151
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Carro B. SARS-CoV-2 mechanisms of action and impact on human organism, risk factors and potential treatments. An exhaustive survey. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1977186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Belén Carro
- Department of Signal Theory and Communications, Universidad de Valladolid, Valladolid, Spain
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152
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Mohapatra PR, Mishra B, Behera B. BCG vaccination induced protection from COVID-19. Indian J Tuberc 2021; 68:119-124. [PMID: 33641831 PMCID: PMC7413058 DOI: 10.1016/j.ijtb.2020.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
There are worldwide urgency, efforts, and uncertainties for the discovery of a vaccine against SARS CoV2. If successful, it will take its own time till useful for the humans. Till the specific vaccine is available, there are evidences for repurposing existing other vaccines. It is observed that countries having a routine BCG vaccination programme, have shown to have lower incidence of COVID-19, suggesting some protective mechanisms of BCG against COVID-19 in such countries. In countries like India despite vast population density and other adversities, and growing numbers of COVID19 infections, the mortality rate and severity of COVID has been low in comparison to some TB non-endemic countries (like Europe and USA). In addition, there are evidences that BCG vaccination offers partial protection and survival in low-income countries where tuberculosis is prevalent. The nonspecific effects (NSEs) of immune responses induced by BCG vaccination protect against other infections seem to be due to its immunological memory eliciting lymphocytes response and trained immunity. The protective effect on other viral infection in humans are believed to be mediated by heterologous lymphocyte activation and the initiation of innate immune memory may be applicable to SARS CoV2. The BCG vaccination at birth does not have a protective effect beyond childhood against COVID-19. In adults, there might be other factors dampening the virulence and pathogenicity of COVID-19. In the TB endemic countries like India, with high population density, similar to BCG vaccination, the environmental Mycobacteria might be imparting some immune-protection from severity and deaths of COVID-19.
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Affiliation(s)
- Prasanta Raghab Mohapatra
- Professor & Head, Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Baijayantimala Mishra
- Professor & Head, Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Bijayini Behera
- Associate Professor, Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
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153
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Affiliation(s)
- Rajesh Bhatia
- Former Director, Communicable Diseases, World Health Organization South-East Asia Regional Office, New Delhi 110 002, India
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154
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155
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Abstract
The development of vaccines is one of the greatest medical interventions in the history of global infectious diseases and has contributed to the annual saving of at least 2 to 3 million lives worldwide. However, many diseases are not preventable through currently available vaccines, and the potential of modulating the immune response during vaccination has not been fully exploited. The first golden age of vaccines was based on the germ theory and the use of live, attenuated, inactivated pathogens or toxins. New strategies and formulations (e.g., adjuvants) with an immunomodulatory capacity to enhance the protective qualities and duration of vaccines have been incompletely exploited. These strategies can prevent disease and improve protection against infectious diseases, modulate the course of some noncommunicable diseases, and increase the immune responses of patients at a high risk of infection, such as the elderly or immunocompromised patients. In this minireview, we focus on how metabolic and epigenetic modulators can amplify and enhance the function of immunity in a given vaccine. We propose the term “amplifier” for such additives, and we pose that future vaccines will have three components: antigen, adjuvant, and amplifier.
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156
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Sohrabi Y, Dos Santos JC, Dorenkamp M, Findeisen H, Godfrey R, Netea MG, Joosten LAB. Trained immunity as a novel approach against COVID-19 with a focus on Bacillus Calmette-Guérin vaccine: mechanisms, challenges and perspectives. Clin Transl Immunology 2020; 9:e1228. [PMID: 33363733 PMCID: PMC7755499 DOI: 10.1002/cti2.1228] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/03/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022] Open
Abstract
COVID-19 is a severe health problem in many countries and has altered day-to-day life in the whole world. This infection is caused by the SARS-CoV-2 virus, and depending on age, sex and health status of the patient, it can present with variety of clinical symptoms such as mild infection, a very severe form or even asymptomatic course of the disease. Similarly to other viruses, innate immune response plays a vital role in protection against COVID-19. However, dysregulation of innate immunity could have a significant influence on the severity of the disease. Despite various efforts, there is no effective vaccine against the disease so far. Recent data have demonstrated that the Bacillus Calmette-Guérin (BCG) vaccine could reduce disease severity and the burden of several infectious diseases in addition to targeting its primary focus tuberculosis. There is growing evidence for the concept of beneficial non-specific boosting of immune responses by BCG or other microbial compounds termed trained immunity, which may protect against COVID-19. In this manuscript, we review data on how the development of innate immune memory due to microbial compounds specifically BCG can result in protection against SARS-CoV-2 infection. We also discuss possible mechanisms, challenges and perspectives of using innate immunity as an approach to reduce COVID-19 severity.
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Affiliation(s)
- Yahya Sohrabi
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
- Institute of Molecular Genetics of the Czech Academy of SciencesPragueCzech Republic
| | - Jéssica Cristina Dos Santos
- Department of Internal Medicine and Radboud Centre of Infectious Diseases (RCI)Radboud University Medical CentreNijmegenThe Netherlands
| | - Marc Dorenkamp
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
| | - Hannes Findeisen
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
| | - Rinesh Godfrey
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Centre of Infectious Diseases (RCI)Radboud University Medical CentreNijmegenThe Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES)University of BonnBonnGermany
| | - Leo AB Joosten
- Department of Internal Medicine and Radboud Centre of Infectious Diseases (RCI)Radboud University Medical CentreNijmegenThe Netherlands
- Núcleo de Pesquisa da Faculdade da Polícia Militar (FPM) do Estado de GoiásGoiâniaBrazil
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157
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Tcheutchoua DN, Tankeu AT, Angong DLW, Agoons BB, Nguemnang NYY, Djeunga HCN, Kamgno J. Unexpected low burden of coronavirus disease 2019 (COVID-19) in sub-Saharan Africa region despite disastrous predictions: reasons and perspectives. Pan Afr Med J 2020; 37:352. [PMID: 33796166 PMCID: PMC7992902 DOI: 10.11604/pamj.2020.37.352.25254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/08/2020] [Indexed: 01/13/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the development of a highly contagious disease called coronavirus disease (COVID-19). Ten months after the onset of the pandemic, America and Europe remain the most affected regions. Initially, experts predicted that Africa, the poorest continent with the most vulnerable population and health system, would be greatly affected by the ongoing outbreak. However, 240days after the first confirmed case, Africa is among the least affected region, with lower than expected incident cases and mortality. In this review, we discuss possible explanations and reasons for this unexpected low burden of COVID-19 in Africa. We focus on the characteristics of the virus, specificities of the sub-Saharan African population and local environment.
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Affiliation(s)
- Daryl Nzokou Tcheutchoua
- Public Health Department, Faculty of Medical and Paramedical Sciences, Aix-Marseille University, Marseille, France
| | - Aurel Tiakouang Tankeu
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
- Centre for Research on Filariasis and Other Tropical Diseases, Yaoundé, Cameroon
| | - Dominic Leandry Wouna Angong
- Public Health Department, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Batakeh Ba Agoons
- Public Health Department, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Nathan Yves Yanwou Nguemnang
- Public Health Department, Faculty of Medical and Paramedical Sciences, Aix-Marseille University, Marseille, France
| | | | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases, Yaoundé, Cameroon
- Public Health Department, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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158
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Bellini C, Horváti K. Recent Advances in the Development of Protein- and Peptide-Based Subunit Vaccines against Tuberculosis. Cells 2020; 9:cells9122673. [PMID: 33333744 PMCID: PMC7765234 DOI: 10.3390/cells9122673] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
The World Health Organization (WHO) herald of the “End TB Strategy” has defined goals and targets for tuberculosis prevention, care, and control to end the global tuberculosis endemic. The emergence of drug resistance and the relative dreadful consequences in treatment outcome has led to increased awareness on immunization against Mycobacterium tuberculosis (Mtb). However, the proven limited efficacy of Bacillus Calmette-Guérin (BCG), the only licensed vaccine against Mtb, has highlighted the need for alternative vaccines. In this review, we seek to give an overview of Mtb infection and failure of BCG to control it. Afterward, we focus on the protein- and peptide-based subunit vaccine subtype, examining the advantages and drawbacks of using this design approach. Finally, we explore the features of subunit vaccine candidates currently in pre-clinical and clinical evaluation, including the antigen repertoire, the exploited adjuvanted delivery systems, as well as the spawned immune response.
