Prevent Coronavirus Disease Research Articles

In search of protective antibody for coronavirus disease 2019: A retrospective study

IntroductionThe search for a protective antibody titer level to prevent coronavirus disease 2019 (COVID-19) infection, progression, and death is far from over. To date, no specific cut-off values have been established for these protective antibodies or neutralizing antibody (NAb) titers. NAb titers inhibit viral replication.AimTo find out the prevailing NAb titre which might give protection from COVID-19 infection, or complication arising out of it.Material and methodsThe data of COVID-19 patients with NAb titers who underwent reverse transcription polymerase chain reaction and presented with mild symptoms within 3 days after receiving the results were analyzed. The data were obtained from the clinic’s electronic database. Of the recruited patients, 63 were included in the final analysis. All statistical analyses were performed using SPSS v. 21.Results and discussionA highly significant correlation (negative) existed between circulating NAb titer and duration of fever (<i>P</i> < 0.001); a positive significant correlation existed between the period from the 1st vaccine dose to the period of infection and the NAb titer level (<i>P</i> < 0.001). The NAb titer was significantly higher in the group that received both doses (<i>P</i> = 0.00016). Death and admission due to progression to moderate COVID-19 occurred in the group with a NAb titer of less than 10 U/L.ConclusionsThe risk of complications and death due to COVID-19 may increase if the protective antibody level remains less than 10 U/L. The sample size used in this study was relatively small; therefore, this finding cannot be generalized. Hence, more robust studies should be performed to determine the appropriate protective NAb titer levels.

Antibody response to the messenger RNA-1273 vaccine (Moderna) in liver transplant recipients.

Different reports have shown the clinical and serologic response to the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) messenger RNA (mRNA) vaccines in preventing coronavirus disease 2019 (COVID‐19) in the general population, but few studies have examined these responses in transplant recipients. We assessed the vaccine immunogenicity of two doses (100 μg) of the mRNA‐1273 vaccine (Moderna) administered with a 28‐day interval in liver transplant recipients (LTRs) at follow‐up at the Marques de Valdecilla University Hospital. LTRs without a history of COVID‐19 infection were tested for SARS‐CoV‐2 immunoglobulin G (IgG) antibodies directed against the spike protein (S) a median of 43 days after receiving the second Moderna vaccine dose. Clinical data, including immunosuppressive regimen and routine laboratory data, were obtained from the medical record of each patient up to 3 months before the date of the first vaccination. Factors associated with serologic response were evaluated through logistic regression. In total, 129 LTRs who had anti‐S results were included. Most patients were men (n = 99; 76.7%) with a median age of 63 years (interquartile range, 56–68). Alcohol (43.4%) and chronic hepatitis C (18.6%) were the most frequent causes of liver transplantation. A positive anti‐S IgG response was observed in 113 LTRs (87.6%; 95% confidence interval [CI], 80.8–92.2). A strong inverse relationship between mycophenolate mofetil use and serologic response was found (odds ratio, 0.07; 95% CI, 0.02–0.26; p = 0.001). Conclusion: Most LTRs develop an immunological response to the Moderna SARS‐CoV‐2 mRNA‐based vaccine. An immunosuppressive regimen that includes mycophenolate predicts a weak serologic response.

Thrombosis and thrombocytopenia after HPV vaccination

BackgroundVaccine‐induced immune thrombotic thrombocytopenia (VITT) has so far only been reported after adenovirus vector severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccines. ObjectiveWe report findings in a 25‐year‐old woman who presented with thrombocytopenia, venous thrombosis, elevated D‐dimer levels, and high levels of platelet‐activating antibodies to platelet factor 4‐polyanion complexes 10 days after Gardasil 9 vaccination for human papillomavirus (HPV). The patient exhibited clinical and laboratory features in line with the recently defined VITT syndrome, described after adenoviral vector vaccination to prevent coronavirus disease 2019. ConclusionWe report a case of VITT following HPV vaccination. This should raise awareness of the possibility of VITT also occurring after other vaccines, not exclusively adenoviral vector‐based SARS‐CoV‐2 vaccines.

