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Hartantri Y, Andriyoko B, Debora J, Rachman FR, Susandi E, Ferdian F, Ganiem AR, Alisjahbana B, Soeroto AY, Turbawaty DK. BA.5 sub-lineages associated with higher severity of COVID-19 infection: A cross-sectional study in Indonesia. IJID REGIONS 2024; 11:100379. [PMID: 38855022 PMCID: PMC11157273 DOI: 10.1016/j.ijregi.2024.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/21/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
Objectives We aimed to compare the clinical severity and outcome among laboratory-confirmed Omicron variant cases admitted between January and December 2022. Methods This is a cross-sectional study conducted in Hasan Sadikin General Hospital between January and December 2022. We enrolled patients aged ≥18 years with laboratory-confirmed Omicron infection. Data were collected from clinical records and a whole genome sequencing database. We compared the risk of severe symptoms and mortality using a logistic regression analysis adjusted for sex, age, comorbidities, and vaccination status. Results We enrolled 255 patients and the main sub-lineages were BA.1 (16.1%), BA.2 (11.4%), BA.5 (35.7%), XBB (22.7%), and BQ.1 (14.1%). Compared with BA.1/BA.2, BA.5 sub-lineages were associated with severe symptoms (adjusted odds ratio of 2.9, 95% confidence interval 1.1-8.2, P <0.05). The highest risk of severe symptoms and mortality was linked with a high number of comorbidities (adjusted odds ratio of 7.8, 95% confidence interval 1.7-22.4, P <0.05). Booster vaccination was protective of severity and mortality. Conclusions Disease severity was associated with BA.5 sub-lineages and multiple comorbidities. Good management is particularly important for people with comorbidities. Furthermore, booster vaccination is also required to reduce severity and mortality.
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Affiliation(s)
- Yovita Hartantri
- Division of Tropical and Infectious Diseases, Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Basti Andriyoko
- Department of Clinical Pathology, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Josephine Debora
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Febi Ramdhani Rachman
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
| | - Evan Susandi
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ferdy Ferdian
- Division of Pulmonology and Critical Illness, Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ahmad Rizal Ganiem
- Department of Neurology, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Bachti Alisjahbana
- Division of Tropical and Infectious Diseases, Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
| | - Arto Yuwono Soeroto
- Division of Pulmonology and Critical Illness, Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dewi Kartika Turbawaty
- Department of Clinical Pathology, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Tiara MR, Prayuda CB, Maulidya TT, Djauhari H, Suhendar D, Wisaksana R, Hamijoyo L, Supriyadi R, Indrati AR, Alisjahbana B. Accuracy of Anti-SARS-CoV-2 Antibody in Comparison with Surrogate Viral Neutralization Test in Persons Living with HIV, Systemic Lupus Erythematosus, and Chronic Kidney Disease. Vaccines (Basel) 2024; 12:558. [PMID: 38793809 PMCID: PMC11125822 DOI: 10.3390/vaccines12050558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/03/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
The presence of the anti-SARS-CoV-2-RBD antibody (anti-RBD) prevents severe COVID-19. We aimed to determine the accuracy of a point-of-care anti-RBD testing implemented in persons living with HIV (PLWH), systemic lupus erythematosus (SLE), and chronic kidney disease (CKD). We enrolled 182 non-comorbid subjects and 335 comorbid subjects (PLWH, SLE, CKD) to test the anti-RBD assay compared to the surrogate viral neutralization test (sVNT) as the reference test. We performed linear correlation analysis between anti-RBD and sVNT, along with an ROC analysis to ascertain the anti-RBD cutoff at 30%, 60%, and 90% inhibition of sVNT, to calculate accuracy. The correlations between anti-RBD and sVNT among all groups were excellent, with R = 0.7903, R = 0.7843, and R = 0.8153 among the non-comorbid, SLE, and CKD groups, respectively, and with significantly higher correlation among the PLWH group (R = 0.8877; p-value = 0.0072) compared to the non-comorbid group. The accuracy of the anti-RBD test among the PLWH and CKD groups was similar to that among the non-comorbid group but showed lower sensitivity in the SLE group (p = 0.000014). The specificity of the test remained high in all groups. In conclusion, the anti-RBD test had excellent correlation with the sVNT. The persistently high specificity in all groups suggests that this test can be reliably utilized to detect the presence of low neutralization capacity, prompting additional vaccination.