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Affiliation(s)
- Chiara Bellini
- Hevesy György PhD School of Chemistry, Eötvös Loránd University, 1117 Budapest, Hungary;
- MTA-ELTE Research Group of Peptide Chemistry, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Kata Horváti
- MTA-ELTE Research Group of Peptide Chemistry, Eötvös Loránd University, 1117 Budapest, Hungary
- Correspondence:
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159
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Khan A, Singh VK, Mishra A, Soudani E, Bakhru P, Singh CR, Zhang D, Canaday DH, Sheri A, Padmanabhan S, Challa S, Iyer RP, Jagannath C. NOD2/RIG-I Activating Inarigivir Adjuvant Enhances the Efficacy of BCG Vaccine Against Tuberculosis in Mice. Front Immunol 2020; 11:592333. [PMID: 33365029 PMCID: PMC7751440 DOI: 10.3389/fimmu.2020.592333] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/03/2020] [Indexed: 12/20/2022] Open
Abstract
Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) kills about 1.5 million people each year and the widely used Bacille Calmette-Guérin (BCG) vaccine provides a partial protection against TB in children and adults. Because BCG vaccine evades lysosomal fusion in antigen presenting cells (APCs), leading to an inefficient production of peptides and antigen presentation required to activate CD4 T cells, we sought to boost its efficacy using novel agonists of RIG-I and NOD2 as adjuvants. We recently reported that the dinucleotide SB 9200 (Inarigivir) derived from our small molecule nucleic acid hybrid (SMNH)® platform, activated RIG-I and NOD2 receptors and exhibited a broad-spectrum antiviral activity against hepatitis B and C, Norovirus, RSV, influenza and parainfluenza. Inarigivir increased the ability of BCG-infected mouse APCs to secrete elevated levels of IL-12, TNF-α, and IFN-β, and Caspase-1 dependent IL-1β cytokine. Inarigivir also increased the ability of macrophages to kill MTB in a Caspase-1-, and autophagy-dependent manner. Furthermore, Inarigivir led to a Capsase-1 and NOD2- dependent increase in the ability of BCG-infected APCs to present an Ag85B-p25 epitope to CD4 T cells in vitro. Consistent with an increase in immunogenicity of adjuvant treated APCs, the Inarigivir-BCG vaccine combination induced robust protection against tuberculosis in a mouse model of MTB infection, decreasing the lung burden of MTB by 1-log10 more than that afforded by BCG vaccine alone. The Inarigivir-BCG combination was also more efficacious than a muramyl-dipeptide-BCG vaccine combination against tuberculosis in mice, generating better memory T cell responses supporting its novel adjuvant potential for the BCG vaccine.
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Affiliation(s)
- Arshad Khan
- Department of Pathology and Genomic Medicine, Center for Human Infectious Diseases, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Vipul K Singh
- Department of Pathology and Genomic Medicine, Center for Human Infectious Diseases, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Abhishek Mishra
- Department of Pathology and Genomic Medicine, Center for Human Infectious Diseases, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Emily Soudani
- Department of Pathology and Genomic Medicine, Center for Human Infectious Diseases, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Pearl Bakhru
- Department of Pathology and Genomic Medicine, Center for Human Infectious Diseases, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Christopher R Singh
- Department of Pathology and Genomic Medicine, Center for Human Infectious Diseases, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Dekai Zhang
- Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, United States
| | - David H Canaday
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH, United States
| | | | | | - Sreerupa Challa
- Spring Bank Pharmaceuticals, Inc., Hopkinton, MA, United States
| | | | - Chinnaswamy Jagannath
- Department of Pathology and Genomic Medicine, Center for Human Infectious Diseases, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
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160
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Locht C, Lerm M. Good old BCG - what a century-old vaccine can contribute to modern medicine. J Intern Med 2020; 288:611-613. [PMID: 33315299 PMCID: PMC7756310 DOI: 10.1111/joim.13195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Affiliation(s)
- C Locht
- CIIL-Centre for Infection and Immunity of Lille, Univ. Lille, CNRS, Inserm, CHU Lille, Institute Pasteur de Lille, Lille, France
| | - M Lerm
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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161
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Akca UK, Kesici S, Ozsurekci Y, Aykan HH, Batu ED, Atalay E, Demir S, Sag E, Vuralli D, Bayrakci B, Bilginer Y, Ozen S. Kawasaki-like disease in children with COVID-19. Rheumatol Int 2020; 40:2105-2115. [PMID: 32936318 PMCID: PMC7492688 DOI: 10.1007/s00296-020-04701-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Children with Coronavirus disease 2019 (COVID-19) are being reported to have manifestations of hyperinflammatory states and/or Kawasaki-like disease. In this study, we investigated children with typical and atypical Kawasaki disease (KD) likely to be associated with COVID-19. We have reported four children with Kawasaki-like disease probably associated with COVID-19. The clinical features were consistent with incomplete KD in three patients. SARS-CoV-2 RT-PCR was positive in one and the serology was positive in one patient with negative RT-PCR. Corticosteroids, anakinra, intravenous immunoglobulin (IVIG), and acetylsalicylic acid were used in the treatment. Three patients recovered after the treatment while one patient died. The literature review revealed 36 articles describing 320 children with Kawasaki-like disease associated with COVID-19. SARS-CoV-2 RT-PCR was negative in 120 (65.5%) of 183 patients while the serology was positive in 130 (83.8%) of 155 patients. The therapeutic options have included IVIG, acetylsalicylic acid, tocilizumab, anakinra, enoxaparin, and methylprednisolone. Pediatric COVID-19 cases may present with atypical/incomplete Kawasaki-like disease. Thus, pediatricians need to be aware of such atypical presentations resembling KD for early diagnosis of COVID-19.
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Affiliation(s)
- Ummusen Kaya Akca
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hayrettin Hakan Aykan
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdal Atalay
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dogus Vuralli
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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162
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Ebrahimi N, Aslani S, Babaie F, Hemmatzadeh M, Hosseinzadeh R, Joneidi Z, Mehdizadeh Tourzani Z, Pakravan N, Mohammadi H. Recent findings on the Coronavirus disease 2019 (COVID-19); immunopathogenesis and immunotherapeutics. Int Immunopharmacol 2020; 89:107082. [PMID: 33068865 PMCID: PMC7547582 DOI: 10.1016/j.intimp.2020.107082] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) is responsible for recent ongoing public health emergency in the world. Sharing structural and behavioral similarities with its ancestors [SARS and Middle East Respiratory Syndrome (MERS)], SARS-CoV-2 has lower fatality but faster transmission. We have gone through a long path to recognize SARS and MERS, therefore our knowledge regarding SARS-CoV-2 is not raw. Various responses of the immune system account for the wide spectrum of clinical manifestations in Coronavirus disease-2019 (COVID-19). Given the innate immune response as the front line of defense, it is immediately activated after the virus entry. Consequently, adaptive immune response is activated to eradicate the virus. However, this does not occur in every case and immune response is the main culprit causing the pathological manifestations of COVID-19. Lethal forms of the disease are correlated with inefficient and/or insufficient immune responses associated with cytokine storm. Current therapeutic approach for COVID-19 is in favor of suppressing extreme inflammatory responses, while maintaining the immune system alert and responsive against the virus. This could be contributing along with administration of antiviral drugs in such patients. Furthermore, supplementation with different compounds, such as vitamin D, has been tested to modulate the immune system responses. A thorough understanding of chronological events in COVID-19 contributing to the development of a highly efficient treatment has not figured out yet. This review focuses on the virus-immune system interaction as well as currently available and potential therapeutic approaches targeting immune system in the treatment of COVID-19 patients.
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Affiliation(s)
- Negin Ebrahimi
- Department of International Medicine, Faculty of Medicine, Health Sciences University, Istanbul, Turkey
| | - Saeed Aslani
- Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Babaie
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran; Department of Medical Genetics and Immunology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Maryam Hemmatzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Hosseinzadeh
- Department of Medical Genetics and Immunology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | | | - Nafiseh Pakravan
- Department of Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | - Hamed Mohammadi
- Department of Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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163
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Lerm M. On the relationship between BCG coverage and national COVID-19 outcome: could 'heterologous' herd immunity explain why some countries are better off? J Intern Med 2020; 288:682-688. [PMID: 33107999 PMCID: PMC7839714 DOI: 10.1111/joim.13198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has affected most parts of the global society since its emergence, and the scientific community has been challenged with questions urgently demanding answers. One of the early hypotheses on COVID-19 outcome was that some protection could be offered by the tuberculosis vaccine (BCG), and several clinical studies were initiated along with the emergence of numerous observational studies on the relationship between BCG and COVID-19 severity. In the present work, I demonstrate a strong correlation between the number of years that countries implemented BCG vaccination plans and age-standardized mortality rates during the first months of the pandemic in Europe. Further analyses of age groups in two European countries with comparably few confounding factors and easily identifiable groups of BCG-vaccinated and non-vaccinated subgroups suggest a population-level effect of BCG on national outcomes of COVID-19. This phenomenon of 'heterologous herd immunity' deserves further investigation, both in epidemiological and experimental studies.
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Affiliation(s)
- M Lerm
- From the, Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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164
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Ismail MB, Omari SA, Rafei R, Dabboussi F, Hamze M. COVID-19 in children: Could pertussis vaccine play the protective role? Med Hypotheses 2020; 145:110305. [PMID: 33032174 PMCID: PMC7521348 DOI: 10.1016/j.mehy.2020.110305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/19/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022]
Abstract
While COVID-19 continues to spread across the globe, diligent efforts are made to understand its attributes and dynamics to help develop treatment and prevention measures. The paradox pertaining to children being the least affected by severe illness poses exciting opportunities to investigate potential protective factors. In this paper, we propose that childhood vaccination against pertussis (whooping cough) might play a non-specific protective role against COVID-19 through heterologous adaptive responses in this young population. Pertussis is a vaccine-preventable infectious disease of the respiratory tract and it shares many similarities with COVID-19 including transmission and clinical features. Although pertussis is caused by a bacterium (Bordetella pertussis) while COVID-19 is a viral infection (SARS-CoV-2), previous data showed that cross-reactivity and heterologous adaptive responses can be seen with unrelated agents of highly divergent groups, such as between bacteria and viruses. While we build the arguments of this hypothesis on theoretical and previous empirical evidence, we also outline suggested lines of research from different fields to test its credibility. Besides, we highlight some concerns that may arise when attempting to consider such an approach as a potential public health preventive intervention against COVID-19.