Effectiveness of and Immune Responses to SARS-CoV-2 mRNA Vaccines and Their Mechanisms

Following the online publication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome in January 2020, two lipid nanoparticle-encapsulated mRNA vaccines, BNT162b2 and mRNA-1273, were rapidly developed and are now being used worldwide to prevent coronavirus disease 2019 (COVID-19). The mRNA of both vaccines encodes the full-length spike protein of SARS-CoV-2, which binds to the host cell receptor angiotensin-converting enzyme 2 and is believed to mediate virus entry into cells. After intramuscular injection of the vaccine, the spike protein is produced in the cells. Both humoral and cellular immune responses to the spike protein are elicited for protection against COVID-19. The efficacy of the two mRNA vaccines against COVID-19 with wild-type SARS-CoV-2 is more than 90% and is slightly decreased with the Delta variant, which is currently the predominant variant in many countries. In this review, the effectiveness of and immune responses to COVID-19 mRNA vaccines and their mechanisms are summarized and discussed. Potential waning immunity and an additional dose of COVID-19 mRNA vaccines are also discussed.

Common Side Effects of COVID-19 Vaccines Used in Iran: A Review

Context: Iran was one of the first countries in the world to encounter acute respiratory syndrome coronavirus 2 in February 2020. Numerous efforts have been made worldwide to develop safe and effective vaccines to prevent coronavirus disease 2019 (COVID-19). Finally, several vaccines with different platforms have been licensed for use in various countries. The injection of these vaccines can lead to a range of unwanted side effects (mild to severe). Objectives: This study tried to collect the common adverse effects of the most frequently used COVID-19 vaccines in Iran and provide readers with relevant information and statistics. Methods: This review study collected papers by searching in foreign journals using databases, such as PubMed, PubMed Central, MEDLINE, EBSCO, Google Scholar, and Embase, with the keywords of side effects, COVID-19, vaccine, AstraZeneca, Sputnik V, and Sinopharm, which were published within 2000 - 2021. Results: According to available information and studies, vaccines, unlike COVID-19, do not have any threatening and high-risk side effects, and their benefits outweigh their insignificant side effects. A total of 48 full-text studies and 10 valid websites with high citations and up-to-date information were selected. Among the relevant references, 26, 16, and 16 studies performed on AstraZeneca, Sputnik V, and Sinopharm vaccines were chosen for review, respectively. Conclusions: The findings of this study can reassure readers and be effective in combating misconceptions about vaccination. Undoubtedly, the main solution to overcome the economic damage and social health burden caused by the COVID-19 pandemic is to accelerate global vaccination.

Review of current vaccine development platform to prevent coronavirus disease.

On January 30, 2020, the World Health Organization (WHO) declared a severe respiratory disorder syndrome which originated in Wuhan city as a global public health emergency, and the pandemic declaration by the WHO was made on March 11, 2020. Persons infected with SARS-CoV-2 are frequently asymptomatic, yet they have high respiratory viral loads, and they are major purveyors of viral spread. These factors have led to the current explosion of COVID-19 hospitalizations and deaths. Vaccines could play an important role by preventing severe diseases and increasing population immunity and reducing the ongoing health crisis. There is wealth of information for the review available since it is a current topic of interest. Initially, Google Scholar was utilized to take an initial sample of what types of articles are available. We searched other databases such as PubMed, EMBASE, and COCHRANE LIBRARY for research articles published up to March 2021, with no language restrictions. We found seven peer-reviewed publications available on the efficacy of SARS-CoV-2 vaccines: AZD1222 (AstraZeneca/University of Oxford), a ChAdOx1-based vaccine with a reported efficacy of 70.4% and two mRNA-based vaccines: BNT162b2 (Pfizer/BioNTech) with a reported efficacy of 95% and mRNA-1273 (Moderna/NIAID) with a reported efficacy of 94.1%. Internet was used as a source because of its limitless networking of resources. Sources used from the internet were written by professionals in their fields and published on reliable sites, in referred publications, or on professional organization sites. The cited references were within the last 2 years.

