. Knowledge of correct hand-washing and mask protocols had maintained over time (-1.7%, p = 0.553 and - 2.5%, p = 0.473, respectively). Attitudes toward preventive measures was adequate in the first interview (86%), but attitudes regarding use of face masks decreased significantly (-9.1%, p = 0.048) over time in participants with higher risk of severe COVID-19. However, most short-term changes in knowledge and attitudes were not statistically significant. Household contacts showed correct knowledge and attitude towards COVID-19 and its preventive measures, without significant changes in the short term despite a relaxation of government-mandated preventive measures. These results provide relevant information in case of a new health emergency due to respiratory viruses.

Oral antiviral utilisation among older adults with COVID-19 in primary care: A population-wide study during successive Omicron waves in Singapore

Studies have repeatedly demonstrated the real-world effectiveness of oral antivirals (OAVs) in preventing hospitalisation and death in patients with mild-to-moderate COVID-19 at high risk for progression to severe COVID-19 when initiated within 5 days of symptom onset, even during waves of Omicron transmission.1 However, there is a need to determine if OAVs are reaching recommended groups, particularly among older adults and socioeconomically disadvantaged groups at higher risk of severe COVID-19. Disparities in access to OAVs based on area-level socioeconomic status (SES) have been documented in the US, UK and Australia,2-4 with substantially lower dispensing rates reported from more deprived areas. However, to the best of our knowledge, no studies have evaluated disparities in OAV access among urbanised Asian populations, including Singapore.

Immunisation efficacy of a stabilised SARS-CoV-2 spike glycoprotein in two geriatric animal models

Age is associated with reduced efficacy of vaccines and linked to higher risk of severe COVID-19. Here we determined the impact of ageing on the efficacy of a SARS-CoV-2 vaccine based on a stabilised Spike glycoprotein (S-29) that had previously shown high efficacy in young animals. Thirteen to 18-month-old golden Syrian hamsters (GSH) and 22–23-month-old K18-hCAE2 mice were immunised twice with S-29 protein in AddaVaxTM adjuvant. GSH were intranasally inoculated with SARS-CoV-2 either two weeks or four months after the booster dose, while all K18-hACE2 mice were intranasally inoculated two weeks after the second immunisation. Body weight and clinical signs were recorded daily post-inoculation. Lesions and viral load were investigated in different target tissues. Immunisation induced seroconversion and production of neutralising antibodies; however, animals were only partially protected from weight loss. We observed a significant reduction in the amount of viral RNA and a faster viral protein clearance in the tissues of immunized animals. Infectious particles showed a faster decay in vaccinated animals while tissue lesion development was not altered. In GSH, the shortest interval between immunisation and inoculation reduced RNA levels in the lungs, while the longest interval was equally effective in reducing RNA in nasal turbinates; viral nucleoprotein amount decreased in both tissues. In mice, immunisation was able to improve the survival of infected animals. Despite the high protection shown in young animals, S-29 efficacy was reduced in the geriatric population. Our research highlights the importance of testing vaccine efficacy in older animals as part of preclinical vaccine evaluation.

Characteristics of Elderly-Onset Rheumatoid Arthritis Patients With COVID-19

Abstract This study aimed to investigate the clinical characteristics of elderly-onset rheumatoid arthritis (EORA) patients with COVID-19. We retrospectively enrolled EORA patients diagnosed with COVID-19 from December 2022 through February 2023 and followed them up. Demographic characteristics of the patients and clinical data on COVID-19 were collected, and EORA-related data at the onset of rheumatoid arthritis and during COVID-19 episodes were evaluated. A total of 102 EORA outpatients were enrolled and stratified into the COVID-19 group (n = 60) and the non–COVID-19 group (n = 42). In the COVID-19 group, 56 (93.3%) had symptoms, 8 (13.3%) had viral pneumonia, and 4 (6.7%) developed severe COVID-19. Multivariate logistic regression analysis showed that lack of COVID-19 vaccination (P = 0.016 and P = 0.030, respectively) and having interstitial lung disease (P = 0.013 and P = 0.001, respectively) were independent risk factors for viral pneumonia and severe COVID-19. Compared with the general population, EORA patients did not show significantly higher susceptibility to COVID-19 or a higher risk of severe COVID-19. However, EORA patients with interstitial lung disease require special consideration during COVID-19 episodes.