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Affiliation(s)
- Mohamad Bachar Ismail
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon; Faculty of Sciences, Lebanese University, Tripoli, Lebanon
| | - Sarah Al Omari
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rayane Rafei
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
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165
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Lommatzsch M, Rabe KF, Taube C, Joest M, Kreuter M, Wirtz H, Blum TG, Kolditz M, Geerdes-Fenge H, Otto-Knapp R, Häcker B, Schaberg T, Ringshausen FC, Vogelmeier CF, Reinmuth N, Reck M, Gottlieb J, Konstantinides S, Meyer FJ, Worth H, Windisch W, Welte T, Bauer T. [Risk Assessment for Patients with Chronic Respiratory and Pulmonary Conditions in the Context of the SARS-CoV-2 Pandemic - Statement of the German Respiratory Society (DGP) with the Support of the German Association of Respiratory Physicians (BdP)]. Pneumologie 2020; 75:19-30. [PMID: 33242887 DOI: 10.1055/a-1321-3400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- M Lommatzsch
- Zentrum für Innere Medizin, Abteilung Pneumologie, Universitätsmedizin Rostock, Rostock
| | - K F Rabe
- LungenClinic Großhansdorf, Großhansdorf.,Deutsches Zentrum für Lungenforschung
| | - C Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik, Westdeutsches Lungenzentrum, Essen
| | - M Joest
- Lungen- und Allergiezentrum Bonn, Bonn
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg.,Deutsches Zentrum für Lungenforschung
| | - H Wirtz
- Abt. Pneumologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - T G Blum
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - M Kolditz
- Medizinische Klinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - H Geerdes-Fenge
- Universitätsmedizin Rostock, Zentrum für Innere Medizin, Abteilung für Infektionskrankheiten und Tropenmedizin, Rostock
| | - R Otto-Knapp
- Dtsch. Zentralkomitee zur Bekämpfung der Tuberkulose, DZK, Berlin
| | - B Häcker
- Dtsch. Zentralkomitee zur Bekämpfung der Tuberkulose, DZK, Berlin
| | | | - F C Ringshausen
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - C F Vogelmeier
- Klinik für Pneumologie, Universitätsklinikum Marburg, Marburg.,Deutsches Zentrum für Lungenforschung
| | - N Reinmuth
- Asklepios Fachkliniken München-Gauting, Thorakale Onkologie, Gauting.,Deutsches Zentrum für Lungenforschung
| | - M Reck
- LungenClinic Großhansdorf, Großhansdorf.,Deutsches Zentrum für Lungenforschung
| | - J Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - S Konstantinides
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik, München
| | | | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln GmbH, Lehrstuhl für Pneumologie der Universität Witten-Herdecke
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - T Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
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166
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Petrović D, Petrović M, Bojković N, Čokić VP. An integrated view on society readiness and initial reaction to COVID-19: A study across European countries. PLoS One 2020; 15:e0242838. [PMID: 33227029 PMCID: PMC7682891 DOI: 10.1371/journal.pone.0242838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/10/2020] [Indexed: 01/16/2023] Open
Abstract
With the wake of the COVID-19 pandemic, the question of society's capability to deal with an acute health crisis is, once again, brought to the forefront. In the core is the need to broaden the perspective on the determinants of a country's ability to cope with the spread of the virus. This paper is about bringing together diverse aspects of readiness and initial reaction to a COVID-19 outbreak. We proposed an integrated evaluation framework which encapsulates six dimensions of readiness and initial reaction. Using a specific multi-level outranking method, we analysed how these dimensions affect the relative positioning of European countries in the early stages of the COVID-19 outbreak. The results revealed that the order of countries based on our six-dimensional assessment framework is significantly reminiscent of the actual positioning of countries in terms of COVID-19 morbidity and mortality in the initial phase of the pandemic. Our findings confirm that only when a country's readiness is complemented by an appropriate societal reaction we can expect a less severe outcome. Moreover, our study revealed different patterns of performance between former communist Eastern European and Western European countries.
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Affiliation(s)
- Dalibor Petrović
- Faculty of Transport and Traffic Engineering, University of Belgrade, Belgrade, Serbia
- Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | | | - Nataša Bojković
- Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Vladan P. Čokić
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
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167
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Chang WH. A review of vaccine effects on women in light of the COVID-19 pandemic. Taiwan J Obstet Gynecol 2020; 59:812-820. [PMID: 33218394 PMCID: PMC7486065 DOI: 10.1016/j.tjog.2020.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
The pandemic situation triggered by the spread of COVID-19 has caused great harm worldwide. More than six million people have been infected, and more than 360,000 of them have died. This is the worst catastrophe suffered by mankind in recent history. In the face of this severe disaster, people all over the world are frightened of the prospect of facing an outbreak or an annual recurrence. However, the development of a vaccine will help control the impact of COVID-19. Women in particular have been more seriously affected by the pandemic. Since the pressure and physical load they suffer are often greater than what men endure, women are more threatened by COVID-19. Though women have a poorer quality of life and work and face worse economic conditions, they also tend to have better physiological immunity than men, which can ease the effect of COVID-19. The early development of a vaccine against COVID-19 is an important issue that must take into consideration women's better immune response to the virus along with the technique of hormone regulation. Relevant research has been conducted on female-specific vaccines in the past, and women's issues were considered during those clinical trials to ensure that complications and antibody responses were positive and effective in women. National policies should also propose good strategies for women to be vaccinated. This could improve consciousness, give women a better vaccination experience, enhance their willingness to vaccinate, and protect them from COVID-19 infection.
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Affiliation(s)
- Wen-Han Chang
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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168
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Fritschi N, Curtis N, Ritz N. Bacille Calmette Guérin (BCG) and new TB vaccines: Specific, cross-mycobacterial and off-target effects. Paediatr Respir Rev 2020; 36:57-64. [PMID: 32958428 PMCID: PMC7439992 DOI: 10.1016/j.prrv.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022]
Abstract
The Bacille Calmette Guérin (BCG) vaccine was developed over a century ago and has become one of the most used vaccines without undergoing a modern vaccine development life cycle. Despite this, the vaccine has protected many millions from severe and disseminated forms of tuberculosis (TB). In addition, BCG has cross-mycobacterial effects against non-tuberculous mycobacteria and off-target (also called non-specific or heterologous) effects against other infections and diseases. More recently, BCG's effects on innate immunity suggest it might improve the immune response against viral respiratory infections including SARS-CoV-2. New TB vaccines, developed over the last 30 years, show promise, particularly in prevention of progression to disease from TB infection in young adults. The role of BCG in the context of new TB vaccines remains uncertain as most participants included in trials have been previously BCG immunised. BCG replacement vaccines are in efficacy trials and these may also have off-target effects.
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Affiliation(s)
- Nora Fritschi
- Infectious Unit and Mycobacterial Research Group, University Children's Hospital and Department of Clinical Research, University of Basel, Switzerland
| | - Nigel Curtis
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nicole Ritz
- Infectious Unit and Mycobacterial Research Group, University Children's Hospital and Department of Clinical Research, University of Basel, Switzerland; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; University of Basel Children's Hospital, Infectious Diseases Unit Basel, Switzerland.
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169
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Affiliation(s)
- R. S. Thwaites
- National Heart and Lung InstituteImperial College LondonLondonUK
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170
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Caminati M, Furci F, Senna G, Delfino G, Poli A, Bovo C, Patella V. BCG vaccination and COVID-19: Much ado about nothing? Med Hypotheses 2020; 144:110109. [PMID: 32758899 PMCID: PMC7361052 DOI: 10.1016/j.mehy.2020.110109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/12/2020] [Indexed: 12/05/2022]
Affiliation(s)
- M Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona and Verona University Hospital, Verona, Italy.
| | - F Furci
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, Messina, Italy
| | - G Senna
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona and Verona University Hospital, Verona, Italy
| | - G Delfino
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
| | - A Poli
- Department of Diagnostics and Public Health, Section of Hygiene and Preventive Medicine, University of Verona, Italy
| | - C Bovo
- Medical Direction, Verona University Hospital, Verona, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy; Postgraduate Program in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
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171
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Wassenaar T, Buzard G, Newman D. BCG vaccination early in life does not improve COVID-19 outcome of elderly populations, based on nationally reported data. Lett Appl Microbiol 2020; 71:498-505. [PMID: 32734625 PMCID: PMC9728116 DOI: 10.1111/lam.13365] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023]
Abstract
The reported numbers of Covid-19 cases and deaths were compared for 18 countries (14 in Western Europe, plus Australia, Brazil, Israel and the USA) to assess the effect of historic and current national BCG immunizations. In view of the high death rate for Covid-19 patients over 70 years of age, and given the fact that BCG vaccination is typically given early in life, we compared countries that had introduced BCG in the 1950s with those that had not. No effect on Covid-19 case fatality rate (CFR) or number of deaths per population could be demonstrated. Since some countries test for Covid-19 more than others, the effect of tests performed per million population on reported deaths per million was also assessed, but again did not demonstrate an effect of BCG vaccination in the 1950s. Whether countries had never used the vaccine, had historically used it but since ceased to do so, or were presently vaccinating with BCG did not correlate with national total number of deaths or CFR. We conclude that there is currently no evidence for a beneficial effect of BCG vaccination on Covid-19 reported cases or fatalities.