Attitudes and Belief among the Population in Saudi Arabia about the Consumption of Herbal Products for the Prevention of COVID-19 Infection: A Cross-Sectional Study

The purpose of this study was to assess the Saudi population’s perceptions about the use of herbal products to prevent coronavirus disease 2019 infection in Saudi Arabia. Here, 803 subjects participated in the online survey, which was cross-sectional in nature and self-administrated. The study included all Saudi Arabian adults, whereas pregnant women were excluded. Participants who decided to participate in the study filled out the questionnaire completed by 803 people. During the coronavirus disease 2019 pandemic, most participants were aware of alternative and complementary medicines, whereas 60.1 % obtained their knowledge from social media sites. Prior to online shops/pharmacies and homemade remedies, the traditional apothecary was the most common source for alternative and complementary medicines. About 56 % of participants (p<0.05) did not believe that the complementary and alternative therapies could prevent or treat coronavirus disease 2019 infection, whereas 53.9 % of them considered safe. Only 22 % of those who took part in the survey agreed that alternative and complementary therapies could successfully combat coronavirus disease 2019 and could be used as a substitute for vaccines. Finally, our study found that during coronavirus disease 2019, medicinal plants and other complementary and alternative therapies were used and considered to be more effective.

Convalescent Plasma Therapy: A Treatment of Choice for COVID-19 during Current Pandemic

The severe acute respiratory syndrome coronavirus 2 which is the source of pandemic coronavirus disease 2019 has engulfed almost whole world. This virus was first reported in Wuhan city (China) in December 2019. Since the discovery of the virus, till today the researchers and scientists have been working to develop new vaccines or therapeutic agents against severe acute respiratory syndrome coronavirus 2. However, thus far no vaccine has emerged that can be approved to treat or prevent coronavirus disease 2019. Due to lack of specific preventative and therapeutic options for the treatment of coronavirus disease 2019, the use of convalescent plasma therapy may be of great benefit in the current situation. Previous use of immune plasma has resulted in successful treatment of hemagglutinin type 1 and neuraminidase type 1 influenza virus, Middle East respiratory syndrome coronavirus and severe acute respiratory syndrome coronavirus 1 epidemics. In the current scenario raised by coronavirus disease 2019, the convalescent plasma therapy has been applied successfully among many patients across various regions. This article presents an up-to-date review of existing literature on recovery through convalescent plasma as a treatment of choice, safety and its efficacy, possibility and its challenges for the treatment of coronavirus disease 2019.

Clinical Images: Severe proteinase 3 antineutrophil cytoplasmic antibody glomerulonephritis temporally associated with Sinovac Biotech's inactivated SARS-CoV-2 vaccine.

