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Funaki T, Yamada M, Miyake K, Ueno S, Myojin S, Aiba H, Matsui T, Ogimi C, Kato H, Miyairi I, Shoji K. Safety and antibody response of the BNT162b2 SARS-CoV-2 vaccine in children aged 5-11 years with underlying diseases: A prospective observational study. J Infect Chemother 2024; 30:773-779. [PMID: 38387787 DOI: 10.1016/j.jiac.2024.02.020] [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: 12/03/2023] [Revised: 01/20/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Data on the safety and antibody response of the BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine in children aged 5-11 years with underlying diseases are limited. Thus, our study aimed to address this gap. METHODS This prospective observational study investigated the antibody titers for SARS-CoV-2 spike protein receptor-binding domain (S-IgG) and nucleocapsid protein (N-IgG) in patients aged 5-11 years with chronic underlying diseases following two doses of BNT162b2. Additionally, a questionnaire was used to assess adverse events (AEs) arising within 7 days after each dose. Data on severe AEs arising within 28 days after each dose were extracted from the patients' electronic medical records. RESULTS Among 122 patients, 24.6% (30/122) were immunocompromised. Furthermore, 79 patients experienced at least one AE following vaccination, but all recovered without sequelae, including one severe case after the first dose. The seropositivity rate after the second dose was 99.1% (116/117). Excluding 19 N-IgG-positive patients, the geometric mean antibody titer (GMT) was significantly higher in immunocompetent patients than in immunocompromised patients (1496 U/mL [95% confidence interval 1199-1862] vs. 472 U/mL [200-1119], p = 0.035). Additionally, the GMT of S-IgG was higher in N-IgG-positive patients than in N-IgG-negative patients (8203 [5847-11482] U/mL vs. 1127 [855-1486] U/mL, p < 0.001). CONCLUSIONS BNT162b2 is acceptably safe and immunogenic for children aged 5-11 years with underlying diseases. Although seroconversion was satisfactory in immunocompromised patients, the titers were lower than in immunocompetent patients.
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Affiliation(s)
- Takanori Funaki
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
| | - Masaki Yamada
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Advanced Medicine for Viral Infections, National Center for Child Health and Development, Tokyo, Japan
| | - Kozue Miyake
- Department of Clinical Research Promotion, National Center for Child Health and Development, Tokyo, Japan
| | - Saki Ueno
- Department of Clinical Research Promotion, National Center for Child Health and Development, Tokyo, Japan
| | - Shota Myojin
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroyuki Aiba
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiro Matsui
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Kato
- National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
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Siragusa L, Angelico R, Angrisani M, Zampogna B, Materazzo M, Sorge R, Giordano L, Meniconi R, Coppola A. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons. Updates Surg 2023; 75:1711-1727. [PMID: 37578735 PMCID: PMC10435629 DOI: 10.1007/s13304-023-01613-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/23/2023] [Indexed: 08/15/2023]
Abstract
COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice.
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Affiliation(s)
- Leandro Siragusa
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - Roberta Angelico
- HPB and Transplant Unit, Department of Surgical Sciences, University of "Rome Tor Vergata", Rome, Italy
| | - Marco Angrisani
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Biagio Zampogna
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128, Rome, Italy
| | - Marco Materazzo
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy.
- HPB and Transplant Unit, Department of Surgical Sciences, University of "Rome Tor Vergata", Rome, Italy.
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Roberto Sorge
- Department of Biostatistics, University of Rome Tor Vergata, Rome, Italy
| | - Luca Giordano
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Roberto Meniconi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
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Cacciola R, Delbue S. Managing the "Sword of Damocles" of Immunosuppression: Prevention, Early Diagnosis, and Treatment of Infectious Diseases in Kidney Transplantation. Pathogens 2023; 12:pathogens12050649. [PMID: 37242318 DOI: 10.3390/pathogens12050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The careful tailoring of the most appropriate immunosuppressive strategy for recipients of a kidney transplant (KT) regularly faces a risk of complications that may harm the actual graft and affect patient survival [...].
