Positive COVID-19 Test Research Articles

Safety, tolerability, and pharmacokinetics of AZD5462, a small molecule agonist of the RXFP1 relaxin receptor

Abstract Introduction Despite multiple new drug advancements for patients with heart failure in recent years (specifically, sodium-glucose co-transporter-2 and sacubitril/valsartan), morbidity and mortality remain high. AZD5462 is a selective RXFP1 agonist which mimics the pregnancy hormone relaxin and its actions on systemic hemodynamics and kidney function. Purpose To assess the safety, tolerability, and pharmacokinetics (PK) of AZD5462 in a first-in-human study following single ascending dose (SAD) and multiple ascending dose (MAD) administration in healthy participants. Methods This was a phase 1 randomized, double-blind, placebo-controlled study. The SAD evaluated doses of 20, 80, 400, 750, and 1000 mg across 7 cohorts, with 2 cohorts comprising solely participants of Japanese descent. The MAD evaluated doses of 40, 120, 250, and 500 mg BID for 10 days across 5 cohorts, with 1 cohort of Japanese descent. There were approximately 8 participants in each cohort, randomized 6:2 to AZD5462 or placebo. AZD5462 was administered as an oral liquid solution. Results Overall, 98 participants were randomized and 92 completed the study (56 of 56 in SAD; 36 of 42 in MAD). The majority of participants randomized were male, and the median age was 39 years in the SAD and 36 years in the MAD. There were no major safety and tolerability concerns up to the highest dose administered (1000 mg SAD; 500 mg BID MAD). Pre-specified study stopping criteria were not met. There were no deaths or other serious adverse events. AEs were more common in the pooled AZD5462 group than placebo (approximately 40% for AZD5462 and 20% for placebo). The most common AEs were GI disorders (nausea, abdominal pain, vomiting), headache, medical device site dermatitis, and orthostatic heart rate response increase, but without clear relationship to dose. Three participants discontinued the MAD due to dizziness, supraventricular tachycardia, and positive COVID-19 test. There was no clear pattern in the effect on SBP with 120 mg and higher doses in the MAD. There was a trend for DBP decrease but no signs of hypotension. HR increased in all cohorts, which was dose-dependent in SAD but without clear relationship to dose in MAD. Treatment with AZD5462 led to a dose-dependent increase in plasma renin in all but the lowest SAD dose. AZD5462 was rapidly absorbed with a median Tmax between 0.53 hr and 1.75 hr. Plasma concentrations declined in a biphasic manner, with a geometric mean terminal half-life after a single dose between 3 h and 6 h. The exposure to AZD5462 increased more than proportionately with dose. Conclusions AZD5462 was generally well tolerated at all dose levels in this phase 1 study. These data pave the way for development of a chronic oral relaxin therapy for patients with heart failure.

COVID-19-Related Outcomes Among Group Home Residents with Serious Mental Illness in Massachusetts in the First Year of the Pandemic.

This study examined COVID-19 infection and hospitalizations among people with serious mental illness who resided in residential care group homes in Massachusetts during the first year of the COVID-19 pandemic. The authors analyzed data on 2261 group home residents and COVID-19 data from the Massachusetts Department of Public Health. Outcomes included positive COVID-19 tests and COVID-19 hospitalizations March 1, 2020-June 30, 2020 (wave 1) and July 1, 2020-March 31, 2021 (wave 2). Associations between hazard of outcomes and resident and group home characteristics were estimated using multi-level Cox frailty models including home- and city-level frailties. Between March 2020 and March 2021, 182 (8%) residents tested positive for COVID-19, and 51 (2%) had a COVID-19 hospitalization. Compared with the Massachusetts population, group home residents had age-adjusted rate ratios of 3.0 (4.86 vs. 1.60 per 100) for COVID infection and 13.5 (1.99 vs. 0.15 per 100) for COVID hospitalizations during wave 1; during wave 2, the rate ratios were 0.5 (4.55 vs. 8.48 per 100) and 1.7 (0.69 vs. 0.40 per 100). In Cox models, residents in homes with more beds, higher staff-to-resident ratios, recent infections among staff and other residents, and in cities with high community transmission risk had greater hazard of COVID-19 infection. Policies and interventions that target group home-specific risks are needed to mitigate adverse communicable disease outcomes in this population.Clinical Trial Registration Number This study provides baseline (i.e., pre-randomization) data from a clinical trial study NCT04726371.