Mass vaccination campaigns to prevent coronavirus disease 2019 (COVID-19) are occurring worldwide; not surprisingly, reports of rare postvaccination immune-mediated adverse events, as seen with the influenza vaccination (1), also started to surface, including cases of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) after receipt of the Pfizer-BioNTech and Moderna COVID-19 vaccines (2, 3). Here, we report a case from Brazil of new-onset AAV temporally associated with inactivated COVID-19 vaccination. The patient, a previously asymptomatic 78-year-old White woman with a medical history of odontogenic maxillary sinusitis resolved after sinus surgery (in 2011), presented with asthenia, low-grade fever, and a mild dry cough 2 weeks after receiving Sinovac Biotech’s COVID-19 vaccine (CoronaVac) on March 12, 2021 (second shot on April 5, 2021). Over the weeks, in addition to persistent fever, the patient experienced worsening of fatigue, weight loss, night sweats, and renal dysfunction. Of note, various antibiotics were empirically used until she underwent a kidney biopsy on June 22. At that time, she had leukocytosis, anemia, thrombocytosis, elevated inflammatory biomarkers and serum creatinine (peak at 7.3 vs 0.8 mg/dl on May 1, 2021), cytoplasmic ANCA 1:20 by indirect immunofluorescence (reference: negative), an anti-proteinase-3 level of 19 U/ml by fluorescent-enzyme immunoassay (positive >3 U/ml), a normal complement level, polyclonal hypergammaglobulinemia, and active urinary sediment. The diagnostic workup was negative for COVID-19 (reverse transcription–polymerase chain reaction), antinuclear antibodies (ANA), rheumatoid factor, cryoglobulins, anti-myeloperoxidase, anti-phospholipids, anti-Ro, anti-La, anti-Smith (Sm), anti–double-stranded DNA, anti-ribonucleoprotein (RNP), anti–glomerular basement membrane, HIV, and hepatitis B and C. Computed tomography (head, chest, paranasal sinuses, and abdomen), echocardiography, and nasal and laryngeal videoendoscopy findings were either normal or nonspecific. Urine and blood culture results were negative. The result of a kidney biopsy (14 glomeruli yielded) was compatible with necrotizing (9 of 14 glomeruli) and crescentic (cellular crescents in 6 of 14 glomeruli) glomerulonephritis. The renal biopsy specimen shows a cellular crescent and break of the glomerular basement membrane (periodic acid–Schiff stain, original magnification ×40) (A), break in Bowman’s capsule (Jones stain, original magnification ×40) (B), an acute tubular injury (hematoxylin–eosin stain, original magnification ×40) (C), and fibrinoid necrosis in the glomerulus capillary loop (hematoxylin–eosin stain, original magnification ×40) (D). Renal immunostaining results were negative for C1q; C3; immunoglobulins A, M, and G; and light chains κ and λ. The patient received high-dose corticosteroids, pulse cyclophosphamide, and needed hemodialysis for 12 weeks. She is now controlled on low-dose corticosteroids and mycophenolate mofetil but with chronic renal impairment. To our knowledge, this is the first report of AAV possibly triggered by an inactivated COVID-19 vaccine. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Preclinical Efficacy and Clinical Feasibility of a Novel Aerosol-Exposure Protection Mask for Esophagogastroduodenoscopy.

Background/AimsThis study aimed to assess the efficacy of a novel aerosol-exposure protection (AP) mask in preventing coronavirus disease in healthcare professionals during upper gastrointestinal endoscopy and to evaluate its clinical feasibility. MethodsIn Study 1, three healthy volunteers volitionally coughed with and without the AP mask in a cleanroom. Microparticles were visualized and counted with a specific measurement system and compared with and without the AP mask. In Study 2, 30 patients underwent endoscopic resection with the AP mask covering the face, and the SpO2 was measured throughout the procedure. ResultsIn Study 1, the median number of microparticles in volunteers 1, 2, and 3 with and without the AP mask was 8.5 and 110.0, 7.0 and 51.5, and 8.0 and 95.0, respectively (p<0.01). Using the AP mask, microparticles were reduced by approximately 92%. The median distances of microparticle scattering without the AP mask were 60, 0, and 68 in volunteers 1, 2, and 3, respectively. In Study 2, the mean SpO2 was 96.3%, and desaturation occurred in three patients.ConclusionThe AP mask could provide protection from aerosol exposure and can be safely used for endoscopy in clinical practice.