Risk of Severe COVID-19 and Protective Effectiveness of Vaccination Among Solid Organ Transplant Recipients.

Solid organ transplant recipients (SOTRs) are at higher risk for severe infection. However, the risk for severe COVID-19 and vaccine effectiveness among SOTRs remain unclear. This retrospective study used a nationwide health care claims database and COVID-19 registry from the Republic of Korea (2020 to 2022). Adult SOTRs diagnosed with COVID-19 were matched with up to 4 non-SOTR COVID-19 patients by propensity score. Severe COVID-19 was defined as treatment with high-flow nasal cannulae, mechanical ventilation, or extracorporeal membrane oxygenation. Among 6783 SOTRs with COVID-19, severe COVID-19 was reported with the highest rate in lung transplant recipients (13.16%), followed by the heart (6.30%), kidney (3.90%), and liver (2.40%). SOTRs had a higher risk of severe COVID-19 compared to non-SOTRs, and lung transplant recipients showed the highest risk (adjusted odds ratio, 18.14; 95% confidence interval [CI], 8.53-38.58). Vaccine effectiveness against severe disease among SOTRs was 47% (95% CI, 18%-65%), 64% (95% CI, 49%-75%), and 64% (95% CI, 29%-81%) for 2, 3, and 4 doses, respectively. SOTRs are at significantly higher risk for severe COVID-19 compared to non-SOTRs. Vaccination is effective in preventing the progression to severe COVID-19. Efforts should be made to improve vaccine uptake among SOTRs, while additional protective measures should be developed.

Healthcare resource utilisation and costs of hospitalisation and primary care among adults with COVID-19 in England: a population-based cohort study

ObjectivesTo quantify direct costs and healthcare resource utilisation (HCRU) associated with acute COVID-19 in adults in England.DesignPopulation-based retrospective cohort study using Clinical Practice Research Datalink Aurum primary care electronic medical...

Risk of Severe Sars-Cov-2 Infections in COVID-19 Vaccinated Individuals with Hematologic Malignancies (SAVE HEM): A Nationwide Cohort Study in the Netherlands

Introduction COVID-19 vaccination protects against a severe course of COVID-19. Nevertheless, individuals with hematologic malignancies (HM) remain at increased risk of COVID-19-related morbidity and mortality compared to the general population. However, these relative risks are unknown for individuals with specific hematologic cancers and treatments. We aimed to quantify the risk of severe COVID-19 among individuals with HM who had completed primary COVID-19 vaccination (i.e., two-dose generally, but three-dose in patients with a malignancy history). Therefore, we compared COVID-19 outcomes to those in individuals with no malignancy (NM) and individuals with solid malignancies (SM) who had completed primary COVID-19 vaccination. Thanks to unique centrally registered data on cancer care (Netherlands Cancer Registry, NCR), we were able to stratify risk for different hematologic malignancies. Methods We conducted a nationwide cohort study including all inhabitants of the Netherlands registered in the Personal Records Database on January 1, 2020, (n = 17 407 585) through linkage of data on cancer care, COVID-19 vaccination, SARS-CoV-2 testing, COVID-19-related hospitalization, and mortality. We used data from January 1, 2010, to December 31, 2022. We included individuals who completed primary COVID-19 vaccination at age 18 years or older and were SARS-CoV-2-infected more than two weeks later. Severe disease was defined as a SARS-CoV-2 infection resulting in hospital admission or death. We fitted generalized estimating equations and calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the associations between an HM history and severe COVID-19, relative to a history with NM and SM. In addition, we calculated aORs for associations between malignancy history and COVID-19-related hospital admission, ICU admission, and mortality. Odds ratios were adjusted for age and sex as potential confounders. We conducted stratified analyses by type of hematologic malignancy and incidence period of SARS-CoV-2 infection. For technical reasons, we calculated aORs using a random sample of 350 000 SARS-CoV-2-infected individuals from the NM group. Results We included 8 210 individuals with HM, 350 000 individuals with NM, and 37 752 individuals with SM. We observed 8 552, 364 530, and 38 432 SARS-CoV-2 infections in individuals with HM, NM, and SM, respectively. Severe COVID-19 was recorded in 817, 2 834 and 1 412 cases, respectively. Individuals with HM were at higher risk of severe COVID-19 compared to individuals with NM and SM (aOR [95% CI] for HM vs. NM 4.6 [4.2-5.0]; for HM vs. SM 3.3 [3.0-3.7]) (Figure 1). Patients with HM were at increased risk for COVID-19-related hospitalization (aOR [95% CI] for HM vs. NM 4.6 [4.3-5.1]; for HM vs. SM 3.4 [3.1-3.7]), for COVID-19-related ICU admission (aOR [95% CI] for HM vs. NM 6.5 [5.0-8.4]; for HM vs. SM 6.3 [4.6-8.6]), and for COVID-19-related mortality (aOR [95% CI] for HM vs. NM 1.7 [0.9-3.0]; for HM vs. SM 1.9 [1.0-3.7]). Within the group of HM, those with a diagnosis of acute lymphatic leukemia/lymphoblastic lymphoma or acute myeloid leukemia were at the highest risk of severe COVID-19 compared to individuals with NM, while those with myeloproliferative malignancies or cutaneous lymphomas had the lowest risk (Figure 1). Stratified analyses by incidence period of SARS-CoV-2 infection demonstrated that the aORs for severe COVID-19 remained increased over time, comparing individuals with HM to those with NM. Adjustments for other confounders, such as socio-economic status, and stratified analyses by incidence year of malignancy, immunosuppressive treatment, and number of booster vaccinations are currently being performed. Conclusions Despite intensified COVID-19 vaccination, individuals with HM remain at increased risk for a severe course of COVID-19 compared to both individuals with NM and SM. However, the degree of vulnerability within the hematologic population depends on type of malignancy and this should be taken into account when offering additional booster vaccinations or scarce COVID-19 therapeutics, such as protease inhibitors or antibody-based therapy.