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Affiliation(s)
- T.M. Wassenaar
- Molecular Microbiology and Genomics Consultants Zotzenheim Germany
- European Molecular Biology Laboratory (EMBL)
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172
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Karcıoğlu O, Yüksel A, Baha A, Er AB, Esendağlı D, Gülhan PY, Karaoğlanoğlu S, Erçelik M, Şerifoğlu İ, Yıldız E, Köktürk N. Covid-19: The Biggest Threat of the 21 st Century: In Respectful Memory of the Warriors All Over the World. Turk Thorac J 2020; 21:409-418. [PMID: 33352097 PMCID: PMC7752102 DOI: 10.5152/turkthoracj.2020.20069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023]
Abstract
Since the first case was diagnosed in China, the new coronavirus infection (COVID-19) has become the number one issue in the world and it seems to remain trend-topic for a long time. Until 17 April, it affected 210 countries, infected over 2 million people and caused approximately 150000 deaths. Although the course of the disease ranges from asymptomatic state to severe ARDS; the majority of patients reveal only mild symptoms. Though adults are the most commonly affected group; it can also be seen in newborns and elderly patients. Unfortunately, elderly patients are the most vulnerable group with higher mortality. Elderly patients, smokers and patients with comorbid conditions are most affected by the disease. In certain diagnostical tool is the real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test. However, it can be resulted in false-negative results and in this case the computed thorax tomography (CT) is one of the most important tools with high sensitivity. Besides the supportive treatment, most commonly used agents are immunomodulatory drugs such as plaquenil and azitromycin, and anti-virals including oseltamivir, ritonavir-lopinavir, favipiravir. Until a vaccine or a specific therapy invented, the most important intervention to control the disease is to fight against transmission. This is a real war and the doctors are the soldiers.
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Affiliation(s)
- Oğuz Karcıoğlu
- Clinic of Chest Diseases, Çubuk Halil Şıvgın State Hospital, Ankara, Turkey
| | - Aycan Yüksel
- Department of Chest Diseases, Ufuk University School of Medicine, Ankara, Turkey
| | - Ayşe Baha
- Department of Chest Diseases, Near East University School of Medicine, Mersin, Turkey
| | - Aslıhan Banu Er
- Clinic of Chest Diseases, Denizli State Hospital, Denizli, Turkey
| | - Dorina Esendağlı
- Department of Chest Diseases, Başkent University School of Medicine, Ankara Turkey
| | - Pınar Yıldız Gülhan
- Department of Chest Diseases, Düzce University School of Medicine, Düzce, Turkey
| | - Selen Karaoğlanoğlu
- Department of Chest Diseases, Ordu University School of Medicine, Ordu, Turkey
| | - Merve Erçelik
- Department of Chest Diseases, Düzce University School of Medicine, Düzce, Turkey
| | - İrem Şerifoğlu
- Clinic of Chest Diseases, Kırıkhan State Hospital, Hatay, Turkey
| | - Ethem Yıldız
- Clinic of Chest Diseases, Bingöl State Hospital, Bingöl, Turkey
| | - Nurdan Köktürk
- Department of Chest Diseases, Gazi University School of Medicine, Ankara, Turkey
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173
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Das RC. Forecasting incidences of COVID-19 using Box-Jenkins method for the period July 12-Septembert 11, 2020: A study on highly affected countries. CHAOS, SOLITONS, AND FRACTALS 2020; 140:110248. [PMID: 32863619 PMCID: PMC7444906 DOI: 10.1016/j.chaos.2020.110248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/23/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND The devastating spread of the novel coronavirus, named COVID-19, starting its journey from Wuhan Province of China on January 21st, 2020, has now threatened lives of almost all the countries of the world in different magnitudes. Mostly the developed countries have been hit hard, besides the emerging countries like China, India and Brazil. The scientists and the policy makers are in dark with respect to its spread and claiming lives in coming days. OBJECTIVES The present study aims to forecast the number of incidences in severely affected seven countries, USA, UK, Italy, Spain, France, China and India, for the period July 12-Septmeber 11, 2020 and compares the forecasted values with the actual values to judge its depth of severity and growth. METHOD The study uses Box-Jenkins method of forecasting in an Autoregressive Integrated Moving Average (ARIMA) structure on the basis of the daily data published by World Health Organization from January 21st to July 11, 2020. RESULTS It is observed that USA and India are the two countries whose increasing trends will continue in the forecasted period (July 12 to September 11), others except China will face lower number of incidences. China's incidence has come to halt around 80000 in numbers. The growth rates of the number of incidences for all the countries during the forecasted period will be diminishing. The mean difference test results between the forecasted and actual values in level and growth forms show that in the former case, USA, India, UK will face increasing forecast than the actual number but in the latter case, all of the countries will face significantly decreasing growth rates in the forecasted values compared to their actual growth values.
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174
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Shishak M, Sarkar R. Dermatological therapies with relevance to COVID-19. Dermatol Ther 2020; 33:e13813. [PMID: 32526093 PMCID: PMC7300467 DOI: 10.1111/dth.13813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel single-stranded RNA virus that has gripped humanity all over. It affects primarily the respiratory system, but is not limited to it, causing widespread involvement of many organ systems. The cases are still rising at an exponential rate and manifold trials are on to test different agents with the hope for potential limitation of spread and control of symptoms. Various classes of drugs have been tried; some with moderate success while many are yet to be proven to be of definite benefit. We have observed that the drugs used in dermatology practice are featured in more than a few of such studies. Here, we wish to highlight the ones that we are familiar with, which has featured at some point, in the management of this very challenging pandemic.
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Affiliation(s)
- Mansak Shishak
- Consultant DermatologistIndian Spinal Injuries Multispecialty CentreNew DelhiIndia
| | - Rashmi Sarkar
- Department of DermatologyLady Hardinge Medical CollegeNew DelhiIndia
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175
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Admou B, Hazime R, Brahim I, El Adib AR. Influencing factors of SARS-Cov2 spread in Africa. J Glob Health 2020; 10:020331. [PMID: 33110531 PMCID: PMC7561272 DOI: 10.7189/jogh.10.020331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Brahim Admou
- Center of Clinical Research, Laboratory of Immunology, University Hospital Mohammed VI, Marrakech, Morocco.,Bioscience Research Laboratory, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Raja Hazime
- Center of Clinical Research, Laboratory of Immunology, University Hospital Mohammed VI, Marrakech, Morocco
| | - Imane Brahim
- Center of Clinical Research, Laboratory of Immunology, University Hospital Mohammed VI, Marrakech, Morocco
| | - Ahmed Rhassane El Adib
- Bioscience Research Laboratory, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco.,Department of Anesthesiology, Intensive Care and Emergency Medicine, University Hospital Mohammed VI, Marrakech, Morocco
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176
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Protection against SARS-CoV-2 by BCG vaccination is not supported by epidemiological analyses. Sci Rep 2020; 10:18377. [PMID: 33110184 PMCID: PMC7591473 DOI: 10.1038/s41598-020-75491-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/26/2020] [Indexed: 12/14/2022] Open
Abstract
The Bacillus Calmette–Guerin (BCG) vaccine provides protection against tuberculosis (TB), and is thought to provide protection against non-TB infectious diseases. BCG vaccination has recently been proposed as a strategy to prevent infection with SARS-CoV-2 (CoV-2) to combat the COVID-19 outbreak, supported by its potential to boost innate immunity and initial epidemiological analyses which observed reduced severity of COVID-19 in countries with universal BCG vaccination policies. Seventeen clinical trials are currently registered to inform on the benefits of BCG vaccinations upon exposure to CoV-2. Numerous epidemiological analyses showed a correlation between incidence of COVID-19 and BCG vaccination policies. These studies were not systematically corrected for confounding variables. We observed that after correction for confounding variables, most notably testing rates, there was no association between BCG vaccination policy and COVD-19 spread rate or percent mortality. Moreover, we found variables describing co-morbidities, including cardiovascular death rate and smoking prevalence, were significantly associated COVID-19 spread rate and percent mortality, respectively. While reporting biases may confound our observations, our epidemiological findings do not provide evidence to correlate overall BCG vaccination policy with the spread of CoV-2 and its associated mortality.
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177
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Tercan H, Riksen NP, Joosten LAB, Netea MG, Bekkering S. Trained Immunity: Long-Term Adaptation in Innate Immune Responses. Arterioscler Thromb Vasc Biol 2020; 41:55-61. [PMID: 33086868 DOI: 10.1161/atvbaha.120.314212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adaptive immune responses are characterized by antigen specificity and induction of lifelong immunologic memory. Recently, it has been reported that innate immune cells can also build immune memory characteristics-a process termed trained immunity. Trained immunity describes the persistent hyperresponsive phenotype that innate immune cells can develop after brief stimulation. Pathogenic stimuli such as microorganisms, and also endogenous molecules including uric acid, oxidized LDL (low-density lipoprotein), and catecholamines, are capable of inducing memory in monocytes and macrophages. While trained immunity provides favorable cross-protection in the context of infectious diseases, the heightened immune response can be maladaptive in diseases driven by chronic systemic inflammation, such as atherosclerosis. Trained immunity is maintained by distinct epigenetic and metabolic mechanisms and persists for at least several months in vivo due to reprogramming of myeloid progenitor cells. Additionally, certain nonimmune cells are also found to exhibit trained immunity characteristics. Thus, trained immunity presents an exciting framework to develop new approaches to vaccination and also novel pharmacological targets in the treatment of inflammatory diseases.
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Affiliation(s)
- Helin Tercan
- Department of Internal Medicine and Research Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (H.T., N.P.R., L.A.B.J., M.G.N., S.B.)
| | - Niels P Riksen
- Department of Internal Medicine and Research Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (H.T., N.P.R., L.A.B.J., M.G.N., S.B.)
| | - Leo A B Joosten
- Department of Internal Medicine and Research Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (H.T., N.P.R., L.A.B.J., M.G.N., S.B.).,Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (L.A.B.J.)
| | - Mihai G Netea
- Department of Internal Medicine and Research Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (H.T., N.P.R., L.A.B.J., M.G.N., S.B.).,Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Germany (M.G.N.)
| | - Siroon Bekkering
- Department of Internal Medicine and Research Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (H.T., N.P.R., L.A.B.J., M.G.N., S.B.)