Reduced antibody activity against SARS-CoV-2 B.1.617.2 delta virus in serum of mRNA-vaccinated individuals receiving tumor necrosis factor-α inhibitors

BackgroundAlthough vaccines effectively prevent coronavirus disease 2019 (COVID-19) in healthy individuals, they appear to be less immunogenic in individuals with chronic inflammatory disease (CID) or receiving chronic immunosuppression therapy.MethodsHere we assessed a cohort of 77 individuals with CID treated as monotherapy with chronic immunosuppressive drugs for antibody responses in serum against historical and variant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses after immunization with the BNT162b2 mRNA vaccine.FindingsLongitudinal analysis showed the greatest reductions in neutralizing antibodies and Fc effector function capacity in individuals treated with tumor necrosis factor alpha (TNF-α) inhibitors (TNFi), and this pattern appeared to be worse against the B.1.617.2 delta virus. Within 5 months of vaccination, serum neutralizing titers of all TNFi-treated individuals tested fell below the presumed threshold correlate for antibody-mediated protection. However, TNFi-treated individuals receiving a third mRNA vaccine dose boosted their serum neutralizing antibody titers by more than 16-fold.ConclusionsVaccine boosting or administration of long-acting prophylaxis (e.g., monoclonal antibodies) will likely be required to prevent SARS-CoV-2 infection in this susceptible population.FundingThis study was supported by grants and contracts from the NIH (R01 AI157155, R01AI151178, and HHSN75N93019C00074; NIAID Centers of Excellence for Influenza Research and Response (CEIRR) contracts HHSN272201400008C and 75N93021C00014; and Collaborative Influenza Vaccine Innovation Centers [CIVIC] contract 75N93019C00051).

Analysis of Factors Affecting Behavior of the Implementation of Health Protocols to Prevent Corona Virus Disease 2019 (Covid-19) in the Work Area of Ngoro Public Health Center Mojokerto Regency

The community has an important role in breaking the chain of Covid-19 transmission so as not to cause new sources of transmission / clusters in places where people move, interact between people and gather many people. The role of the community in being able to break the chain of Covid-19 transmission (risk of contracting and transmitting) must be carried out by implementing health protocols. This study aims to determine the influence of the factors of knowledge, attitudes, availability of facilities and infrastructure and support for the behavior of implementing health protocols in an effort to prevent Covid-19 in the work area of ​​Ngoro Public Health Center Mojokerto Regency. This research is an analytic survey research with a cross sectional approach. The study population was the population in Ngoro Public Health Center area. The sampling technique used is a simple sampling technique with a total sample size of 348 people. Retrieval of data using a questionnaire. Data analysis using multiple linear regression analysis. The results of this study indicate that the knowledge factor, attitude factor, and support factor partially influence the behavior of implementing health protocols. Attitude factor is the dominant factor affecting the behavior of implementing health protocols. While the knowledge factor, attitude factor, availability of health protocol facilities as well as support factors simultaneously influence the behavior of implementing health protocols in an effort to prevent Covid-19 in the work area of Ngoro Public Health Center Mojokerto Regency. To improve the behavior of implementing health protocols in the community, it is necessary to carry out activities of counseling, education, socialization, dissemination of information and supported by policies and regulations. Examples from health workers and community leaders are also needed in order to become a reference for the community.

Virucidal, photocatalytic and chiromagnetic cobalt oxide quantum dots

Multifunctional quantum dots (QDs) of Co3O4 were fabricated using cobalt II nitrate hexahydrate with tomato (Solanum lycopersicum L.) seed extract and were efficiently applied as a virucidal additive in cotton fabric. The low-dimensional semiconductor, exhibiting a quantum confinement regime along with charge carrier confinement, resulted in superior antiviral characteristics. The QDs were characterized by UV-visible spectrophotometry, high-resolution transmission electron microscopy, X-ray excited photoelectron spectrometry, Fourier transform infrared spectroscopy, and magnetic properties using a superconductor quantum interference device. Co3O4 QDs exhibit chirality, as evidenced by the magnetic circular dichroism spectrum in the spectral region in which the material absorbs. The high ferritin content in tomato seeds, as evidenced by electron paramagnetic resonance, suggested that this protein acts as a nanocage for the growth of Co3O4. Commercially purified horse spleen ferritin was equally efficient in producing Co3O4 QDs. Based on these results, it can be concluded that the multifunctional platform of Co3O4 QDs satisfactorily meets the requirements to be an efficient photocatalyst and exhibits the potential to be employed as a semiconductor textile-based to combat/ to prevent coronavirus disease as a sustainable personal protective clothing.