Humoral and cellular immunity against different SARS-CoV-2 variants in patients with chronic kidney disease

Chronic kidney disease (CKD) patients are at higher risk of severe COVID-19. Humoral and cellular immunity from prior infection or vaccination are important for protection, but the neutralizing antibody (nAb) response against SARS-CoV-2 variants is impaired. We investigated the variant-specific nAb and T cell immunity among CKD patients. Adult CKD patients were recruited between August and October 2022. nAb against the SARS-CoV-2 (ancestral strains and four Omicron sublineages) and T cell response were measured using the live virus neutralization assay and interferon-gamma release assay (IGRA). The correlation between nAb/T-cell response and subsequent infection after recruitment were also determined. Among the 88 recruited patients, 95.5% had prior infection or had completed the primary vaccine series. However, only 77.3% had detectable nAb against at least one SARS-CoV-2 strains, 59.1% tested positive in IGRA, and 52.3% had detectable nAb and tested positive in the IGRA. The nAb geometic mean titers (GMTs) against XBB.1, BA.5 and BA.2.3.20 were significantly lower than those against BA.2 and ancestral strain. Prior SARS-CoV-2 infection was associated with elevated nAb and T cell response. More kidney transplant recipients (KTRs) showed absent nAb and T cell response (36.8% vs. 10.1%), despite a higher prevalence of vaccine booster in this population (94.7% vs. 50.7%). Lower levels of nAb titer and T cell response were significantly associated with subsequent infection. A considerable proportion of CKD patients, especially KTRs, showed absence of humoral and cellular protective immunity against SARS-CoV-2. Strategies to improve immunogenicity in this population are urgently needed.

Clinical characteristics and factors associated with severe COVID-19 in hospitalized children during the SARS-CoV-2 Omicron pandemic in Taiwan.

Since April 2022, a notable increase in COVID-19 cases with the rapid spread of the SARS-CoV-2 Omicron variant has been reported in Taiwan. In the epidemic, children were one of the most vulnerable groups, so we analyzed their clinical presentations and factors associated with severe complications of COVID-19 in children. We included hospitalized patients under 18 years old with lab-confirmed SARS-CoV-2 infection from March 1, 2022, to July 31, 2022. We collected the demographic and clinical characteristics of the patients. Patients requiring intensive care were defined as severe cases. Among the 339 enrolled patients, the median age was 31 months (interquartile range (IQR), 8-79.0 months); and 96 patients (28.3%) had underlying diseases. Fever was noted in 319 patients (94.1%) with a median duration of two days (IQR 2-3 days). Twenty-two patients (6.5%) were severe cases, including 10 patients (2.9%) with encephalopathy with abnormal neuroimaging and ten patients (2.9%) with shock. Two patients (0.6%) died. Patients with congenital cardiovascular disease (aOR: 21.689), duration of fever up to four days or more (aOR: 6.466), desaturation (aOR: 16.081), seizure (aOR: 20.92), and procalcitonin >0.5ng/mL (aOR: 7.886) had a higher risk of severe COVID-19. Vital signs need close monitoring, early management and/or intensive care may be applied in COVID-19 patients with congenital cardiovascular diseases, fever lasting ≥4 days, seizures, desaturation and/or elevated procalcition since they are at higher risks of severe diseases.