Depression, anxiety, and stress among COVID-19 patients in South Sinai, Egypt: prevalence and associated predictors

Infectious diseases trigger fear and anxiety among patients leading to disturbance in psychological health of patients. Psychological symptoms were found during SARS-COV-1 epidemic which raise the curiosity about their presence with SARS-COV-2 infection. The current study aimed to estimate the prevalence and severity of psychiatric disorders (depression, anxiety, and stress) among COVID-19 patients and their associated significant predictors. A cross-sectional study was conducted among 382 patients infected with COVID-19 in South Sinai governorate, Egypt, during the period June 2021 through January 2022. Patients with positive PCR test for COVID-19 were included if no more than 6 months have passed after being isolated in the hospital or at home. The patients were being contacted after being cured from COVID-19. The Arabic version of the Depression Anxiety Stress was used to assess the psychological status of patients. Multivariate linear regression analysis was done to detect the predictors of psychiatric symptoms among patients. A total of 382 participants with mean age of 41.5 ± 15.0 years old, of whom 72.5% were males were included in the study. 91.6% of participants had all the three studied psychological disorders; depression, anxiety and stress with most of participants had either severe or extremely severe conditions (13.9 and 75.7 for anxiety, 22.8 and 46.3% for depression, 38.5 and % 19.6 for stress, respectively). Healthcare workers had higher prevalence rates of depression, anxiety and stress. In bivariate analysis, educational level, HCWs and visiting healthcare facility were significantly affecting DASS scores. In linear regression analysis, hospital admission was the main predictor of the three psychological disorders. In Conclusion, majority of patients affected with COVID-19 suffered from symptoms of anxiety, depression and stress within six months after being infected. Hospital admission was found to be the main predictor of the presence of psychiatric disorders with prolonged recovery time from COVID-19 infection. More attention should be paid to COVID-19 patient’s mental health as psychological care and presence of psychiatric in the isolation hospitals should be considered.

COVID-19 induced type 1 diabetes: A systematic review of case reports and series.

To provide an overview of reported cases of new-onset type 1 diabetes mellitus (T1D) following COVID-19 infection. PubMed and Scopus library databases were screened for relevant case reports published between January 2020 and June 2022. Study design, geographic region or language were not restricted. Twenty studies were identified and involved 37 patients (20 [54%] male, 17 [46%] female). Median age was 11.5 years (range 8 months-33 years) and 31 (84%) patients were aged ≤17 years. Most patients (33, 89%) presented with diabetic ketoacidosis (DKA). In total, 23 (62%) patients presented at the time of positive COVID-19 testing and 14 (38%) had symptoms consistent with COVID-19 infection or a previous positive test (1-56 days). Diabetes symptomatology was provided in 22 cases and (19, 86%) reported polyuria, polydipsia, polyphagia, fatigue, or weight loss or a combination of the aforementioned in the preceding weeks (3 days-12 weeks). Of the 28 patients that had data on acute and long-term treatment, all recovered well and most were managed with basal bolus insulin regimens. Quality assessment showed that most reports were either 'good' or 'moderate quality'. Although uncommon, new-onset T1D is a condition healthcare professionals may expect to see following a COVID-19 infection.

General practitioners’ knowledge, perception and experience on Long Covid: a cross-sectional study in Belgium and Malta

Abstract Background Over 10% of Covid-19 infected people experience persistent symptoms (Long Covid). As most Long Covid cases are in patients with a mild acute Covid-19 infection, primary health care and general practitioners (GPs) are at the forefront in their care. This study investigated GPs’ knowledge, perception and experience on Long Covid at cross-country level. Methods A cross-sectional study targeting GPs was conducted in Belgium and Malta during mid-2022. An online survey on Long Covid was disseminated. Descriptive and logistic regression analyses were performed. Results The survey was completed by 150 GPs (105 for Belgium, 45 for Malta). In both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Accessibility to educational material was limited and an awareness-rising campaign was seen as merited, especially by Maltese GPs (OR = 6.81, 95%CI [1.49;31.12]). For diagnosing Long Covid, 54.7% reported the requirement of a positive Covid-19 test, more among Belgian than Maltese GPs (64.3% vs 45.2%, p = 0.036). To assess Long Covid, GPs applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms. 76.0% GPs reported caring for Long Covid patients, irrespective of practice type and GPs’ country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%, p = 0.291) stated that Long Covid patients should follow multidisciplinary approach, only 29.8% of them reported to care for these patients by multidisciplinary cooperation and 48.3% by themselves/GP colleagues. Conclusions GPs frequently provide care to Long Covid patients and GPs’ care showed similarities at cross-country level. Although GPs perceived lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria were noted. Across Europe, uniform evidence-based guidelines, scientific support and training for GPs must be a priority to empower GPs in their Long Covid approach.