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Affiliation(s)
- Marita Restie Tiara
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 40161, Indonesia; (M.R.T.); (C.B.P.); (T.T.M.); (H.D.); (R.W.); (A.R.I.)
- Mayapada Hospital Buah Batu, Bandung 40266, Indonesia
| | - Chrisan Bimo Prayuda
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 40161, Indonesia; (M.R.T.); (C.B.P.); (T.T.M.); (H.D.); (R.W.); (A.R.I.)
| | - Tara Titian Maulidya
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 40161, Indonesia; (M.R.T.); (C.B.P.); (T.T.M.); (H.D.); (R.W.); (A.R.I.)
| | - Hofiya Djauhari
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 40161, Indonesia; (M.R.T.); (C.B.P.); (T.T.M.); (H.D.); (R.W.); (A.R.I.)
| | - Dadang Suhendar
- Research Center for Applied Microbiology, National Research and Innovation Agency (BRIN), KST Soekarno, Cibinong, Jl. Raya Jakarta—Bogor KM 46, Cibinong 16911, Indonesia;
| | - Rudi Wisaksana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 40161, Indonesia; (M.R.T.); (C.B.P.); (T.T.M.); (H.D.); (R.W.); (A.R.I.)
- Infectious and Tropical Disease Division, Internal Medicine Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 40261, Indonesia
| | - Laniyati Hamijoyo
- Rheumatology Division, Department of Internal Medicine, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Rudi Supriyadi
- Nephrology and Hypertension Division, Internal Medicine Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Agnes Rengga Indrati
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 40161, Indonesia; (M.R.T.); (C.B.P.); (T.T.M.); (H.D.); (R.W.); (A.R.I.)
- Clinical Pathology Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 40161, Indonesia; (M.R.T.); (C.B.P.); (T.T.M.); (H.D.); (R.W.); (A.R.I.)
- Infectious and Tropical Disease Division, Internal Medicine Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 40261, Indonesia
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Sila T, Suriyaamorn W, Toh C, Rajborirug S, Surasombatpattana S, Thongsuksai P, Kongkamol C, Chusri S, Sornsenee P, Wuthisuthimethawee P, Chaowanawong R, Sangkhathat S, Ingviya T. Factors associated with the worsening of COVID-19 symptoms among cohorts in community- or home-isolation care in southern Thailand. Front Public Health 2024; 12:1350304. [PMID: 38572011 PMCID: PMC10987961 DOI: 10.3389/fpubh.2024.1350304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction This study aimed to investigate factors associated with time-to-referral due to worsening symptoms in patients with laboratory-confirmed COVID-19 in southern Thailand. While underlying diseases have been evaluated to assess COVID-19 severity, the influence of vaccinations and treatments is also crucial. Methods A cohort of 8,638 patients quarantined in home or community isolation with laboratory-confirmed COVID-19 was analyzed. Survival analysis and the Cox proportional hazard ratio were employed to assess factors influencing time-toreferral. Results Age ≥ 60 years, neurologic disorders, cardiovascular disease, and human immunodeficiency virus infection were identified as significant risk factors for severe COVID-19 referral. Patients who received full- or booster-dose vaccinations had a lower risk of experiencing severe symptoms compared to unvaccinated patients. Notably, individuals vaccinated during the Omicron-dominant period had a substantially lower time-to-referral than those unvaccinated during the Delta-dominant period. Moreover, patients vaccinated between 1 and 6 months prior to infection had a significantly lower risk of time-to-referral than the reference group. Discussion These findings demonstrate early intervention in high-risk COVID-19 patients and the importance of vaccination efficacy to reduce symptom severity. The study provides valuable insights for guiding future epidemic management strategies and optimising patient care during infectious disease outbreaks.