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178
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Gopalaswamy R, Ganesan N, Velmurugan K, Aravindhan V, Subbian S. The Strange Case of BCG and COVID-19: The Verdict Is Still up in the Air. Vaccines (Basel) 2020; 8:E612. [PMID: 33081331 PMCID: PMC7711751 DOI: 10.3390/vaccines8040612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
COVID-19, caused by a novel coronavirus, SARS-CoV-2, contributes significantly to the morbidity and mortality in humans worldwide. In the absence of specific vaccines or therapeutics available, COVID-19 cases are managed empirically with the passive immunity approach and repurposing of drugs used for other conditions. Recently, a concept that bacilli Calmette-Guerin (BCG) vaccination could confer protection against COVID-19 has emerged. The foundation for this widespread attention came from several recent articles, including the one by Miller et al. submitted to MedRxiv, a pre-print server. The authors of this article suggest that a correlation exists between countries with a prolonged national BCG vaccination program and the morbidity/mortality due to COVID-19. Further, clinical BCG vaccination trials are currently ongoing in the Netherlands, Australia, the UK, and Germany with the hope of reducing mortality due to COVID-19. Although BCG vaccination helps protect children against tuberculosis, experimental studies have shown that BCG can also elicit a non-specific immune response against viral and non-mycobacterial infections. Here, we summarize the pros and cons of BCG vaccination and critically analyze the evidence provided for the protective effect of BCG against COVID-19 and highlight the confounding factors in these studies.
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Affiliation(s)
- Radha Gopalaswamy
- Department of Bacteriology, ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India;
| | | | - Kalamani Velmurugan
- Department of Zoology, Kongunadu Arts and Science College, Coimbatore 641029, India;
| | | | - Selvakumar Subbian
- Public Health Research Institute at New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
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179
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Reche PA. Potential Cross-Reactive Immunity to SARS-CoV-2 From Common Human Pathogens and Vaccines. Front Immunol 2020; 11:586984. [PMID: 33178220 PMCID: PMC7596387 DOI: 10.3389/fimmu.2020.586984] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Abstract
The recently emerged SARS-CoV-2 causing the ongoing COVID-19 pandemic is particularly virulent in the elderly while children are largely spared. Here, we explored the potential role of cross-reactive immunity acquired from pediatric vaccinations and exposure to common human pathogens in the protection and pathology of COVID-19. To that end, we sought for peptide matches to SARS-CoV-2 (identity ≥ 80%, in at least eight residues) in the proteomes of 25 human pathogens and in vaccine antigens, and subsequently predicted their T and B cell reactivity to identify potential cross-reactive epitopes. We found that viruses subject to pediatric vaccinations do not contain cross-reactive epitopes with SARS-CoV-2, precluding that they can provide any general protection against COVID-19. Likewise, common viruses including rhinovirus, respiratory syncytial virus, influenza virus, and several herpesviruses are also poor or null sources of cross-reactive immunity to SARS-CoV-2, discarding that immunological memory against these viruses can have any general protective or pathological role in COVID-19. In contrast, we found combination vaccines for treating diphtheria, tetanus, and pertussis infectious diseases (DTP vaccine) to be significant sources of potential cross-reactive immunity to SARS-CoV-2. DTP cross-reactive epitopes with SARS-CoV-2 include numerous CD8 and CD4 T cell epitopes with broad population protection coverage and potentially neutralizing B cell epitopes in SARS-CoV-2 Spike protein. Worldwide, children receive several DTP vaccinations, including three-four doses the first year of life and one at 4-6 years of age. Moreover, a low antigenic Tdap dose is also given at ages 9-14. Thereby, children may well be protected from SARS-CoV-2 through cross-reactive immunity elicited by DTP vaccinations, supporting testing in the general population to prevent COVID-19.
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Affiliation(s)
- Pedro A. Reche
- Department of Immunology & O2, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
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180
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Munshi R, Hussein MH, Toraih EA, Elshazli RM, Jardak C, Sultana N, Youssef MR, Omar M, Attia AS, Fawzy MS, Killackey M, Kandil E, Duchesne J. Vitamin D insufficiency as a potential culprit in critical COVID-19 patients. J Med Virol 2020; 93:733-740. [PMID: 32716073 DOI: 10.1002/jmv.26360] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND As an immune modulator, vitamin D has been implicated in the coronavirus disease-2019 (COVID-19) outcome. We aim to systematically explore the association of vitamin D serum levels with COVID-19 severity and prognosis. METHODS The standardized mean difference (SMD) or odds ratio and 95% confidence interval (CI) were applied to estimate pooled results from six studies. The prognostic performance of vitamin D serum levels for predicting adverse outcomes with detection of the best cutoff threshold was determined by receiver operating characteristic curve analysis. Decision tree analysis by combining vitamin D levels and clinical features was applied to predict severity in COVID-19 patients. RESULTS Mean vitamin D serum level of 376 patients, was 21.9 nmol/L (95% CI = 15.36-28.45). Significant heterogeneity was found (I2 = 99.1%, p < .001). Patients with poor prognosis (N = 150) had significantly lower serum levels of vitamin D compared with those with good prognosis (N = 161), representing an adjusted standardized mean difference of -0.58 (95% Cl = -0.83 to -0.34, p < .001). CONCLUSION Serum vitamin D levels could be implicated in the COVID-19 prognosis. Diagnosis of vitamin D deficiency could be a helpful adjunct in assessing patients' potential of developing severe COVID-19. Appropriate preventative and/or therapeutic intervention may improve COVID-19 outcomes.
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Affiliation(s)
- Ruhul Munshi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mohammad H Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Eman A Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Rami M Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical Therapy, Horus University, New Damietta, Egypt
| | - Christina Jardak
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Nasrin Sultana
- Department of Medicine, Larkin Community Hospital, South Miami, Florida, USA
| | - Mohanad R Youssef
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Abdallah S Attia
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Mary Killackey
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Juan Duchesne
- Department of Surgery, Trauma/Acute Care and Critical Care, School of Medicine, Tulane University, New Orleans, Louisiana, USA
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181
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Aduh U, Folayan MO, Afe A, Onyeaghala AA, Ajayi IO, Coker M, Tebeje YK, Ndembi N. Risk perception, public health interventions, and Covid-19 pandemic control in sub-saharan Africa. J Public Health Afr 2020. [DOI: 10.4081/jphia.2021.1622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Coronavirus disease 2019 (COVID 19) has had serious social, economic, and health effects globally. The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), which was first announced in December 2019 has resulted in more than 24 million infections. There is paucity of knowledge on the role of risk perception in the adoption of public health interventions needed to control the spread of COVID 19 infections within communities. This was a scoping review and documents how risk perception may be a major challenge for populations to adopt and implement different behavioral changes recommended to curtail the spread COVID- 19 pandemic in sub-Saharan Africa; and seeks to proffer solutions on how the identified challenges can be addressed drawing from lessons learnt from previous epidemics within the region. Database search of Google Scholar, PubMed, Research Gate among others were performed using related keywords to identify relevant journals and lists of primary articles. Culture, religious beliefs and poverty may influence how populations respond to infectious disease outbreaks. Risk strategies that focus only on biomedical approaches to control the COVID-19 pandemic may not mobilize the needed behavioral change. Lessons learnt from HIV and Ebola epidemics showed that involvement of communities could help transform weak adoption of public health measures when measures were framed in the relevant cultural context. An understanding of the factors influencing risk perception is needed to design appropriate risk communication strategies. Community engagement and reliance on local communication networks could promote mutual trust and increase the uptake of public-health interventions.
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182
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Flanagan KL, Best E, Crawford NW, Giles M, Koirala A, Macartney K, Russell F, Teh BW, Wen SCH. Progress and Pitfalls in the Quest for Effective SARS-CoV-2 (COVID-19) Vaccines. Front Immunol 2020; 11:579250. [PMID: 33123165 PMCID: PMC7566192 DOI: 10.3389/fimmu.2020.579250] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
There are currently around 200 SARS-CoV-2 candidate vaccines in preclinical and clinical trials throughout the world. The various candidates employ a range of vaccine strategies including some novel approaches. Currently, the goal is to prove that they are safe and immunogenic in humans (phase 1/2 studies) with several now advancing into phase 2 and 3 trials to demonstrate efficacy and gather comprehensive data on safety. It is highly likely that many vaccines will be shown to stimulate antibody and T cell responses in healthy individuals and have an acceptable safety profile, but the key will be to confirm that they protect against COVID-19. There is much hope that SARS-CoV-2 vaccines will be rolled out to the entire world to contain the pandemic and avert its most damaging impacts. However, in all likelihood this will initially require a targeted approach toward key vulnerable groups. Collaborative efforts are underway to ensure manufacturing can occur at the unprecedented scale and speed required to immunize billions of people. Ensuring deployment also occurs equitably across the globe will be critical. Careful evaluation and ongoing surveillance for safety will be required to address theoretical concerns regarding immune enhancement seen in previous contexts. Herein, we review the current knowledge about the immune response to this novel virus as it pertains to the design of effective and safe SARS-CoV-2 vaccines and the range of novel and established approaches to vaccine development being taken. We provide details of some of the frontrunner vaccines and discuss potential issues including adverse effects, scale-up and delivery.