Health inequality and protective factors for post COVID-19 condition among older adults in Europe

Abstract Background COVID-19 affected people and countries disproportionately and continues to impact health of people. The aim of this study was to investigate protective health and social factors for post-COVID conditions in adults aged 50 years and older in Europe using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), which were collected from June to August 2021. Methods A study sample of 1,909 respondents who self-reported a positive COVID-19 test result was included in our multiple logistic regression models. Binary logistic regression was performed to assess whether having no post COVID-19 condition was associated with sociodemographic factors (sex, age, education and region) and health-related factors (BMI, comorbidity and COVID-19 vaccination status). Results In the fully-adjusted model, male sex (OR 1.54; CI1.24, 1.90), having tertiary or higher education (OR1.42; 95% CI 1.05, 1.92), healthy weight (BMI 18.5 to 24.9 kg/m2)(OR 1.46; 95% CI 1.11, 1.93), no underlying health condition (OR 1.68; CI 1.31, 2.15), COVID-19 vaccination (OR 1.39; CI 1.11, 1.75) and living in countries other than Visegrad group (OR 2.03; CI 1.53, 2.69) showed protective effects against post COVID-19 conditions. BMI in the high education group (mean 26.7 kg/m2) differed significantly as compared to medium (mean 28.3 kg/m2) and low education groups (mean 28.7 kg/m2). BMI of respondents without comorbidity (mean 26.5 kg/m2) was significantly lower than respondents with comorbidities (ranging from 27.4 to 29.0 kg/m2). Significant differences were observed in education levels and BMI between the Visegrad group and Non-Visegrad group (p<.001). Conclusions Our study suggests that high education attainment is a predictor for no post COVID-19 conditions and is associated with lower BMI and fewer underlying comorbidities. Health inequality associated with education attainment was particularly relevant in the Visegrad group. Key messages • Maintaining healthy weight and vaccination may protect older adults from post COVID-19 condition. • Our results highlight health inequality in which BMI was associated with comorbidities and educational attainment.

Duration of SARS-CoV-2 Culturable Virus Shedding in Children

This cohort study evaluates the duration of SARS-CoV-2 infectivity and its association with vaccination status in children after a positive COVID-19 test result.

Decreasing the Risk for Transmission of SARS-CoV-2 During In-Person Visitation Within a State Prison System.

To decrease the introduction of COVID-19, in-person visitation programs were temporarily limited at California Department of Corrections and Rehabilitation facilities. After consultation with the California Department of Public Health, and in accordance with Centers for Disease Control and Prevention guidelines, in-person visitation was reintroduced on April 10, 2021, with COVID-19 mitigation strategies. To assess the risk of visitation as a mode of entry for COVID-19 into a prison setting, data were gathered demonstrating the number of visitors who were not allowed into the prison due to a positive COVID-19 test prior to visitation. The number of patients who tested positive for COVID-19 after interaction with visitors was also assessed. Between April 10 and June 27, 2021, 33,212 visitors participated in the in-person visiting program. Eight visitors received positive test results prior to entry. Between January 1 and October 1, 2021, 19,025 patients received a total of 93,135 visitations. Of these, 66 patients received positive test results from post-visit testing. These data suggest that when appropriate mitigation strategies are implemented, the visitation process is not a significant contributor to COVID-19 entry into the prison facility when compared with the total number of COVID-19 cases among patients.

Adjusting expected deaths for mortality displacement during the COVID-19 pandemic: a model based counterfactual approach at the level of individuals

BackgroundNear-real time surveillance of excess mortality has been an essential tool during the COVID-19 pandemic. It remains critical for monitoring mortality as the pandemic wanes, to detect fluctuations in the death rate associated both with the longer-term impact of the pandemic (e.g. infection, containment measures and reduced service provision by the health and other systems) and the responses that followed (e.g. curtailment of containment measures, vaccination and the response of health and other systems to backlogs). Following the relaxing of social distancing regimes and reduction in the availability of testing, across many countries, it becomes critical to measure the impact of COVID-19 infection. However, prolonged periods of mortality in excess of the expected across entire populations has raised doubts over the validity of using unadjusted historic estimates of mortality to calculate the expected numbers of deaths that form the baseline for computing numbers of excess deaths because many individuals died earlier than they would otherwise have done: i.e. their mortality was displaced earlier in time to occur during the pandemic rather than when historic rates predicted. This is also often termed “harvesting” in the literature.MethodsWe present a novel Cox-regression-based methodology using time-dependent covariates to estimate the profile of the increased risk of death across time in individuals who contracted COVID-19 among a population of hip fracture patients in England (N = 98,365). We use these hazards to simulate a distribution of survival times, in the presence of a COVID-19 positive test, and then calculate survival times based on hazard rates without a positive test and use the difference between the medians of these distributions to estimate the number of days a death has been displaced. This methodology is applied at the individual level, rather than the population level to provide a better understanding of the impact of a positive COVID-19 test on the mortality of groups with different vulnerabilities conferred by sociodemographic and health characteristics. Finally, we apply the mortality displacement estimates to adjust estimates of excess mortality using a “ball and urn” model.ResultsAmong the exemplar population we present an end-to-end application of our methodology to estimate the extent of mortality displacement. A greater proportion of older, male and frailer individuals were subject to significant displacement while the magnitude of displacement was higher in younger females and in individuals with lower frailty: groups who, in the absence of COVID-19, should have had a substantial life expectancy.ConclusionOur results indicate that calculating the expected number of deaths following the first wave of the pandemic in England based solely on historical trends results in an overestimate, and excess mortality will therefore be underestimated. Our findings, using this exemplar dataset are conditional on having experienced a hip fracture, which is not generalisable to the general population. Fractures that impede mobility in the weeks that follow the accident/surgery considerably shorten life expectancy and are in themselves markers of significant frailty. It is therefore important to apply these novel methods to the general population, among whom we anticipate strong patterns in mortality displacement – both in its length and prevalence – by age, sex, frailty and types of comorbidities. This counterfactual method may also be used to investigate a wider range of disruptive population health events. This has important implications for public health monitoring and the interpretation of public health data in England and globally.