Patterns of physical activity and SARS-CoV-2 severe pneumonia: A case–control study

BackgroundRegular physical activity is associated with a low risk of severe community-acquired infections. However, the hypothesis that a physical inactivity pattern is associated with a higher risk for severe COVID-19 has not been completely proven, especially with severe pneumonia. ObjectiveThe goal of this study was to confirm the link between physical activity patterns and severe SARS-CoV-2 pneumonia. DesignCase–control study. MethodsThis study involved 307 patients who developed SARS-CoV-2 severe pneumonia and were hospitalized in an intensive care unit. Age- and sex-matched controls (307) were selected from the same population: patients with mild to moderate forms of COVID-19 who were not hospitalized. Physical activity patterns were assessed using the short version of the International Physical Activity Questionnaire. ResultsThe mean physical activity levels were lower in the SARS-CoV-2 severe pneumonia group as compared to the control group: 1576±2939 vs 2438±2999, metabolic equivalent of task (MET-min/week), p<0.001. A high or moderate physical activity level was more common in the control group, and a low physical activity level was more observed in the case group (p<0.001). Obesity was also associated with severe SARS-CoV-2 pneumonia (p<0.001). Multivariable analysis showed that a low physical activity level was associated with a higher risk for severe SARS-CoV-2 pneumonia, independent of nutritional status (CI 3.7; 2.24–5.99), p<0.001). ConclusionA higher and moderate level of physical activity is linked to a lower risk of SARS-CoV-2 severe pneumonia.

Analysis of the Relationship between Serum Magnesium Levels and Severity of COVID-19 Patients

Magnesium (Mg) plays an important role in the homeostasis functions of the lungs and heart for humankind. However, there is limited information concerning the importance of such an electrolyte mineral to COVID-19 pathogenesis. The Mg level is not primarily considered for the analysis of infectious diseases in the laboratory. The purpose of this study was to analyze the relationship between Mg levels and COVID-19 patient severity at Dr. Wahidin Sudirohusodo Hospital, Makassar. This research was a retrospective study with a cross-sectional design. Samples were prepared from 186 patients. Serum Mg levels were measured using an ABX Pentra 400C analyzer and the patients diagnosed with COVID-19 were then classified into abnormal and normal magnesemia. Based on the severity of COVID-19, patients were then categorized into severe and non-severe. The obtained data were then statistically analyzed using the Kolmogorov-Smirnov test, Mann-Whitney test, Chi-Square, and odd ratio with a significant level of p &lt;0.05. The mean values of serum Mg levels of severe COVID-19 patients (2.53±2.03 mg/dL) were not significantly different compared to those of non-severe COVID-19 patients (2.12±0.83 mg/dL) with p=0.712. Patients with abnormal magnesemia had a 2.625 times higher risk of severe COVID-19 (95% CI = 1.499 – 4.757, p-value=0.001) compared to those with normal magnesemia. There was a significant relationship between serum Mg levels and the severity of COVID-19 patients at Dr. Wahidin Sudirohusodo Hospital. Patients with abnormal Mg levels had a 2.625 times higher risk of severe COVID-19. Magnesium concentration is an important parameter, which must be monitored in the laboratory analyses of COVID-19 patients.  

Association of Anthropometric Parameters and Severity of SARS-COV-2 Infection among Hospitalized Patients in a Tertiary care Center in Western Maharashtra – an Analytical Cross-Sectional Study