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Affiliation(s)
- Roberto Cacciola
- Department of Surgery, King Salman Armed Forces Hospital, Tabuk 47512, Saudi Arabia
- Department of Surgical Sciences, University of Tor Vergata, 00133 Rome, Italy
| | - Serena Delbue
- Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milano, Italy
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4
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The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the "Extended Criteria Donor" Era. Pathogens 2022; 11:pathogens11101193. [PMID: 36297249 PMCID: PMC9610733 DOI: 10.3390/pathogens11101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols are still underused in kidney transplantation (KT) due to recipients’ “frailty” and risk of postoperative complications. We aimed to evaluate the feasibility and safety of ERAS in KT during the “extended-criteria donor” era, and to identify the predictive factors of prolonged hospitalization. In 2010−2019, all patients receiving KT were included in ERAS program targeting a discharge home within 5 days of surgery. Recipient, transplant, and outcomes data were analyzed. Of 454 KT [male: 280, 63.9%; age: 57 (19−77) years], 212 (46.7%) recipients were discharged within the ERAS target (≤5 days), while 242 (53.3%) were discharged later. Patients within the ERAS target (≤5 days) had comparable recipient and transplant characteristics to those with longer hospital stays, and they had similar post-operative complications, readmission rates, and 5 year graft/patient survival. In the multivariate analysis, DGF (HR: 2.16, 95% CI: 1.08−4.34, p < 0.030) and in-hospital dialysis (HR: 3.68, 95% CI: 1.73−7.85, p < 0.001) were the only predictive factors for late discharge. The ERAS approach is feasible and safe in all KT candidates, and its failure is primarily related to the postoperative graft function, rather than the recipient’s clinical status. ERAS pathways, integrated with strict collaboration with local nephrologists, allow early discharge after KT, with clinical benefits.
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Perego M, Iesari S, Gandolfo MT, Alfieri C, Delbue S, Cacciola R, Ferraresso M, Favi E. Outcomes of Patients Receiving a Kidney Transplant or Remaining on the Transplant Waiting List at the Epicentre of the COVID-19 Pandemic in Europe: An Observational Comparative Study. Pathogens 2022; 11:pathogens11101144. [PMID: 36297201 PMCID: PMC9610233 DOI: 10.3390/pathogens11101144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/20/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023] Open
Abstract
Since the declaration of the COVID-19 pandemic, the number of kidney transplants (KT) performed worldwide has plummeted. Besides the generalised healthcare crisis, this unprecedented drop has multiple explanations such as the risk of viral transmission through the allograft, the perceived increase in SARS-CoV-2-related morbidity and mortality in immunocompromised hosts, and the virtual "safety" of dialysis while awaiting effective antiviral prophylaxis or treatment. Our institution, operating at the epicentre of the COVID-19 pandemic in Italy, has continued the KT programme without pre-set limitations. In this single-centre retrospective observational study with one-year follow-up, we assessed the outcomes of patients who had undergone KT (KTR) or remained on the transplant waiting list (TWL), before (Pre-COV) or during (COV) the pandemic. The main demographic and clinical characteristics of the patients on the TWL or receiving a KT were very similar in the two periods. The pandemic did not affect post-transplant recipient and allograft loss rates. On the contrary, there was a trend toward higher mortality among COV-TWL patients compared to Pre-COV-TWL subjects. Such a discrepancy was primarily due to SARS-CoV-2 infections. Chronic exposure to immunosuppression, incidence of delayed allograft function, and rejection rates were comparable. However, after one year, COV-KTR showed significantly higher median serum creatinine than Pre-COV-KTR. Our data confirm that KT practice could be safely maintained during the COVID-19 pandemic, with excellent patient- and allograft-related outcomes. Strict infection control strategies, aggressive follow-up monitoring, and preservation of dedicated personnel and resources are key factors for the optimisation of the results in case of future pandemics.
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Affiliation(s)
- Marta Perego
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Samuele Iesari
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium
| | - Maria Teresa Gandolfo
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Alfieri
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Roberto Cacciola
- Surgery, King Salman Armed Forces Hospital, Tabuk 47512, Saudi Arabia
- HPB Surgery and Transplantation, Fondazione PTV, 00133 Rome, Italy
| | - Mariano Ferraresso
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Evaldo Favi
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255035603
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6
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Clinical and Surgical Challenges in Kidney Transplantation: Toward a Personalized Approach? Medicina (B Aires) 2022; 58:medicina58050604. [PMID: 35630023 PMCID: PMC9144170 DOI: 10.3390/medicina58050604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
The continuously evolving practice of solid organ transplantation (SOT) in general and kidney transplantation (KT) in particular embodies the complexity of a composite, multi-step healthcare service [...]