Results of myocardial revascularization in patients with acute coronary syndrome and COVID-19: experience of the urban multidisciplinary hospital

Background. The 2019 novel coronavirus pandemic has had a significant impact on the prognosis and outcomes of patients with acute coronary syndrome (ACS).Objective. Study of the impact of a new coronavirus infection (NCI) on the nature of the course and outcomes of the disease in patients with ACS.Materials and methods. The study included patients with ACS and a positive test for COVID-19 upon admission to the hospital in the period from April 2020 to August 2021.Results. The study included 107 patients. Among patients with and without ST elevation with more than 50 % lesions (n = 10; n = 10), 8 patients died, which was 80 % in each group. In the group with and without ST elevation with less than 50 % involvement (n = 20; n = 67), 5 and 8 patients died, accounting for 25 % and 11.9 %, respectively. The role of the influence of the levels of Il-6 (interleukin-6), troponin T and creatinine on the course and outcomes of the patients’ disease was analyzed.Conclusion. COVID-19 infection, namely the degree of damage to the lung tissue, significantly worsens the course and outcomes in patients with both NSTE-ACS and STE-ACS. Further accumulation of clinical experience in endovascular treatment of ACS and the development of algorithms for providing medical care to patients with ACS in the context of COVID-19 is required.

SAT196 COVID-19 Pneumonia And Primary Hyperparathyroidism Exacerbation

Abstract Disclosure: A. Khan: None. P. Rimal: None. M. Biggs: None. A. Ahmed: None. C. Musurakis: None. J.L. Gilden: None. A. Moid: None. Introduction: It is well known that COVID-19 virus damages the body by either inflicting the injury directly, or by initiating a systemic immune response, resulting in inflammation. Our case report explores how parathyroid glandular dysfunction and calcium levels (Ca) can be affected in a patient with active COVID-19 pneumonia. Clinical Case: A 58-year-old male, unvaccinated for COVID-19, with COPD, primary hyperparathyroidism (PHPT), chronic kidney disease, and ethanol use presented to the emergency room with confusion, vomiting, and lethargy. Preadmission medications included hydrochlorothiazide. Following a positive COVID-19 test, he was diagnosed with acute hypoxic respiratory failure secondary to COVID-19 pneumonia. After emergent treatment with BiPAP and IV steroids, he was transferred to the ICU, where he completed treatment with remdesivir, dexamethasone, and baricitinib. He was also treated for ethanol withdrawal. Notably, this patient had a history of chronic asymptomatic hypercalcemia secondary to PHPT with Ca prior to admission ranging from 10.9-13.6 mg/dl (nl=8.5-10.1mg/dl), PTH range 145-345 pg/ml (nl=14-65 pg/ml), creatinine (Cr) 1.2-1.4 mg/dl (nl= 0.67-1.17 mg/dl). On this admission, Ca was 12.2mg/dl, albumin 2.4 g/dl (3.4-5.0 g/dl), PTH 531 pg/ml, Cr 3.4 mg/dl, 25OH vitamin D 29.3 ng/mL (nl= 30-100 ng/mL). After fluids, Ca initially improved to 10.9mg/dl and Cr soon after normalized. Mental status also improved after hydration. However, Ca then rose significantly to 14.1mg/dl with mental status decline. IV zoledronic acid was administered, resulting in lowering serum calcium and improvement of mental status. Conclusion: This patient’s clinical course was notable for the improvement of Ca initially with hydration. However, a significant rise in Ca approaching parathyroid crisis range was seen shortly thereafter, despite normalization of Cr. Whereas hypocalcemia has been noted in most cases of Ca dysfunction associated with COVID-19 infection, in this case, we postulate that the COVID-19 infection may have triggered parathyroiditis, thus exacerbating the underlying PHPT. One such mechanism is the use of receptors like angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) by COVID-19 virus, which are found on endocrine glands including the parathyroid. Similarly, COVID-19 virus exerts its inflammatory effects using IL-6, which is also a key cytokine that causes hypercalcemia by stimulating bone resorption. Furthermore, COVID-19 infection is notorious for causing nausea/vomiting, and diarrhea, culminating in dehydration which worsens hypercalcemia. It is therefore necessary that physicians foresee impending complications of COVID-19 infection with concurrent parathyroid disease and take early steps to prevent and treat them. Presentation: Saturday, June 17, 2023