Review: Development of SARS-CoV-2 immuno-enhanced COVID-19 vaccines with nano-platform.

Vaccination is the most effective way to prevent coronavirus disease 2019 (COVID-19). Vaccine development approaches consist of viral vector vaccines, DNA vaccine, RNA vaccine, live attenuated virus, and recombinant proteins, which elicit a specific immune response. The use of nanoparticles displaying antigen is one of the alternative approaches to conventional vaccines. This is due to the fact that nano-based vaccines are stable, able to target, form images, and offer an opportunity to enhance the immune responses. The diameters of ultrafine nanoparticles are in the range of 1–100 nm. The application of nanotechnology on vaccine design provides precise fabrication of nanomaterials with desirable properties and ability to eliminate undesirable features. To be successful, nanomaterials must be uptaken into the cell, especially into the target and able to modulate cellular functions at the subcellular levels. The advantages of nano-based vaccines are the ability to protect a cargo such as RNA, DNA, protein, or synthesis substance and have enhanced stability in a broad range of pH, ambient temperatures, and humidity for long-term storage. Moreover, nano-based vaccines can be engineered to overcome biological barriers such as nonspecific distribution in order to elicit functions in antigen presenting cells. In this review, we will summarize on the developing COVID-19 vaccine strategies and how the nanotechnology can enhance antigen presentation and strong immunogenicity using advanced technology in nanocarrier to deliver antigens. The discussion about their safe, effective, and affordable vaccines to immunize against COVID-19 will be highlighted.

MPO-ANCA-associated vasculitis after the Pfizer/BioNTech SARS-CoV-2 vaccination.

ABSTRACTVaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has demonstrated high efficacy at preventing coronavirus disease 2019 (COVID-19) and a favorable safety profile, however it has also been reported that COVID-19 vaccines may put increase of immune-mediated disease. We herein report a case of MPO-anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis following the mRNA vaccine BNT162b2 (Pfizer/BioNTech) for COVID-19. Although the causal relationship between vaccine and ANCA-associated vasculitis is uncertain, environmental and genetic factors may have set the stage for the development of vasculitis, and the vaccine may have triggered a domino effect.

Pharmacological interventions to prevent Covid-19 disease: A rapid review.

SummaryThe aim of this rapid review was to determine the effectiveness of pharmacological interventions (excluding vaccines) to prevent coronavirus disease 2019 (Covid‐19) or reduce the severity of disease. A systematic search of published peer‐reviewed articles and non‐peer‐reviewed pre‐prints was undertaken from 1 January 2020 to 17 August 2021. Four randomised controlled trials (RCTs) and one non‐RCT were included; three trials (two RCTs and one non‐RCT) tested ivermectin with or without carrageenan. While all reported some potential protective effect of ivermectin, these trials had a high risk of bias and the certainty of evidence was deemed to be ‘very low’. One RCT tested bamlanivimab compared to placebo and reported a significantly reduced incidence of Covid‐19 in the intervention group; this trial had a low risk of bias however the certainty of evidence was deemed ‘very low’. The fifth RCT tested casirivimab plus imdevimab versus placebo and reported that the combination of monoclonal antibodies significantly reduced the incidence of symptomatic and asymptomatic SARS‐CoV‐2 infection, viral load, duration of symptomatic disease and the duration of a high viral load; this trial was deemed to have a low risk of bias, and the certainty of evidence was ‘low’. The designations ‘low' and ‘very low’ regarding the certainty of evidence indicate that the estimate of effect is uncertain and therefore is unsuitable for informing decision‐making. At the time of writing, there is insufficient high quality evidence to support the use of pharmacological interventions to prevent Covid‐19.

Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase

BackgroundAt interim analysis in a phase 3, observer-blinded, placebo-controlled clinical trial, the mRNA-1273 vaccine showed 94.1% efficacy in preventing coronavirus disease 2019 (Covid-19). After emergency use of the vaccine was authorized, the protocol was amended to include an open-label phase. Final analyses of efficacy and safety data from the blinded phase of the trial are reported.MethodsWe enrolled volunteers who were at high risk for Covid-19 or its complications; participants were randomly assigned in a 1:1 ratio to receive two intramuscular injections of mRNA-1273 (100 μg) or placebo, 28 days apart, at 99 centers across the United States. The primary end point was prevention of Covid-19 illness with onset at least 14 days after the second injection in participants who had not previously been infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The data cutoff date was March 26, 2021.ResultsThe trial enrolled 30,415 participants; 15,209 were assigned to receive the mRNA-1273 vaccine, and 15,206 to receive placebo. More than 96% of participants received both injections, 2.3% had evidence of SARS-CoV-2 infection at baseline, and the median follow-up was 5.3 months in the blinded phase. Vaccine efficacy in preventing Covid-19 illness was 93.2% (95% confidence interval [CI], 91.0 to 94.8), with 55 confirmed cases in the mRNA-1273 group (9.6 per 1000 person-years; 95% CI, 7.2 to 12.5) and 744 in the placebo group (136.6 per 1000 person-years; 95% CI, 127.0 to 146.8). The efficacy in preventing severe disease was 98.2% (95% CI, 92.8 to 99.6), with 2 cases in the mRNA-1273 group and 106 in the placebo group, and the efficacy in preventing asymptomatic infection starting 14 days after the second injection was 63.0% (95% CI, 56.6 to 68.5), with 214 cases in the mRNA-1273 group and 498 in the placebo group. Vaccine efficacy was consistent across ethnic and racial groups, age groups, and participants with coexisting conditions. No safety concerns were identified.ConclusionsThe mRNA-1273 vaccine continued to be efficacious in preventing Covid-19 illness and severe disease at more than 5 months, with an acceptable safety profile, and protection against asymptomatic infection was observed. (Funded by the Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases; COVE ClinicalTrials.gov number, NCT04470427.)

Differential plasmacytoid dendritic cell phenotype and type I Interferon response in asymptomatic and severe COVID-19 infection.

SARS-CoV-2 fine-tunes the interferon (IFN)-induced antiviral responses, which play a key role in preventing coronavirus disease 2019 (COVID-19) progression. Indeed, critically ill patients show an impaired type I IFN response accompanied by elevated inflammatory cytokine and chemokine levels, responsible for cell and tissue damage and associated multi-organ failure. Here, the early interaction between SARS-CoV-2 and immune cells was investigated by interrogating an in vitro human peripheral blood mononuclear cell (PBMC)-based experimental model. We found that, even in absence of a productive viral replication, the virus mediates a vigorous TLR7/8-dependent production of both type I and III IFNs and inflammatory cytokines and chemokines, known to contribute to the cytokine storm observed in COVID-19. Interestingly, we observed how virus-induced type I IFN secreted by PBMC enhances anti-viral response in infected lung epithelial cells, thus, inhibiting viral replication. This type I IFN was released by plasmacytoid dendritic cells (pDC) via an ACE-2-indipendent but Neuropilin-1-dependent mechanism. Viral sensing regulates pDC phenotype by inducing cell surface expression of PD-L1 marker, a feature of type I IFN producing cells. Coherently to what observed in vitro, asymptomatic SARS-CoV-2 infected subjects displayed a similar pDC phenotype associated to a very high serum type I IFN level and induction of anti-viral IFN-stimulated genes in PBMC. Conversely, hospitalized patients with severe COVID-19 display very low frequency of circulating pDC with an inflammatory phenotype and high levels of chemokines and pro-inflammatory cytokines in serum. This study further shed light on the early events resulting from the interaction between SARS-CoV-2 and immune cells occurring in vitro and confirmed ex vivo. These observations can improve our understanding on the contribution of pDC/type I IFN axis in the regulation of the anti-viral state in asymptomatic and severe COVID-19 patients.