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7
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Favi E, Leonardis F, Manzia TM, Angelico R, Alalawi Y, Alfieri C, Cacciola R. "Salus Populi Suprema Lex": Considerations on the Initial Response of the United Kingdom to the SARS-CoV-2 Pandemic. Front Public Health 2021; 9:646285. [PMID: 34660502 PMCID: PMC8514989 DOI: 10.3389/fpubh.2021.646285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
In several countries worldwide, the initial response to coronavirus disease 2019 (COVID-19) has been heavily criticized by general public, media, and healthcare professionals, as well as being an acrimonious topic in the political debate. The present article elaborates on some aspects of the United Kingdom (UK) primary reaction to SARS-CoV-2 pandemic; specifically, from February to July 2020. The fact that the UK showed the highest mortality rate in Western Europe following the first wave of COVID-19 certainly has many contributing causes; each deserves an accurate analysis. We focused on three specific points that have been insofar not fully discussed in the UK and not very well known outside the British border: clinical governance, access to hospital care or intensive care unit, and implementation of non-pharmaceutical interventions. The considerations herein presented on these fundamental matters will likely contribute to a wider and positive discussion on public health, in the context of an unprecedented crisis.
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Affiliation(s)
- Evaldo Favi
- Department of General Surgery, Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Leonardis
- Intensive Care Unit, Department of Surgical Sciences, Università di Tor Vergata, Rome, Italy
| | - Tommaso Maria Manzia
- HPB Surgery and Transplantation, Department of Surgical SciencesUniversità di Tor Vergata, Rome, Italy
| | - Roberta Angelico
- HPB Surgery and Transplantation, Department of Surgical SciencesUniversità di Tor Vergata, Rome, Italy
| | - Yousof Alalawi
- Department of Surgery, Kidney Transplantation, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Carlo Alfieri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Internal Medicine, Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Cacciola
- HPB Surgery and Transplantation, Department of Surgical SciencesUniversità di Tor Vergata, Rome, Italy.,Department of Surgery, Kidney Transplantation, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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8
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Manzia TM, Gazia C, Lenci I, Angelico R, Toti L, Monaco A, Anselmo A, Baiocchi L, Grossi P, Tisone G. Liver transplantation performed in a SARS-CoV-2 positive hospitalized recipient using a SARS-CoV-2 infected donor. Am J Transplant 2021; 21:2600-2604. [PMID: 33621393 PMCID: PMC8013325 DOI: 10.1111/ajt.16548] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 02/05/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 currently affected more than 108 million people worldwide with a fatality rate of 2.2%. Herein, we report the first case of liver transplantation (LT) performed with a liver procured from a SARS-CoV-2 positive donor. The recipient was a 35-year-old SARS-CoV-2 positive female patient affected by severe end-stage HBV-HDV-related liver disease (model of end-stage liver disease = 32) who had neutralizing SARS-CoV-2 antibodies (titers 1:320) at time of LT. The LT was successful, and the graft is functioning two months after surgery. The recipient cleared the SARS-CoV-2 infection 1 month after LT. The current case shows that the prompt use of SARS-CoV-2 infected liver donors offers an invaluable life-saving opportunity for SARS-CoV-2 positive wait-listed patients who developed neutralizing SARS-CoV-2 antibodies.
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Affiliation(s)
- Tommaso Maria Manzia
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
- Correspondence Tommaso Maria Manzia, Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Carlo Gazia
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Roberta Angelico
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luca Toti
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Monaco
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Anselmo
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Paolo Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giuseppe Tisone
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
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Perra N. Non-pharmaceutical interventions during the COVID-19 pandemic: A review. PHYSICS REPORTS 2021; 913:1-52. [PMID: 33612922 PMCID: PMC7881715 DOI: 10.1016/j.physrep.2021.02.001] [Citation(s) in RCA: 224] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 05/06/2023]
Abstract
Infectious diseases and human behavior are intertwined. On one side, our movements and interactions are the engines of transmission. On the other, the unfolding of viruses might induce changes to our daily activities. While intuitive, our understanding of such feedback loop is still limited. Before COVID-19 the literature on the subject was mainly theoretical and largely missed validation. The main issue was the lack of empirical data capturing behavioral change induced by diseases. Things have dramatically changed in 2020. Non-pharmaceutical interventions (NPIs) have been the key weapon against the SARS-CoV-2 virus and affected virtually any societal process. Travel bans, events cancellation, social distancing, curfews, and lockdowns have become unfortunately very familiar. The scale of the emergency, the ease of survey as well as crowdsourcing deployment guaranteed by the latest technology, several Data for Good programs developed by tech giants, major mobile phone providers, and other companies have allowed unprecedented access to data describing behavioral changes induced by the pandemic. Here, I review some of the vast literature written on the subject of NPIs during the COVID-19 pandemic. In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency. While the large majority of the sample was obtained by querying PubMed, it includes also a hand-curated list. Considering the focus, and methodology I have classified the sample into seven main categories: epidemic models, surveys, comments/perspectives, papers aiming to quantify the effects of NPIs, reviews, articles using data proxies to measure NPIs, and publicly available datasets describing NPIs. I summarize the methodology, data used, findings of the articles in each category and provide an outlook highlighting future challenges as well as opportunities.