THU327 Characterization Of New Onset Diabetes Mellitus Concurrent With COVID-19; A Single Institution Experience

Abstract Disclosure: T. Haque: None. M. Gaddis: None. R. Asad: None. S. Simon: None. B.M. Drees: None. Objective: The global pandemic of novel SARS-COV2 virus causing Covid-19 infection, is reported to lead to development of new onset diabetes mellitus (DM). This study describes the types of DM following Covid-19 infection, the patient characteristics and the disease course up to 12 months. Methods: A database of patients with DM treated at the institution was searched for a positive PCR Covid-19 test between March 1, 2020, and November 30, 2021. Charts were manually reviewed for diagnosis of co-morbidities, laboratory results, medications, disposition, and verification of type of DM. Outcomes data were collected at 0, 6, and 12 months. Results: Among 1643 Covid-19 positive patients with DM, 96 were diagnosed with new onset DM. There were 42% Black, 24% White, and 23% Hispanic; 94 had type 2 DM and two had type 1 DM. Average age was 50; half were women. Patients with more severe Covid (inpatient and ER visits) were more likely to require insulin, multiple DM medications, and had higher HbA1c levels. Insulin use and multiple DM medications decreased over time (25% and 25% at diagnosis; 10% and 18% at 12 months, respectively). HbA1c decreased over time (9.1% at diagnosis and 7.3% at 12 months). One-year follow-up was available on 73 patients, of whom 19 were on no medications for DM. Conclusion: New onset diabetes mellitus following Covid-19 infection is common and predominantly type 2 DM. However, glucose levels tend to improve over time requiring less medication, with 26% requiring no DM medications at one year. Presentation: Thursday, June 15, 2023

Nosocomial Transmission of SARS CoV-2 in a Tertiary Care Hospital in Peshawar, Pakistan

Objective 
 The study aimed to determine the frequency of nosocomial transmission of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) in a tertiary care hospital in Peshawar, Pakistan.
 Methodology
 This cross sectional, analytical study was carried out in Hayatabad Medical Complex, Peshawar, Pakistan from 1st June 2021 to 31st August 2021. Consecutive patients aged 18 years and above admitted for conditions other than COVID-19 with a negative rapid antigen test for COVID-19 at admission were included. Patients with respiratory symptoms or those who were hospitalized for any reason in the preceding six weeks in any health care facility were excluded. The study protocol was completed by 90.9% of participants. The rapid antigen test was repeated for participants at the time of discharge or symptoms suggestive of COVID-19. Patients with a positive rapid antigen test for COVID-19 either at the time of discharge or symptom onset were considered to have acquired nosocomial SARS-CoV-2 infection. Statistical Package for the Social Sciences version 21 for Windows was used for data analysis.
 Results
 The frequency of nosocomial transmission of SARS-CoV-2 was 2.7% (13/482). Patients with nosocomial COVID-19 stayed longer in the hospital than those who tested negative (7.5±4.0 versus 4.8±3.6 days; p=0.006). Age (p=0.796), gender (p=0.453), department of inpatient stay (p=0.943), major surgery (p=0.678), minor surgery (p=0.576), and visit to the radiology department (p=0.707) did not affect nosocomial spread of SARS-CoV-2.
 Conclusion
 Nosocomial transmission of COVID-19 was infrequent, accounting for 2.7% of participants in this study.

Centralizing Telehealth Test-to-Treat Through a Regional Clinical Contact Center: A Veterans Health Administration Pilot.