Background: On March 11, 2020, the World Health Organization (WHO) confirmed COVID-19 as a pandemic. COVID-19 has infected more than 5.5 million people worldwide, resulting in more than 3,47,000 fatalities. Obese individuals may be more susceptible to infection with SARSCoV-2. This study was conducted to assess the association between anthropometric parameters and the severity of SARS-CoV-2 infection.&#x0D; Methodology: This analytical cross-sectional study was undertaken on COVID-19-positive patients admitted to COVID-dedicated wards at a tertiary care center in Pune. The data was collected using a convenient sampling method from 185 COVID-19-positive patients.&#x0D; Result: Among those Positive for SARS-COV-2, 128 (69.19%) patients had mild COVID-19, and 57 (30.81%) patients were having severe COVID-19 disease. 36 patients (28.13%) with mild COVID-19 disease were average weight, 48 patients (37.50%) were overweight, and 42 patients (32.81%) were obese. Three (5.26%) of the 57 patients with severe COVID-19 disease were overweight, and 54 (94.74%) were obese. 19 (10.2%) patients had previously been diagnosed with hypertension, and 22 (11.8%) patients had both hypertension and diabetes.&#x0D; Conclusion: Obesity in patients with COVID-19 was associated with severe diseases, particularly pneumonia. Patients having underlying medical illnesses like hypertension and diabetes were found to be at higher risk of severe COVID-19.

Severe coronavirus disease 2019 in pediatric solid organ transplant recipients: Big data convergence study in Korea (K-COV-N cohort)

ObjectivesThe risk of severe COVID-19 in children with a solid organ transplant (SOT) is not well established. We compare the relative risk of severe COVID-19 infection between pediatric SOT and non-SOT children. MethodsThe newly constructed K-COV-N cohort (Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service) was used. Children with COVID-19 (<18 years old) who underwent SOT between January 2008 to January 2022 were included. Non-SOT children with COVID-19 were selected in a ratio of 1:4 using propensity score matching. Three definitions of severe COVID-19 were established based on their requirement for respiratory support: severe I (requiring respiratory support above a high-flow nasal cannula or prolonged hospitalization ≥6 days), severe II (requiring any oxygen supplement), and severe III (requiring any oxygen supplement or prolonged hospitalization ≥6 days). ResultsAmong 2,957,323 children with COVID-19, 206 pediatric SOT recipients (SOTRs) were identified and included in the analysis along with 803 matched non-SOT children. Most infections (96.6%) occurred during the Omicron period; no cases of mortality were reported. Pediatric SOTR had a 3.6-fold (95% confidence interval = 1.1-11.7, P = 0.03) higher risk of severe I, and a 4.9-fold (95% confidence interval = 1.6-15.0, P = 0.006) higher risk of severe III than non-SOT children. No cases of severe II occurred in the non-SOT children. Although not statistically significant, no severe COVID-19 cases were reported in the vaccinated SOT group (0.0% vs 5.7%, P = 0.09 in severe III). ConclusionPediatric SOTRs have a significantly higher risk of severe COVID-19 than non-SOT children. Our findings support the need for tailored strategies for these high-risk children.

Altered anti-viral immune responses in monocytes in overweight heavy drinkers

Alcohol abuse causes increased susceptibility to respiratory syndromes like bacterial pneumonia and viral infections like SARS-CoV-2. Heavy drinkers (HD) are at higher risk of severe COVID-19 if they are also overweight, yet the molecular mechanisms are unexplored. Single-cell RNA-sequencing (scRNA-seq) was performed on peripheral blood mononuclear cells from lean or overweight HD and healthy controls (HC) after challenge with a dsRNA homopolymer (PolyI:C) to mimic a viral infection and/or with lipopolysaccharide (LPS). All monocyte populations responded to both PolyI:C and LPS with pro-inflammatory gene expression. However, the expression of interferon-stimulated genes, essential for inhibiting viral pathogenesis, was greatly reduced in overweight patients. Interestingly, the number of upregulated genes in response to the PolyI:C challenge was far greater in monocytes from HD compared to HC, including much stronger pro-inflammatory cytokine and interferon-γ signaling responses. These results suggest that increased body weight reduced anti-viral responses while heavy drinking increased pro-inflammatory cytokines.

Causal associations between type 1 diabetes and COVID-19 infection and prognosis: a two-sample Mendelian randomization study

IntroductionIt has been suggested that type 1 diabetes was associated with increased COVID-19 morbidity and mortality. However, their causal relationship is still unclear. Herein, we performed a two-sample Mendelian randomization...

The challenges of the pandemic and the vaccination against covid-19 in pediatric patients with kidney disease.