Mandate or Not Mandate: Knowledge, Attitudes, and Practices of Italian Occupational Physicians towards SARS-CoV-2 Immunization at the Beginning of Vaccination Campaign.

Vaccinations used to prevent coronavirus disease (COVID-19)—the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—are critical in order to contain the ongoing pandemic. However, SARS-CoV-2/COVID-19 vaccination rates have only slowly increased since the beginning of the vaccination campaign, even with at-risk workers (e.g., HCWs), presumptively because of vaccine hesitancy. Vaccination mandates are considered instrumental in order to rapidly improve immunization rates (but they minimize the impact of vaccination campaigns). In this study, we investigated the acceptance (i.e., knowledge, attitudes, and practices) from occupational physicians (OPs)) in regard to SARS-CoV-2/COVID-19 vaccination mandates. A total of 166 OPs participated in an internet-based survey by completing structured questionnaires. Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of OPs. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.5% regarding its occurrence, 81.9% regarding its potential severity). SARS-CoV-2/COVID-19 vaccination was endorsed by 90.4% of respondents, acceptance for SARS-CoV-2 vaccine was quite larger for mRNA formulates (89.8%) over adenoviral ones (59.8%). Endorsement of vaccination mandates was reported by 60.2% of respondents, and was more likely endorsed by OPs who exhibited higher concern for SARS-CoV-2 infection occurrence (odds ratio 3.462, 95% confidence intervals 1.060–11.310), who were likely to accept some sort of payment/copayment for SARS-CoV-2/COVID-19 vaccination (3.896; 1.607; 9.449), or who were more likely to believe HCWs not vaccinates against SARS-CoV-2 as unfit for work (4.562; 1.935; 10.753). In conclusion, OPs exhibited wide acceptance of SARS-CoV-2/COVID-19 vaccinations, and the majority endorsed vaccination mandates for HCWs, which may help improve vaccination rates in occupational settings.

Effectiveness of Severe Acute Respiratory Syndrome Coronavirus 2 Messenger RNA Vaccines for Preventing Coronavirus Disease 2019 Hospitalizations in the United States.

BackgroundAs SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe Covid-19 and among people at increased risk for poor outcomes.MethodsIn a multicenter case-control analysis of US adults hospitalized March 11-May 5, 2021, we evaluated vaccine effectiveness to prevent Covid-19 hospitalizations by comparing odds of prior vaccination with an mRNA vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with Covid-19 and hospital-based controls who tested negative for SARS-CoV-2.ResultsAmong 1212 participants, including 593 cases and 619 controls, median age was 58 years, 22.8% were Black, 13.9% were Hispanic, and 21.0% had immunosuppression. SARS-CoV-2 lineage B.1.1.7 (Alpha) was the most common variant (67.9% of viruses with lineage determined). Full vaccination (receipt of two vaccine doses ≥14 days before illness onset) had been received by 8.2% of cases and 36.4% of controls. Overall vaccine effectiveness was 87.1% (95% CI: 80.7 to 91.3%). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.4%; 95% CI: 79.3 to 99.7%). Among 45 patients with vaccine-breakthrough Covid hospitalizations, 44 (97.8%) were ≥50 years old and 20 (44.4%) had immunosuppression. Vaccine effectiveness was lower among patients with immunosuppression (62.9%; 95% CI: 20.8 to 82.6%) than without immunosuppression (91.3%; 95% CI: 85.6 to 94.8%).ConclusionDuring March–May 2021, SARS-CoV-2 mRNA vaccines were highly effective for preventing Covid-19 hospitalizations among US adults. SARS-CoV-2 vaccination was beneficial for patients with immunosuppression, but effectiveness was lower in the immunosuppressed population.