Background: This project describes a Veterans Health Administration telehealth pilot to facilitate COVID-19 oral antiviral treatment as part of the national test-to-treat (T2T) strategy. The pilot was operationalized for two pilot VA medical centers by the regional clinical contact center (CCC) for a Veteran Integrated Service Network, which offers multiple services through several virtual modalities. Methods: Nurse triage and medical provider evaluation templates were developed for the CCC to standardize clinical interventions with veteran callers reporting positive home COVID-19 test results. When veterans were determined eligible and consented to treatment with an emergency use authorization (EUA) antiviral medication, CCC providers used secure direct messaging for synchronous communication with local pharmacy services to facilitate adjudication and dispensing. Templates for pharmacy documentation and primary care follow-up monitoring were also developed and disseminated. Results: In total, 198 veterans (mean age 65 years, 89% male, 88% non-Hispanic White) were evaluated through telehealth by regional CCC providers using the T2T process and 96% were prescribed an antiviral medication. Primary care follow-up occurred in 86% of cases, a median of 3 days after the telehealth evaluation. The 30-day all-cause hospitalization rate was 1.5% and there were no deaths within 30 days of treatment initiation. Conclusions: Veterans Integrated Service Network's CCC telehealth triage and evaluation processes enabled safe EUA-compliant care delivery, improved evaluator experience and efficiency, and augmented existing EUA processes in place by front-line pharmacy and primary care teams.

SARS-CoV-2 infection following booster vaccination: Illness and symptom profile in a prospective, observational community-based case-control study

Booster COVID-19 vaccines have shown efficacy in clinical trials and effectiveness in real-world data against symptomatic and severe illness. However, some people still become infected with SARS-CoV-2 following a third (booster) vaccination. This study describes the characteristics of SARS-CoV-2 illness following a third vaccination and assesses the risk of progression to symptomatic disease in SARS-CoV-2 infected individuals with time since vaccination. This prospective, community-based, case-control study used data from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile application, self-reporting a first positive COVID-19 test between June 1, 2021 and April 1, 2022. To describe the characteristics of SARS-CoV-2 illness following a third vaccination, we selected cases and controls who had received a third and second dose of monovalent vaccination against COVID-19, respectively, and reported a first positive SARS-CoV-2 test at least 7 days after most recent vaccination. Cases and controls were matched (1:1) based on age, sex, BMI, time between first vaccination and infection, and week of testing. We used logistic regression models (adjusted for age, sex, BMI, level of social deprivation and frailty) to analyse associations of disease severity, overall disease duration, and individual symptoms with booster vaccination status. To assess for potential waning of vaccine effectiveness, we compared disease severity, duration, and symptom profiles of individuals testing positive within 3 months of most recent vaccination (reference group) to profiles of individuals infected between 3 and 4, 4-5, and 5-6 months, for both third and second dose. All analyses were stratified by time period, based on the predominant SARS-CoV-2 variant at time of infection (Delta: June 1, 2021-27 Nov, 2021; Omicron: 20 Dec, 2021-Apr 1, 2022). During the study period, 50,162 (Delta period) and 162,041 (Omicron) participants reported a positive SARS-CoV-2 test. During the Delta period, infection following three vaccination doses was associated with lower odds of long COVID (symptoms≥ 4 weeks) (OR=0.83, CI[0.50-1.36], p<0.0001), hospitalisation (OR=0.55, CI[0.39-0.75], p<0.0001) and severe symptoms (OR=0.36, CI[0.27-0.49], p<0.0001), and higher odds of asymptomatic infection (OR=3.45, CI[2.86-4.16], p<0.0001), compared to infection following only two vaccination doses. During the Omicron period, infection following three vaccination doses was associated with lower odds of severe symptoms (OR=0.48, CI[0.42-0.55], p<0.0001). During the Delta period, infected individuals were less likely to report almost all individual symptoms after a third vaccination. During the Omicron period, individuals were less likely to report most symptoms after a third vaccination, except for upper respiratory symptoms e.g. sneezing (OR=1.40, CI[1.18-1.35], p<0.0001), runny nose (OR=1.26, CI[1.18-1.35], p<0.0001), sore throat (OR=1.17, CI[1.10-1.25], p<0.0001), and hoarse voice (OR=1.13, CI[1.06-1.21], p<0.0001), which were more likely to be reported. There was evidence of reduced vaccine effectiveness during both Delta and Omicron periods in those infected more than 3 months after their most recent vaccination, with increased reporting of severe symptoms, long duration illness, and most individual symptoms. This study suggests that a third dose of monovalent vaccine may reduce symptoms, severity and duration of SARS-CoV-2 infection following vaccination. For Omicron variants, the third vaccination appears to reduce overall symptom burden but may increase upper respiratory symptoms, potentially due to immunological priming. There is evidence of waning vaccine effectiveness against progression to symptomatic and severe disease and long COVID after three months. Our findings support ongoing booster vaccination promotion amongst individuals at high risk from COVID-19, to reduce severe symptoms and duration of illness, and health system burden. Disseminating knowledge on expected symptoms following booster vaccination may encourage vaccine uptake.