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Affiliation(s)
- Nicola Perra
- Networks and Urban Systems Centre, University of Greenwich, London, UK
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10
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Angelico R, Blasi F, Manzia TM, Toti L, Tisone G, Cacciola R. The Management of Immunosuppression in Kidney Transplant Recipients with COVID-19 Disease: An Update and Systematic Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:435. [PMID: 33946462 PMCID: PMC8147172 DOI: 10.3390/medicina57050435] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy may protect from the cytokine storm induced by SARS-CoV-2 infection or a temporary adjustment/withdrawal of IS therapy to restore the immune system may be necessary. We performed a systematic literature review to investigate the current management of IS therapy in KT recipients with COVID-1. Materials and Methods: Out of 71 articles published from 1 February 2020 until 30 October 2020, 554 KT recipients with SARS-CoV-2 infection were identified. Results: Modifications of IS therapy were based on the clinical conditions. For asymptomatic patients or those with mild COVID-19 symptoms, a "wait and see approach" was mostly used; a suspension of antimetabolites drugs (347/461, 75.27%) or mTOR inhibitors (38/48, 79.2%) was adopted in the majority of patients with symptomatic COVID-19 infections. For CNIs, the most frequent attitude was their maintenance (243/502, 48.4%) or dose-reduction (99/502, 19.72%) in patients asymptomatic or with mild COVID-19 symptoms, while drug withdrawal was the preferred choice in severely symptomatic patients (160/450, 31.87%). A discontinuation of all IS drugs was used only in severely symptomatic COVID-19 patients on invasive mechanical ventilation. Renal function remained stable in 422(76.17%) recipients, while 49(8.84%) patients experienced graft loss. Eight (1.44%) patients experienced a worsening of renal function. The overall mortality was 21.84%, and 53(9.56%) patients died with functioning grafts. Conclusion: A tailored approach to the patient has been the preferred strategy for the management of IS therapy in KT recipients, taking into account the clinical conditions of patients and the potential interactions between IS and antiviral drugs, in the attempt to balance the risks of COVID-19-related complications and those due to rejection or graft loss.
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Affiliation(s)
- Roberta Angelico
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Francesca Blasi
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Tommaso Maria Manzia
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Luca Toti
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Giuseppe Tisone
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Roberto Cacciola
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
- Department of Surgery, King Salman Armed Forces Hospital, Tabuk 47512, Saudi Arabia
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11
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Manzia TM, Angelico R, Toti L, Pisani G, Vita G, Romano F, Pirozzi BM, Vinci D, Cacciola R, Iaria G, Tisone G. The hamletic dilemma of patients waiting for kidney transplantation during the COVID-19 pandemic: To accept or not to accept (an organ offer)? Transpl Infect Dis 2021; 23:e13560. [PMID: 33393172 PMCID: PMC7883127 DOI: 10.1111/tid.13560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023]
Abstract
The outbreak of COVID-19 led to a reduction in the number of organ transplant interventions in most Countries. In April 2020, at the Tor Vergata University in Rome, Italy, two patients on the waiting list for kidney transplantation (KT) declined a deceased donor's kidney offer. Therefore, between April 20 and 25, 2020, we conducted a telephone survey among our 247 KT waitlist patients. Our aim was to explore: (a) the COVID-19 diffusion among them and (b) their current willingness to be transplanted in case of a kidney offer from a deceased donor. Two hundred and forty-three patients participated in a phone interview. One patient had died from COVID-19. Eighty-five (35%) KT candidates would decline any kidney offer, in most cases until the end of the COVID-19 pandemic. Upon a multivariate analysis, female gender (OR = 2.25, 95% CI = 1.26-4.03, P = .006), high cardiovascular risk (OR = 2.33, 95% CI = 1.06-5.08, P = .034), a waiting list time <3 years (OR = 0.375, 95% CI = 0.15-0.95, P = .04), and the need to be transferred to another hospital for HD (OR = 2.56, 95% CI = 1.10-5.9, P = .03) were associated with such refusal. The COVID-19 pandemic led to a fear of transplantation in a third of the KT candidates. Proactive educational webinars could be a useful tool to remove, or at least lessen, any doubts on the part of KT candidates and to avoid losing the opportunity to quit dialysis.