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Affiliation(s)
- Katie L. Flanagan
- Department of Infectious Diseases, Launceston General Hospital, Launceston, TAS, Australia
- Faculty of Health Sciences and School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Emma Best
- Department of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Nigel W. Crawford
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital Immunisation Service, Melbourne, VIC, Australia
| | - Michelle Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Infectious Diseases Unit, Alfred Health, Melbourne, VIC, Australia
| | - Archana Koirala
- Department of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research & Surveillance (NCIRS), Sydney, NSW, Australia
- Department of Infectious Diseases, Nepean Hospital, Sydney, NSW, Australia
| | - Kristine Macartney
- Department of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research & Surveillance (NCIRS), Sydney, NSW, Australia
| | - Fiona Russell
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital Immunisation Service, Melbourne, VIC, Australia
| | - Benjamin W. Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Sophie CH Wen
- Infection Management Prevention Services, Queensland Children's Hospital, South Brisbane, QLD, Australia
- University of Queensland Centre for Clinical Research (UQCCR), University of Queensland, Brisbane, QLD, Australia
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183
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Bawaskar HS, Bawaskar PH. From quarantine room: Physician perspective. J Family Med Prim Care 2020; 9:5092-5102. [PMID: 33409170 PMCID: PMC7773063 DOI: 10.4103/jfmpc.jfmpc_896_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/14/2020] [Accepted: 06/29/2020] [Indexed: 01/22/2023] Open
Abstract
This write-up is a brief reflection of a rural doctor couple, Dr. Himmatrao Saluba Bawaskar (HSB) and Dr. Pramodini Himmatrao Bawaskar (PHB), working in the remote area of Maharashtra state of India during COVID-19 pandemic. During the pandemic, rural doctors are routinely exposed to symptomatic COVID-positive cases in the outpatient as well as indoor setting. The authors, both husband and wife, were in compulsory quarantine for twice at home and experienced social stigmas attached to a positive case. Here is a report the details of COVID-19 pattern and its management learned from the published scientific papers on COVID-19, and severe acute respiratory syndrome due to SARS-CoV-2 from December 2019 and their own experience in rural setting and the current literature shared in the form of personal narration. Apart from the personal experience of patients experience regarding quarantine period, COVID-19 is discussed in detail for the benefit of rural practitioners.
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184
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Patella V, Delfino G, Florio G, Spadaro G, Chieco Bianchi F, Senna G, Di Gioacchino M. Management of the patient with allergic and immunological disorders in the pandemic COVID-19 era. Clin Mol Allergy 2020; 18:18. [PMID: 33020697 PMCID: PMC7528155 DOI: 10.1186/s12948-020-00134-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/12/2020] [Indexed: 01/20/2023] Open
Abstract
The pandemic COVID-19 abruptly exploded, taking most health professionals around the world unprepared. Italy, the first European country to be hit violently, was forced to activate the lockdown in mid-February 2020. At the time of the spread, a high number of victims were quickly registered, especially in the regions of Northern Italy which have a high rate of highly-polluting production activities. The need to hospitalize the large number of patients with severe forms of COVID-19 led the National Health System to move a large number of specialists from their disciplines to the emergency hospital departments for the treatment of COVID-19. Furthermore, the lockdown itself has limited the possibility for general practitioners and pediatricians to be able to make outpatient visits and/or home care for patients with chronic diseases. Among them, the patient with atopic diseases, such as asthma, rhinitis and atopic dermatitis, is worthy of particular attention as she/he is immersed in a studded negative scenario with the onset of spring, a factor that should not be underestimated for those who suffer from pollen allergy. The Italian Society of Asthma Allergology and Clinical Immunology, to quickly deal with the lack of references and specialist medical procedures, has produced a series of indications for immunologic patient care that are reported in this paper, and can be used as guidelines by specialists of our discipline.
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Affiliation(s)
- Vincenzo Patella
- Division Allergy and Clinical Immunology, Department of Medicine, "Santa Maria Della Speranza" Hospital, Salerno, Italy.,Postgraduate Program in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Gabriele Delfino
- Division Allergy and Clinical Immunology, Department of Medicine, "Santa Maria Della Speranza" Hospital, Salerno, Italy
| | - Giovanni Florio
- Division Allergy and Clinical Immunology, Department of Medicine, "Santa Maria Della Speranza" Hospital, Salerno, Italy
| | - Giuseppe Spadaro
- Postgraduate Program in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.,Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Gianerico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,Chairman of Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC), Milan, Italy
| | - Mario Di Gioacchino
- Center of Advanced Science and Technology, G. D'Annunzio University, Chieti-Pescara, Italy.,Leonardo Da Vinci, University, Chieti, Italy
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185
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Carter J, Friedland JS, Kirwan DE, Nathavitharana RR. Translating scientific discoveries during pandemics: ensuring equity for people affected by COVID-19 and tuberculosis. ERJ Open Res 2020; 6:00562-2020. [PMID: 33204676 PMCID: PMC7659031 DOI: 10.1183/23120541.00562-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
The #COVID19 pandemic has emphasised major global health inequities: this editorial argues lessons learnt from TB must remind us of the gaps in the research agenda that must be addressed to ensure that scientific advances are equitably disseminated https://bit.ly/3bTZHS3.
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Affiliation(s)
- Jessica Carter
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Jon S. Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Daniela E. Kirwan
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Ruvandhi R. Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Boston, MA, USA
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186
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Prentice S, Dockrell H. Antituberculosis BCG vaccination: more reasons for varying innate and adaptive immune responses. J Clin Invest 2020; 130:5121-5123. [PMID: 32813681 PMCID: PMC7524457 DOI: 10.1172/jci141317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bacillus Calmette-Guérin (BCG) vaccination induces variable protection against pulmonary tuberculosis (TB), and a more effective TB vaccine is needed. The potential for BCG to provide protection against heterologous infections, by induction of innate immune memory, is increasingly recognized. These nonspecific responses may substantially benefit public health, but are also variable. In this issue of the JCI, Koeken and de Bree et al. report that BCG reduces circulating inflammatory markers in males but not in females, while de Bree and Mouritis et al. describe how diurnal rhythms affect the degree of BCG-induced innate memory. These studies further delineate factors that influence the magnitude of responses to BCG and may be crucial to harnessing its potential benefits.
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Affiliation(s)
- S. Prentice
- Department of Paediatrics, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - H.M. Dockrell
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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187
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Ferreira C, Viana SD, Reis F. Gut Microbiota Dysbiosis-Immune Hyperresponse-Inflammation Triad in Coronavirus Disease 2019 (COVID-19): Impact of Pharmacological and Nutraceutical Approaches. Microorganisms 2020; 8:E1514. [PMID: 33019592 PMCID: PMC7601735 DOI: 10.3390/microorganisms8101514] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is a pandemic infection caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients present a complex clinical picture that, in severe cases, evolves to respiratory, hepatic, gastrointestinal, and neurological complications, and eventually death. The underlying pathophysiological mechanisms are complex and multifactorial and have been summarized as a hyperresponse of the immune system that originates an inflammatory/cytokine storm. In elderly patients, particularly in those with pre-existing cardiovascular, metabolic, renal, and pulmonary disorders, the disease is particularly severe, causing prolonged hospitalization at intensive care units (ICU) and an increased mortality rate. Curiously, the same populations have been described as more prone to a gut microbiota (GM) dysbiosis profile. Intestinal microflora plays a major role in many metabolic and immune functions of the host, including to educate and strengthen the immune system to fight infections, namely of viral origin. Notably, recent studies suggest the existence of GM dysbiosis in COVID-19 patients. This review article highlights the interplay between the triad GM dysbiosis-immune hyperresponse-inflammation in the individual resilience/fragility to SARS-CoV-2 infection and presents the putative impact of pharmacological and nutraceutical approaches on the triumvirate, with focus on GM.
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Affiliation(s)
- Carolina Ferreira
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-075 Coimbra, Portugal
| | - Sofia D. Viana
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-075 Coimbra, Portugal
- Polytechnic Institute of Coimbra, ESTESC-Coimbra Health School, Pharmacy, 3046-854 Coimbra, Portugal
| | - Flávio Reis
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-075 Coimbra, Portugal
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188
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Riggioni C, Comberiati P, Giovannini M, Agache I, Akdis M, Alves‐Correia M, Antó JM, Arcolaci A, Azkur AK, Azkur D, Beken B, Boccabella C, Bousquet J, Breiteneder H, Carvalho D, De las Vecillas L, Diamant Z, Eguiluz‐Gracia I, Eiwegger T, Eyerich S, Fokkens W, Gao Y, Hannachi F, Johnston SL, Jutel M, Karavelia A, Klimek L, Moya B, Nadeau KC, O'Hehir R, O'Mahony L, Pfaar O, Sanak M, Schwarze J, Sokolowska M, Torres MJ, van de Veen W, van Zelm MC, Wang DY, Zhang L, Jiménez‐Saiz R, Akdis CA. A compendium answering 150 questions on COVID-19 and SARS-CoV-2. Allergy 2020; 75:2503-2541. [PMID: 32535955 PMCID: PMC7323196 DOI: 10.1111/all.14449] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023]
Abstract
In December 2019, China reported the first cases of the coronavirus disease 2019 (COVID-19). This disease, caused by the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), has developed into a pandemic. To date, it has resulted in ~9 million confirmed cases and caused almost 500 000 related deaths worldwide. Unequivocally, the COVID-19 pandemic is the gravest health and socioeconomic crisis of our time. In this context, numerous questions have emerged in demand of basic scientific information and evidence-based medical advice on SARS-CoV-2 and COVID-19. Although the majority of the patients show a very mild, self-limiting viral respiratory disease, many clinical manifestations in severe patients are unique to COVID-19, such as severe lymphopenia and eosinopenia, extensive pneumonia, a "cytokine storm" leading to acute respiratory distress syndrome, endothelitis, thromboembolic complications, and multiorgan failure. The epidemiologic features of COVID-19 are distinctive and have changed throughout the pandemic. Vaccine and drug development studies and clinical trials are rapidly growing at an unprecedented speed. However, basic and clinical research on COVID-19-related topics should be based on more coordinated high-quality studies. This paper answers pressing questions, formulated by young clinicians and scientists, on SARS-CoV-2, COVID-19, and allergy, focusing on the following topics: virology, immunology, diagnosis, management of patients with allergic disease and asthma, treatment, clinical trials, drug discovery, vaccine development, and epidemiology. A total of 150 questions were answered by experts in the field providing a comprehensive and practical overview of COVID-19 and allergic disease.