Patients with multiple sclerosis: COVID-19 related disease activity and hospitalisations based on a nationwide cohort study

BackgroundIt has not previously been clarified if COVID-19 triggers disease activity and increases the risk of hospitalisation with COVID-19 in patients with multiple sclerosis. We examined the association between COVID-19 and the use of systemic corticosteroids prescriptions and hospital contacts at neurological departments as proxies of disease activity among patients with multiple sclerosis. Furthermore, we examined whether patients with multiple sclerosis were more likely to be hospitalised with COVID-19 compared to references. MethodsThis study was based on nationwide health registries with data on the Danish population of 2,222,946 individuals with a positive COVID-19 PCR test. To study disease activity our study population consisted of all patients with multiple sclerosis and a positive COVID-19 PCR test. Our proxies for disease activity were compared after versus before a positive COVID-19 PCR test using a binomial regression model. Adjustments were made for age, sex, comorbidity, length of multiple sclerosis diagnosis, calendar period, vaccination, and immunomodulatory treatment. To study the risk of hospitalisation with COVID-19 in patients with multiple sclerosis our study population here consisted of all Danish citizens with a COVID-19 positive PCR test. In logistic regression models we estimated odds ratio (OR) for hospitalisation with COVID-19 in patients with multiple sclerosis relative to patients affected with other autoimmune diseases (inflammatory bowel disease/rheumatoid arthritis), and relative to individuals from the general population. Adjustments were made for age, sex, comorbidity, vaccination, and calendar period. To examine the impact of disease-modifying treatment, the risk of hospitalisation with COVID-19 was estimated in those with disease-modifying treatment versus those without any disease-modifying treatment. ResultsWe included 7358 patients with multiple sclerosis and a positive COVID-19 PCR test. The adjusted incidence rate ratio (aIRR) for having corticosteroid prescriptions after COVID-19 in patients with multiple sclerosis was 0.93 (95 % CI 0.78 – 1.10), and the aIRR for hospital contacts at neurological departments/admissions with multiple sclerosis as primary diagnosis after COVID-19 infection was 1.10 (95 % 1.00–1.22). Adjusted OR (aOR) for hospitalisation with COVID-19 in the 30 days after a positive COVID-19 PCR test was 3.21 (95 % CI 2.75–3.74) compared to patients with other autoimmune diseases and the aOR was 5.34 (95 % CI 4.65–6.14) for patients with multiple sclerosis compared to all other individuals in the general population with a positive test. We found no increased risk of hospitalisations with COVID-19 in patients with multiple sclerosis using disease-modifying treatment 6 months prior to a positive COVID-19 PCR test compared to patients with multiple sclerosis without disease-modifying treatment (aOR 0.94 (95 % CI 0.69–1.27)). ConclusionsIn this nationwide cohort of patients with multiple sclerosis, COVID-19 did not seem to trigger multiple sclerosis disease activity (based on proxy variables). We found a significantly increased risk of being hospitalised with COVID-19 in the first 30 days after a positive COVID-19 PCR test in patients with multiple sclerosis irrespective of the type of reference population. In patients with multiple sclerosis, the use of disease-modifying treatment did not increase the risk of hospitalisation with COVID-19.

COVID-19 vaccine or booster hesitancy among children aged 6 month-5 years, 5–11 years, and 12–17 years in the United States: An analytic cross-sectional study

With the increased accessibility of COVID-19 vaccine, many households have had concerns when vaccinating children, leading to vaccine hesitancy. This study examined the COVID-19 vaccine and booster hesitancy among children aged 6 months-5 years, 5–11 years, and 12–17 years in the United States. We analyzed data from Phase 3.8 (March 1, 2023 to May 8, 2023) of the Household Pulse Survey (HPS) collected by the U.S. Census Bureau. We conducted survey-weighted multiple logistic regression models in vaccine hesitancy among respondents with children from those three different age groups, controlling for various demographic factors such as COVID-19 vaccination status, COVID-19 positive test results, race/ethnicity, gender at birth, age, region, marital status, educational attainment, household income, health insurance, and children’s school type. The percentage of respondents indicating hesitancy towards vaccinating their children (expressing uncertainty, probably not, or definitely not) decreased as their children's age increased. Specifically, the proportion was 57.4% for children aged 6 months-5 years, 43.3% for children aged 5–11 years, and 25.9% for children aged 12–17 years. Concerns about possible side effects of the COVID-19 vaccine were the most prevalent among respondents who expressed vaccine hesitancy, regardless of the level of hesitancy, while those with strong hesitancy showed higher proportions of not believing their children need a vaccine, lack of trust in COVID-19 vaccines and the government, and parents/guardians not vaccinating their children. This study provide insight into our current situation, aiming to build assurance among households regarding the efficacy and benefits of COVID-19 vaccines for children of all ages.