The covid-19 vaccine confers direct protection and reduces transmission rates of the virus and new variants. Vaccines from Pfizer/BioNTech and CoronaVac have been cleared for children in Brazil. They are safe, effective, and immunogenic. There are no known complications associated with the use of steroids or vaccines in pediatric patients with covid-19 and nephrotic syndrome. With or without immunosuppression, these patients are not at increased risk of severe covid-19, and steroids are safe for them. A milder form of covid-19 occurs in patients with chronic kidney disease without the need for hospitalization. The vaccine response may be reduced and/or the duration of antibodies after vaccination may be shorter than in the general population. However, considering risk of exposure, vaccination against covid-19 is recommended. It is believed that patients with hemolytic-uremic syndrome are at higher risk of severe covid-19. Vaccination is recommended, although specific data on the safety and efficacy of the covid-19 vaccine are limited. There is agreement that the benefits of induced immunity outweigh the risks of immunization. Vaccination against covid-19 is recommended for children and adolescents needing kidney transplantation or who have undergone transplantation. These patients present decreased immune response after vaccination, but immunization is recommended because the benefits outweigh the risks of vaccination. Current recommendations in Brazil stipulate the use of the messenger RNA vaccine. This paper aims to provide pediatric nephrologists with the latest knowledge about vaccination against covid-19 for children with kidney disease.

Epidemiology and SARS-CoV-2 Infection Patterns among Youth Followed at a Large Los Angeles Health Network during 2020-2022: Clinical Presentation, Prevalent Strains, and Correlates of Disease Severity.

Outcomes of SARS CoV-2 infection in infants, children and young adults are reported less frequently than in older populations. The evolution of SARS-CoV-2 cases in LA County youths followed at a large health network in southern California over two years was evaluated. A prospective cohort study of patients aged 0-24 years diagnosed with COVID-19 was conducted. Demographics, age distribution, disease severity, circulating variants of concern (VOCs), and immunization rates were compared between first and second pandemic years. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) of factors associated with severe/critical COVID-19. In total, 61,208 patients 0-24 years of age were tested for SARS-CoV-2 by polymerase chain reaction (PCR); 5263 positive patients (8.6%) with available data were identified between March 2020 and March 2022. In Year 1, 5.8% (1622/28,088) of youths tested positive, compared to 11% (3641/33,120) in Year 2 (p < 0.001). Most youths had mild/asymptomatic illness over two years. SARS-CoV-2 positivity was >12% across all age groups in the second half of Year 2, when Omicron prevailed. Pulmonary disease was associated with higher risk of severe COVID-19 in both years (OR: 2.4, 95% CI: 1.4-4.3, p = 0.002, Year 1; OR: 11.3, 95% CI: 4.3-29.6, Year 2, p < 0.001). Receipt of at least one COVID-19 vaccine dose was protective against severe COVID-19 (OR: 0.3, 95% CI: 0.11-0.80, p < 0.05). Despite different VOCs and higher rates of test positivity in Year 2 compared to Year 1, most youths with COVID-19 had asymptomatic/mild disease. Underlying pulmonary conditions increased the risk of severe COVID-19, while vaccination was highly protective against severe disease in youths.

Patterns of physical activity and SARS-CoV-2 severe pneumonia: A case–control study

BackgroundRegular physical activity is associated with a low risk of severe community-acquired infections. However, the hypothesis that a physical inactivity pattern is associated with a higher risk for severe COVID-19 has not been completely proven, especially with severe pneumonia. ObjectiveThe goal of this study was to confirm the link between physical activity patterns and severe SARS-CoV-2 pneumonia. DesignCase–control study. MethodsThis study involved 307 patients who developed SARS-CoV-2 severe pneumonia and were hospitalized in an intensive care unit. Age- and sex-matched controls (307) were selected from the same population: patients with mild to moderate forms of COVID-19 who were not hospitalized. Physical activity patterns were assessed using the short version of the International Physical Activity Questionnaire. ResultsThe mean physical activity levels were lower in the SARS-CoV-2 severe pneumonia group as compared to the control group: 1576±2939 vs 2438±2999, metabolic equivalent of task (MET-min/week), p<0.001. A high or moderate physical activity level was more common in the control group, and a low physical activity level was more observed in the case group (p<0.001). Obesity was also associated with severe SARS-CoV-2 pneumonia (p<0.001). Multivariable analysis showed that a low physical activity level was associated with a higher risk for severe SARS-CoV-2 pneumonia, independent of nutritional status (CI 3.7; 2.24–5.99), p<0.001). ConclusionA higher and moderate level of physical activity is linked to a lower risk of SARS-CoV-2 severe pneumonia.