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Affiliation(s)
- Thanit Sila
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Health Science and Clinical Research, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wisanuwee Suriyaamorn
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chanavee Toh
- Department of Health Science and Clinical Research, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Songyos Rajborirug
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Paramee Thongsuksai
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Health Science and Clinical Research, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chanon Kongkamol
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sarunyou Chusri
- Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Phoomjai Sornsenee
- Faculty of Medicine, Department of Family Medicine and Preventive Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Prasit Wuthisuthimethawee
- Department of Emergency Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Raya Chaowanawong
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Surasak Sangkhathat
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Faculty of Medicine, Translational Medicine Research Center, Prince of Songkla University, Songkhla, Thailand
| | - Thammasin Ingviya
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Yavuz S, Duksal F. Identified Factors in COVID-19 Patients in Predicting Mortality. Niger J Clin Pract 2024; 27:62-67. [PMID: 38317036 DOI: 10.4103/njcp.njcp_418_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/16/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in global mortality rates. Numerous studies have been conducted to identify the factors associated with mortality in COVID-19 cases. In these studies, overall mortality was evaluated in patients, and no distinction was made as ward or intensive care mortality. AIM This study aims to determine mortality-related factors in patients who died while in the ward. This could enable us to review the indications for intensive care hospitalization in possible pandemics. MATERIALS AND METHOD This retrospective study was conducted on a cohort of 237 patients who applied to our institution between January 2020 and December 2021 with the diagnosis of COVID-19. Demographic characteristics, length of stay, type of admission (emergency ward or outpatient clinic), presence of comorbidities, thoracic computerized tomography (CT) findings, and laboratory findings were extracted from the hospital database. The demographic and laboratory results of both deceased and recovered patients were compared. RESULTS While many demographic and laboratory findings were statistically significant in the initial analysis, multiple logistic regression analysis showed that decreased albumin levels (adjusted OR = 0.23, 95% CI = 0.09 - 0.57), increased troponin (adjusted OR = 1.03, 95% CI = 1.02 - 1.05), and procalcitonin (adjusted OR = 3.46, 95% CI = 1.04 - 11.47) levels and higher partial thromboplastin time (PTT) (adjusted OR = 1.18, 95% CI = 1.09 - 1.28) values, presence of diabetes mellitus (DM) in patients (adjusted OR = 2.18, 95% CI = 1.01 - 4.69, P = 0.047), and admission to hospital from the emergency department (adjusted OR = 5.15, 95% CI = 1.45 - 18.27, P = 0.011) were significantly associated with mortality when adjusted for age. When a predictive model is constructed with these variables, this model predicted mortality statistically significant (AUC = 0.904, 95% CI = 0.856 - 0.938, P < 0.001), with a sensitivity of 77.2% (95% CI, 67.8 - 85), a specificity of 91.2% (95% CI, 85.1 - 95.4), a positive predictive value (PPV) of 86.7% (95% CI, 72 - 85.3), and an negative predictive value (NPV) of 84.4% (95% CI, 79.4 - 89.6). CONCLUSION In this study, we may predict mortality among COVID-19-diagnosed patients admitted to the ward via this model which has the potential to provide guidance for reconsidering the indications for intensive care unit (ICU) admission.
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Affiliation(s)
- S Yavuz
- Chest Disease Department, Beyhekim Training and Research Hospital, Konya, Turkey
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Brkovic V, Nikolic G, Baralic M, Kravljaca M, Milinkovic M, Pavlovic J, Lausevic M, Radovic M. A Study on Mortality Predictors in Hemodialysis Patients Infected with COVID-19: Impact of Vaccination Status. Vaccines (Basel) 2023; 12:2. [PMID: 38276661 PMCID: PMC10819519 DOI: 10.3390/vaccines12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
The global outbreak of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted significant public health concerns. This study focuses on 442 chronic hemodialysis patients diagnosed with COVID-19, emphasizing the impact of vaccination status on clinical outcomes. The study investigates the correlation between vaccination status and laboratory findings, aiming to identify predictive factors for mortality. Results indicate that vaccination status plays a crucial role in outcomes. Full vaccination, evidenced by two or three doses, is associated with better outcomes, including reduced incidence of bilateral pneumonia and lower risks of complications such as hemorrhage and thrombosis. Laboratory analyses reveal significant differences between vaccinated and unvaccinated patients in parameters like C-reactive protein, ferritin, and white blood cell counts. Univariate and multivariate Cox proportional hazards regression analyses identify several factors influencing mortality, including comorbidities, pneumonia development, and various inflammatory markers. In conclusion among hemodialysis patients affected by COVID-19 infection, vaccination with at least three doses emerges as a protective factor against fatal outcomes. Independent predictors of mortality are CRP levels upon admission, maximum CRP values during the illness and cardiovascular comorbidities. Noteworthy lymphocytopenia during infection exhibits a notable level of specificity and sensitivity in predicting mortality.