Exploring predictors of COVID-19 vaccine acceptance among students, faculty, and staff at a Southeastern University in the United States

Objective Explore predictors of early COVID-19 vaccine adoption on a university campus. Participants Students, faculty, staff, and administration (N = 1,234) completed an online survey exploring COVID-19 vaccine-related experiences, perspectives, and knowledge, from September to October 2021. Methods Based on vaccination status participants were identified as vaccine hesitant or early vaccine adopters. Binary logistic regression was used to examine association between independent variables and vaccine adoption status. Results Democrats (OR = 4.3, p = <.001), participants without a positive COVID-19 test (OR = 2.5, p = <.001), noted seeing/hearing COVID-19 misinformation (OR = 1.8, p = 0.27), and reported trust in public health agencies (OR = 26.2, p = <.001) were more likely to be early COVID-19 vaccine adopters, compared to Republicans, those with a positive COVID-19 test, those who had not seen/heard COVID-19 misinformation, and those reporting distrust in public health agencies, respectively. Conclusion Findings indicate that COVID-19 vaccine adoption is multifactorial. Future research should focus on vaccination status-related trust and health communication.

Influenza and Pneumococcal Vaccination of Healthcare Workers during a Pandemic Reduces the Risk and Severity of COVID-19 in Vaccinated

Background. Individuals who were vaccinated against seasonal influenza or had a history of pneumococcal vaccination were found to be less likely to become infected and tolerate COVID-19 more easily. However, it has not been sufficiently studied how vaccination against these infections, carried out during the pandemic period, can affect the incidence of COVID-19.Aims. The purpose of the investigation: to study the effect of vaccination against influenza and pneumococcal infection carried out during the pandemic of a new coronavirus infection on the susceptibility and course of COVID-19 in healthcare workers.Materials and methods. In August- Setempber 2020, after the first rise in the incidence of COVID-19, out of 547 employees (aged 18 to 70 years) of a medical organization (MO), 266 (49%) were vaccinated against influenza (group II, n = 98), pneumococcal infection (group III, n = 60) and combined vaccination (group IV, n = 108), while 281 (51%) remained unvaccinated (group 1). Follow-up period: from September 2020 to March 2021 with the registration of the incidence of acute respiratory infections (ARI) according to primary medical records and the use of PCR methods for SARS-CoV-2, epidemiological and statistical analysis.Results. Two months after the start of the study, the proportion of cases of COVID-19 in the 1st group (unvaccinated) was 5% versus 1% in the 4th group (persons vaccinated with two vaccines), after 4 months – 15% and 5%, respectively, and at the end of observation (166 days) – 16% and 8%, respectively. That is, among unvaccinated individuals, the risk of getting COVID-19 was higher by HR = 2.1 [95% CI: 1.0÷4.7] times. The time between the start of observation and a positive test for COVID-19 in study participants was significantly higher in the 4th group compared to the group I: 106 [60–136] days versus 47 [17–75] days. The distribution of patients with COVID-19 according to the severity of viral pneumonia showed that in unvaccinated patients in most (64%) cases, pneumonia had a moderate to severe course, while in the 4th group of patients with combined vaccination in 100% of cases, mild (p = 0.04 for the entire sample).Conclusions. During the COVID-19 epidemic rises, vaccination against respiratory infections remains relevant, reducing the number of cases, the severity of the coronavirus infection and preventing the occurrence of co-infections.

Effectiveness of the Booster Dose in Protecting against COVID-19, Colombia 2022.

Vaccination has proven to be one of the most effective strategies against the COVID-19 pandemic. Several studies have evaluated and confirmed its effectiveness in different populations, particularly in reducing severe outcomes such as hospitalization and death. Some studies have investigated the effectiveness of vaccination against the infection, identifying the need for booster doses. This study aimed to explore the effectiveness of the vaccination schedule on the probability of infection in a sample of Colombian patients during the fourth wave of the COVID-19 pandemic, which was associated with the emergence and predominance of the Omicron variant. A cross-sectional study was conducted on individuals who underwent RT-PCR testing for COVID-19 detection in a dedicated laboratory in Bogotá, Colombia, between 30 December 2021 and 7 February 2022. A total of 1468 subjects was included in the study, of whom 36.6% (n = 538) had a positive PCR test for COVID-19. The comparison between fully vaccinated individuals with a booster dose and those without the booster dose revealed a 28% reduction in the odds of infection (OR = 0.719 CI 0.531-0.971). Age (OR = 1.009 CI 1.001-1.018) and low economic status (OR = 1.812 CI 1.416-2.319) were associated with an increased risk of infection. These findings suggest the need for a booster vaccination in the general population to improve the prevention rates of SARS-CoV-2 infection and mitigate severe outcomes.