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189
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Taefehshokr N, Taefehshokr S, Hemmat N, Heit B. Covid-19: Perspectives on Innate Immune Evasion. Front Immunol 2020; 11:580641. [PMID: 33101306 PMCID: PMC7554241 DOI: 10.3389/fimmu.2020.580641] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
The ongoing outbreak of Coronavirus disease 2019 infection achieved pandemic status on March 11, 2020. As of September 8, 2020 it has caused over 890,000 mortalities world-wide. Coronaviral infections are enabled by potent immunoevasory mechanisms that target multiple aspects of innate immunity, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) able to induce a cytokine storm, impair interferon responses, and suppress antigen presentation on both MHC class I and class II. Understanding the immune responses to SARS-CoV-2 and its immunoevasion approaches will improve our understanding of pathogenesis, virus clearance, and contribute toward vaccine and immunotherepeutic design and evaluation. This review discusses the known host innate immune response and immune evasion mechanisms driving SARS-CoV-2 infection and pathophysiology.
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Affiliation(s)
- Nima Taefehshokr
- Department of Microbiology and Immunology, Center for Human Immunology, The University of Western Ontario, London, ON, Canada
| | - Sina Taefehshokr
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nima Hemmat
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bryan Heit
- Department of Microbiology and Immunology, Center for Human Immunology, The University of Western Ontario, London, ON, Canada
- Robarts Research Institute, London, ON, Canada
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190
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Brüssow H. Efforts towards a COVID-19 vaccine. Environ Microbiol 2020; 22:4071-4084. [PMID: 32893468 DOI: 10.1111/1462-2920.15225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
To many scientists and political authorities, the development of a vaccine against Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be the way to restore normality to civil life in this time of a devastating pandemic. Expectations for a vaccine are high while the case numbers continue to rise. As of mid-August 2020, more than 20 million people have been infected and more than 760 000 lives have been lost worldwide. The threat of this virus to health, the economy and to society is so great that the wish for a fast track vaccine is understandable, but how realistic is it? This survey article tries to give an overview of vaccine candidates in development, including preclinical and clinical testing, and it mentions some of the societal problems of vaccine acceptance.
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Affiliation(s)
- Harald Brüssow
- Department of Biosystems, Laboratory of Gene Technology, KU Leuven, Leuven, Belgium
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191
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Li WX. Worldwide inverse correlation between Bacille Calmette-Guérin immunization and COVID-19 mortality. RESEARCH SQUARE 2020:rs.3.rs-42927. [PMID: 32702715 PMCID: PMC7373138 DOI: 10.21203/rs.3.rs-42927/v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has spread to all countries in the world after more than half a year since it was first reported in late 2019, and different countries have been impacted differently. Multivariate statistical analyses were used to evaluate COVID-19 deaths and cases relative to nine other demographic and socioeconomic factors in all countries and regions of the world using data as of August 1, 2020. The factors analyzed in the study include a country's total COVID-19 deaths and cases per million population, per capita gross domestic product (GDP), population density, virus tests per million population, median age, government response stringency index, hospital beds availability per thousand population, extreme poverty rate, Bacille Calmette-Guérin (BCG) vaccination rate, and diphtheria-tetanus-pertussis (DTP3) immunization rate. The study reveals that COVID-19 deaths per million population in a country most significantly correlates, inversely, with the country's BCG vaccination rate, and also significantly correlates a country's per capita GDP and median age, while COVID-19 cases per million population significantly correlate with per capita GDP and tests per thousand population. This study contributes to a growing body of evidence supporting the notion that BCG vaccination may be protective against COVID-19 mortality.
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192
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Algunmeeyn A, El-Dahiyat F, Altakhineh MM, Azab M, Babar ZUD. Understanding the factors influencing healthcare providers' burnout during the outbreak of COVID-19 in Jordanian hospitals. J Pharm Policy Pract 2020; 13:53. [PMID: 32974035 PMCID: PMC7505678 DOI: 10.1186/s40545-020-00262-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/18/2020] [Indexed: 01/19/2023] Open
Abstract
Abstract Background Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. The nature of healthcare providers’ occupation puts them at an increased risk of getting any contagious disease, including COVID-19. They are on the front line of the COVID-19 outbreak response and as such are at risk of contracting this virus. The infectious disease started from China in December 2019 and spread rapidly throughout countries, including Jordan. Especially, recent studies indicated that Jordanian healthcare providers’ work conditions and demographic are significant factors for healthcare providers’ burnout. Additionally, burnout has been increased among healthcare providers in Jordanian hospital. Aim The present investigation aims to better understand the factors affecting pharmacists’, physicians’, and nurses’ burnout during the outbreak of COVID-19 to provide basic information for lowering and preventing the level of burnout in Jordanian hospitals. Method This study is qualitative in nature, adopting face-to-face interviews as the key instrument of data collection in one hospital in Jordan. The sample interviewed consisted of 30 healthcare providers in total (10 nurses, 10 physicians. and 10 pharmacists). Result Three key factors to healthcare providers’ burnout were identified in the sampled hospitals: job stress, staff and resource adequacy, fear of COVID-19 infection, and interprofessional relationships in healthcare practice. The examination also offers recommendations for lowering and preventing healthcare providers' burnout in Jordanian hospitals. Conclusion This study explored the main factors of healthcare providers’ burnout during the outbreak of COVID-19 in Jordanian hospitals, thereby making an original contribution to existing knowledge, as it is the first empirical exploration of healthcare providers' burnout during the outbreak of COVID-19. As such, it has attempted to offer an in-depth understanding of the factors impacting this issue.
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Affiliation(s)
| | | | | | - Mohammad Azab
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
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193
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Bourkhissi L, Fakiri KEL, Nassih H, Qadiry REL, Bourrahouat A, Ait Sab I, Rada N, Draiss G, Bouskraoui M. Laboratory abnormalities in children with novel Coronavirus Disease 2019. Clin Med Insights Pediatr 2020; 14:1179556520955177. [PMID: 32958991 PMCID: PMC7488170 DOI: 10.1177/1179556520955177] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
The novel Coronavirus disease 2019 continues to be a worldwide pandemic. Yet, little is still known about the biological features of this emergent infection in children. In this prospective study, we collected 68 children infected with SARS-COV-2 from March 2020 to May 2020, in Marrakesh, Morocco. No severe cases were observed in this cohort, and 66% of the patients were asymptomatic. The main laboratory abnormalities were hematological, as we found Leucopoenia in 4.4% of the cases, hyperleukocytosis in 1.6%. Neutropenia was found in 5 patients (7%) and only 2 cases (3%) had Lymphopenia. The inflammation and coagulation biomarkers were normal in the majority of the cases, as for liver and kidney function. Lactate dehydrogenase (LDH) serum levels were elevated in 8 cases (11.67%). The COVID-19 in children seems to have mild course and better outcome than in adults, which impacts the laboratory findings in this category. More studies must be conducted to learn more about the laboratory abnormalities in pediatric COVID-19.
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Affiliation(s)
- Laila Bourkhissi
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Karima EL Fakiri
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Houda Nassih
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Rabiy EL Qadiry
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Aicha Bourrahouat
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Imane Ait Sab
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Noureddine Rada
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Ghizlane Draiss
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
| | - Mohammed Bouskraoui
- Department of Paediatrics, University hospital of Mohammed VI, Marrakesh, Morocco
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194
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Dagotto G, Yu J, Barouch DH. Approaches and Challenges in SARS-CoV-2 Vaccine Development. Cell Host Microbe 2020; 28:364-370. [PMID: 32798444 PMCID: PMC7416703 DOI: 10.1016/j.chom.2020.08.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
The explosive spread of SARS-CoV-2 suggests that a vaccine will be required to end this global pandemic. Progress in SARS-CoV-2 vaccine development to date has been faster than for any other pathogen in history. Multiple SARS-CoV-2 vaccine candidates have been evaluated in preclinical models and are currently in clinical trials. In this Perspective, we discuss three topics that are critical for SARS-CoV-2 vaccine development: antigen selection and engineering, preclinical challenge studies in non-human primate models, and immune correlates of protection.
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MESH Headings
- Animals
- Antigens, Viral/chemistry
- Antigens, Viral/genetics
- Betacoronavirus/genetics
- Betacoronavirus/immunology
- COVID-19
- COVID-19 Vaccines
- Coronavirus Infections/epidemiology
- Coronavirus Infections/immunology
- Coronavirus Infections/prevention & control
- Host Microbial Interactions/immunology
- Humans
- Immunity, Cellular
- Immunity, Humoral
- Immunity, Innate
- Models, Animal
- Pandemics/prevention & control
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/immunology
- Pneumonia, Viral/prevention & control
- Primates
- SARS-CoV-2
- Spike Glycoprotein, Coronavirus/chemistry
- Spike Glycoprotein, Coronavirus/genetics
- Spike Glycoprotein, Coronavirus/immunology
- Viral Vaccines/administration & dosage
- Viral Vaccines/immunology
- Viral Vaccines/isolation & purification
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Affiliation(s)
- Gabriel Dagotto
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Harvard Medical School, Boston, MA 02115, USA; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA; Massachusetts Consortium on Pathogen Readiness, Boston, MA 02215, USA.