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Affiliation(s)
- Tommaso M. Manzia
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Roberta Angelico
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Luca Toti
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Gennaro Pisani
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Vita
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Francesca Romano
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Brunella M. Pirozzi
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Danilo Vinci
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Roberto Cacciola
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Iaria
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Tisone
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
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Falah Hasan H. Legal and Health Response to COVID-19 in the Arab Countries. Risk Manag Healthc Policy 2021; 14:1141-1154. [PMID: 33758566 PMCID: PMC7981159 DOI: 10.2147/rmhp.s297565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Arab countries account for almost 6% of the global population, yet they make up only 5% of the total cases and less than 3% of the global death toll attributed to COVID-19. COVID-19 has put the health systems in the various Arab Countries and their ability to deliver healthcare services under tremendous strain. The capacity and stability of any health system is important in any type of response to the pandemic, in order to ensure an effective and efficient delivery of care to the public through COVID-19 and beyond. The objective of this study is to identify the various response of health systems in Arab Countries to COVID-19, and highlight the legal and health challenges faced during the pandemic. The study identified both gaps and good practices that may be utilized in order to guide the efforts in response to COVID-19 and the recovery efforts once the pandemic is over. METHODS To determine why the response of some health systems in Arab Countries responses are more effective than others, a three-step framework is adopted which includes, detection, containment, and treatment stages. In order to identify which countries are excelling at detection, containment, and treatment stages, several indicators were selected for each stage. To be able to understand the legal and health challenges of response to the COVID-19 pandemic, an analysis of the health systems, the resources in terms of quality and access, health workforce, and finance was conducted. Secondary data published by the Global Burden of Disease Study, and the Global Change Data Lab of the University of Oxford was used to study identified gaps and good practices to guide the responses to COVID-19 and recovery efforts once the pandemic is over. RESULTS The epidemiologic record demonstrates that that certain Arab countries are managing to control the pandemic, through a combination of mitigation strategies, suppression strategy and elimination strategy. There are several barriers and challenges in Arab health systems which have been amplified due to COVID-19 and if ignored may pose a further significant challenge in the future. Health systems in Arab countries are not sufficiently equipped to handle all healthcare needs related to COVID-19, in particular issues relating to administration, equity, finances, the supply side of healthcare, and usage of information technology. CONCLUSION In Arab counties, the standard response to COVID-19 was enforced by new health laws, which consist of a combination of the traditional disease control measures (testing, contact-tracing, social distancing), population-based physical distancing (including stay-at-home orders, school and business closures, and social gathering bans), travel limits (including travel bans, and border closures), and economic support measures. Acceptable healthcare quality and access, sufficient health workforce, and sufficient funds are the most imperative needs in the health system in Arab counties to provide a sustainable response to the COVID-19 pandemic.
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Awaidy SA, Mahomed O. Impact of non-pharmaceutical interventions on the COVID-19 epidemic: A modelling study. SAGE Open Med 2020; 8:2050312120979462. [PMID: 33343898 PMCID: PMC7731697 DOI: 10.1177/2050312120979462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to assess the impact of non-pharmaceutical interventions on the COVID-19 epidemic in Oman. METHODS Data were retrieved from published national surveillance data between 24 February and 30 June 2020. To show the impact of the Government introduced public health intervention early in the epidemic, we used a simple disease-transmission model equation of the 2019-n CoV epidemic. RESULTS From all confirmed cases, the rates of intensive care unit admission were 4.56% (1824). We estimated an R 0 of 3.11 with no intervention would result in nearly the entire population of Oman being infected within 65 days. A reduction of the R 0 to 1.51 provided an estimated 89,056 confirmed cases, with 167 deaths or 0.4% mortality by June 30 with a requirement of 4052 intensive care unit beds. The current scenario (24 February to 30 June 2020) indicates an R 0 of 1.41, resulting in 40,070 confirmed COVID-19 cases, 176 deaths and 69% of confirmed cases recovered. CONCLUSION In early implementation of non-pharmaceutical interventions, an intensive lockdown has had a profound impact on the mitigation of a large-scale COVID-19 outbreak in Oman.
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Affiliation(s)
- Barry D Kahan
- Editor-in-Chief, Transplantation Proceedings, Emeritus Professor, The University of Texas Medical School at Houston, Houston, Texas
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