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Affiliation(s)
- Voin Brkovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Gorana Nikolic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Baralic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milica Kravljaca
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marija Milinkovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Pavlovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Mirjana Lausevic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Radovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Zhang F, Li G, Yu J, Shen Y, Yang Y, Fu S, Liu K, Liang Y, Luo X, Chen Y. Characteristics and Prognostic Factors of SARS-CoV-2 Omicron Variant Infection in Hemodialysis Patients: A Single-Center Study in China. Blood Purif 2023; 53:288-300. [PMID: 37972579 PMCID: PMC11251654 DOI: 10.1159/000535244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION This study aimed to evaluate the characteristics and prognostic factors for coronavirus disease 2019 (COVID-19) patients on maintenance hemodialysis (HD). METHODS All admitted HD patients who were infected with SARS-CoV-2 from December 1, 2022, to January 31, 2023, were included. Patients with pneumonia were further classified into the mild, moderate, severe, and critical illness. Clinical symptoms, laboratory results, radiologic findings, treatment, and clinical outcomes were collected. Independent risk factors for progression to critical disease and in-hospital mortality were determined by the multivariate regression analysis. The receiver operating characteristic analysis with the area under the curve was used to evaluate the predictive performance of developing critical status and in-hospital mortality. RESULTS A total of 182 COVID-19 patients with HD were included, with an average age of the 61.55 years. Out of the total, 84 (46.1%) patients did not have pneumonia and 98 (53.8%) patients had pneumonia. Among patients with pneumonia, 48 (49.0%) had moderate illness, 26 (26.5%) severe illness, and 24 (24.5%) critical illness, respectively. Elder age [HR (95% CI): 1.07 (1.01-1.13), p <0.01], increased levels of lactate dehydrogenase (LDH) [1.01 (1.003-1.01), p <0.01], and C-reactive protein (CRP) [1.01 (1.00-1.01), p = 0.04] were risk factors for developing critical illness. Elder age [1.11 (1.03-1.19), p = 0.01], increased procalcitonin (PCT) [1.07 (1.02-1.12), p = 0.01], and LDH level [1.004 (1-1.01), p = 0.03] were factors associated with increased risk of in-hospital mortality. CONCLUSION Age, CRP, PCT, and LDH can be used to predict negative clinical outcomes for HD patients with COVID-19 pneumonia.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Guoli Li
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jie Yu
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yiyu Shen
- Department of Skin, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yiya Yang
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Shuangshuang Fu
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Kanghan Liu
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yumei Liang
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xun Luo
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China,
| | - Yinyin Chen
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Soegiarto G, Purnomosari D. Challenges in the Vaccination of the Elderly and Strategies for Improvement. PATHOPHYSIOLOGY 2023; 30:155-173. [PMID: 37218912 DOI: 10.3390/pathophysiology30020014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
In recent years, the elderly has become a rapidly growing proportion of the world's population as life expectancy is extending. Immunosenescence and inflammaging contribute to the increased risk of chronic non-communicable and acute infectious diseases. Frailty is highly prevalent in the elderly and is associated with an impaired immune response, a higher propensity to infection, and a lower response to vaccines. Additionally, the presence of uncontrolled comorbid diseases in the elderly also contributes to sarcopenia and frailty. Vaccine-preventable diseases that threaten the elderly include influenza, pneumococcal infection, herpes zoster, and COVID-19, which contribute to significant disability-adjusted life years lost. Previous studies had shown that conventional vaccines only yielded suboptimal protection that wanes rapidly in a shorter time. This article reviews published papers on several vaccination strategies that were developed for the elderly to solve these problems: more immunogenic vaccine formulations using larger doses of antigen, stronger vaccine adjuvants, recombinant subunit or protein conjugated vaccines, newly developed mRNA vaccines, giving booster shots, and exploring alternative routes of administration. Included also are several publications on senolytic medications under investigation to boost the immune system and vaccine response in the elderly. With all those in regard, the currently recommended vaccines for the elderly are presented.
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Affiliation(s)
- Gatot Soegiarto
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Dr. Soetomo Academic General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia
- Master Program in Immunology, Postgraduate School, Universitas Airlangga, Surabaya 60286, Indonesia
| | - Dewajani Purnomosari
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gajah Mada, Yogyakarta 55281, Indonesia
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