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195
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Hoummadi L, Hafid J, Machraoui S, Admou B. [To what extent Africa can limit the impact of the COVID-19 pandemic?]. Rev Epidemiol Sante Publique 2020; 68:302-305. [PMID: 32948360 PMCID: PMC7480264 DOI: 10.1016/j.respe.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022] Open
Abstract
Suite au déclenchement de la pandémie COVID-19 et aux alertes lancées par l’Organisation mondiale de la santé, l’attention s’est concentrée depuis plusieurs mois sur l’Afrique en tant que zone gravement menacée par la pandémie. Un grand nombre de pays africains, en particulier ceux à revenu faible et moyen seraient confrontés au risque de débordement de leurs systèmes de santé déjà fragiles, souffrant de la limitation des ressources de soins et de la disponibilité des moyens de base. Pour mieux gérer cette crise multidimensionnelle, l’enjeu va au-delà de la mise à niveau des infrastructures de santé publique, il s’agit aussi de savoir comment anticiper et agir activement sur les facteurs susceptibles de limiter la propagation du SRAS-CoV2 pour amortir le choc de cette pandémie sur le continent. Certains de ces facteurs sont naturels et non maîtrisables (climat, géographie…), mais beaucoup d’autres seraient à la portée des gouvernements et des populations africaines tels que les facteurs socioculturels, audiovisuels et même politiques.
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Affiliation(s)
- L Hoummadi
- Laboratoire aliments, environnement et santé, faculté des sciences et techniques, université Cadi Ayyad, Marrakech, Maroc
| | - J Hafid
- Laboratoire aliments, environnement et santé, faculté des sciences et techniques, université Cadi Ayyad, Marrakech, Maroc
| | - S Machraoui
- Centre de recherche clinique, CHU Mohammed VI, BP2360, principal, avenue Ibn Sina, 40080 Marrakech, Maroc
| | - B Admou
- Centre de recherche clinique, CHU Mohammed VI, BP2360, principal, avenue Ibn Sina, 40080 Marrakech, Maroc; Laboratoire de recherche B2S, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc.
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196
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Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes. Can Respir J 2020; 2020:1401053. [PMID: 32934758 PMCID: PMC7479474 DOI: 10.1155/2020/1401053] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/29/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Abstract
Background The threat of contagious infectious diseases is constantly evolving as demographic explosion, travel globalization, and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. Methods and Results The PubMed electronic database was systematically searched for relevant articles linking TB, influenza, and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria. Using a data mining approach, we also queried the COVID-19 Open Research Dataset (CORD-19). We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (focusing on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID-19? How does one diagnosis affect the other? Discussions. Few essential elements about TB and SARS-CoV coinfections were discussed. First, lessons from past outbreaks (other coronaviruses) and influenza pandemic/seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. Conclusions Because viral respiratory infections and TB impede the host's immune responses, it can be assumed that their lethal synergism may contribute to more severe clinical evolution. Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead. The trial is registered with NCT04327206, NCT01829490, and NCT04121494.
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197
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Joy M, Malavika B, Asirvatham ES, Sudarsanam TD, Jeyaseelan L. Is BCG associated with reduced incidence of COVID-19? A meta-regression of global data from 160 countries. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020; 9:202-203. [PMID: 33163696 PMCID: PMC7597766 DOI: 10.1016/j.cegh.2020.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Global research is running towards to find a vaccine to stop the threat of the COVID-19. The Bacillus Calmette–Guérin (BCG) vaccine that prevents severe forms of tuberculosis is getting more attention in this scenario. The objective of our study was to determine the association between BCG vaccine coverage and incidence of COVID-19 at a national-level across the Globe. Methods The data of 160 countries were included in the study. Meta-regression was done to estimate the difference in the incidence of COVID-19 cases between countries with BCG vaccination coverage. BCG coverage was categorized as ≤70%, >70% and no vaccination. The analyses were carried out by adjusting for factors such as population density, income group, latitude, and percentage of the total population under age groups 15–64 and above 65 years of each country. Results The countries that had ≤70% coverage of BCG vaccine reported 6.5 (95% CI: −8.4 to −4.5) less COVID-19 infections per 10,000 population as compared to countries that reported no coverage. Those that had >70% coverage reported 10.1 (95% CI: −11.4 to −8.7) less infections per 10,000 population compared to those with no BCG countries. Conclusion Our analysis suggests that BCG is associated with reduced COVID-19 infections if the BCG vaccine coverage is over 70%. The region-wise analyses also suggested similar findings, except the Middle East and North African region.
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Affiliation(s)
- Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - B Malavika
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - Edwin Sam Asirvatham
- Health Systems Research India Initiative (HSRII), Thiruvananthapuram, Kerala, India
| | - Thambu David Sudarsanam
- Department of Medicine, and Clinical Epidemiology Unit, Christian Medical College, Vellore, Tamil Nadu, 632 004, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
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198
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Fedeli U, Porreca A, Colicchia M, Schievano E, Artibani W, Biasio LR, Palù G. Intravescical instillation of Calmette-Guérin bacillus and COVID-19 risk. Hum Vaccin Immunother 2020; 17:416-417. [PMID: 32880510 DOI: 10.1080/21645515.2020.1805994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
It has been theorized that Calmette-Guérin bacillus may prevent or reduce the severity of COVID-19 through a nonspecific stimulation of the immune system. A preliminary assessment of SARS-CoV-2 infection rates and outcomes among 2803 individuals affected with high risk non-muscle-invasive bladder cancer and treated with intra-bladder instillation of BCG, showed no evidence of a protective effect. However, the interpretation of these data need some caution, due to the low prevalence of infection (<1%) observed within this population, along with the fact that intra-bladder administration cannot mirror the usual intradermal administration of BCG, in particular in patients partially immunocompromised. Confirmation by larger prospective studies is required.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero Veneto Region , Padua, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme , Padua, Italy
| | | | - Elena Schievano
- Epidemiological Department, Azienda Zero Veneto Region , Padua, Italy
| | - Walter Artibani
- Department of Urology, Policlinico Abano Terme , Padua, Italy
| | | | - Giorgio Palù
- Epidemiological Department, Azienda Zero Veneto Region , Padua, Italy.,Department of Molecular Medicine, University of Padua , Padua, Italy
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199
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Riksen NP, Netea MG. Immunometabolic control of trained immunity. Mol Aspects Med 2020; 77:100897. [PMID: 32891423 PMCID: PMC7466946 DOI: 10.1016/j.mam.2020.100897] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022]
Abstract
Innate immune cells can adopt long-term inflammatory phenotypes following brief encounters with exogenous (microbial) or endogenous stimuli. This phenomenon is named trained immunity and can improve host defense against (recurrent) infections. In contrast, trained immunity can also be maladaptive in the context of chronic inflammatory disorders, such as atherosclerosis. Key to future therapeutic exploitation of this mechanism is thorough knowledge of the mechanisms driving trained immunity, which can be used as pharmacological targets. These mechanisms include profound changes in intracellular metabolism, which are closely intertwined with epigenetic reprogramming at the level of histone modifications. Glycolysis, glutamine replenishment of the tricarboxylic acid cycle with accumulation of fumarate, and the mevalonate pathway have all been identified as critical pathways for trained immunity in monocytes and macrophages. In this review, we provide a state-of-the-art overview of how these metabolic pathways interact with epigenetic programs to develop trained immunity.
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Affiliation(s)
- Niels P Riksen
- Dept. of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Mihai G Netea
- Dept. of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands
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200
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Sarkar B, Sinha RN, Sarkar K. Initial Viral Load of a COVID-19-Infected Case Indicated by its Cycle Threshold Value of Polymerase Chain Reaction Could be used as a Predictor of its Transmissibility - An Experience from Gujarat, India. Indian J Community Med 2020; 45:278-282. [PMID: 33354001 PMCID: PMC7745814 DOI: 10.4103/ijcm.ijcm_593_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Transmission dynamics of the infectious disease Corona Virus Disease - 19 (COVID-19) is yet to be understood fully. The study aimed at exploring whether quantitative viral load of COVID-19-infected case indicated by cycle threshold (Ct) value of real-time reverse transcription polymerase chain reaction could predict about transmission pattern in the community. Materials and Methods: An observational study was conducted involving 1976 individuals, suspected to be suffering from COVID-19 and contacts, of laboratory confirmed cases from selected districts of Gujarat, India. A total of 138 persons were detected to be positive. Weekly positivity showed an overall increasing trend during the studied weeks. It was observed that only 7% had high, 9% as moderate and rest, 84% had low viral load based on Ct values of real-time RT-PCR. Results: Most secondary cases clustered around index cases with high viral load whereas fewer secondary cases clustered around index cases with low viral load. Each index high viral load case transmitted an average of 6.25 secondary cases whereas the same of low viral load transmitted an average of 0.8 case. Conclusion: If cases with higher viral load are selectively isolated on detection from the rest of the community along with contact tracing of all individuals, who came in contact with them during the previous 5 days, the quantum of transmission will reduce subsequently. Moreover, health-care workers often get infected while working, probably due to the fact that they often handle cases with higher viral load. The Ct value of all may be provided along with test report to safeguard everybody's health including health-care workers.
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Affiliation(s)
- Bidisa Sarkar
- Department of Community Medicine, Kallinga Institute of Medical Sciences, Kushabhadra Campus, Bhubaneswar, Odisha, India
| | - Rabindra Nath Sinha
- Department of Maternal and Child Health, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Kamalesh Sarkar
- Director, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
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