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Lima HS, Tupinambás U, Guimarães FG. Estimating time-varying epidemiological parameters and underreporting of Covid-19 cases in Brazil using a mathematical model with fuzzy transitions between epidemic periods. PLoS One 2024; 19:e0305522. [PMID: 38885221 PMCID: PMC11182538 DOI: 10.1371/journal.pone.0305522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 06/01/2024] [Indexed: 06/20/2024] Open
Abstract
Our study conducts a comprehensive analysis of the Covid-19 pandemic in Brazil, spanning five waves over three years. We employed a novel Susceptible-Infected-Recovered-Dead-Susceptible (SIRDS) model with a fuzzy transition between epidemic periods to estimate time-varying parameters and evaluate case underreporting. The initial basic reproduction number (R0) is identified at 2.44 (95% Confidence Interval (CI): 2.42-2.46), decreasing to 1.00 (95% CI: 0.99-1.01) during the first wave. The model estimates an underreporting factor of 12.9 (95% CI: 12.5-13.2) more infections than officially reported by Brazilian health authorities, with an increasing factor of 5.8 (95% CI: 5.2-6.4), 12.9 (95% CI: 12.5-13.3), and 16.8 (95% CI: 15.8-17.5) in 2020, 2021, and 2022 respectively. Additionally, the Infection Fatality Rate (IFR) is initially 0.88% (95% CI: 0.81%-0.94%) during the initial phase but consistently reduces across subsequent outbreaks, reaching its lowest value of 0.018% (95% CI: 0.011-0.033) in the last outbreak. Regarding the immunity period, the observed uncertainty and low sensitivity indicate that inferring this parameter is particularly challenging. Brazil successfully reduced R0 during the first wave, coinciding with decreased human mobility. Ineffective public health measures during the second wave resulted in the highest mortality rates within the studied period. We attribute lower mortality rates in 2022 to increased vaccination coverage and the lower lethality of the Omicron variant. We demonstrate the model generalization by its application to other countries. Comparative analyses with serological research further validate the accuracy of the model. In forecasting analysis, our model provides reasonable outbreak predictions. In conclusion, our study provides a nuanced understanding of the Covid-19 pandemic in Brazil, employing a novel epidemiological model. The findings contribute to the broader discourse on pandemic dynamics, underreporting, and the effectiveness of health interventions.
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Affiliation(s)
- Hélder Seixas Lima
- Instituto Federal do Norte de Minas Gerais, Januária, MG, Brazil
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Unaí Tupinambás
- Department of Medical Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Wiegand RE, Deng Y, Deng X, Lee A, Meyer WA, Letovsky S, Charles MD, Gundlapalli AV, MacNeil A, Hall AJ, Thornburg NJ, Jones J, Iachan R, Clarke KE. Estimated SARS-CoV-2 antibody seroprevalence trends and relationship to reported case prevalence from a repeated, cross-sectional study in the 50 states and the District of Columbia, United States-October 25, 2020-February 26, 2022. LANCET REGIONAL HEALTH. AMERICAS 2023; 18:100403. [PMID: 36479424 PMCID: PMC9716971 DOI: 10.1016/j.lana.2022.100403] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/05/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
Background Sero-surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can reveal trends and differences in subgroups and capture undetected or unreported infections that are not included in case-based surveillance systems. Methods Cross-sectional, convenience samples of remnant sera from clinical laboratories from 51 U.S. jurisdictions were assayed for infection-induced SARS-CoV-2 antibodies biweekly from October 25, 2020, to July 11, 2021, and monthly from September 6, 2021, to February 26, 2022. Test results were analyzed for trends in infection-induced, nucleocapsid-protein seroprevalence using mixed effects models that adjusted for demographic variables and assay type. Findings Analyses of 1,469,792 serum specimens revealed U.S. infection-induced SARS-CoV-2 seroprevalence increased from 8.0% (95% confidence interval (CI): 7.9%-8.1%) in November 2020 to 58.2% (CI: 57.4%-58.9%) in February 2022. The U.S. ratio of the change in estimated seroprevalence to the change in reported case prevalence was 2.8 (CI: 2.8-2.9) during winter 2020-2021, 2.3 (CI: 2.0-2.5) during summer 2021, and 3.1 (CI: 3.0-3.3) during winter 2021-2022. Change in seroprevalence to change in case prevalence ratios ranged from 2.6 (CI: 2.3-2.8) to 3.5 (CI: 3.3-3.7) by region in winter 2021-2022. Interpretation Ratios of the change in seroprevalence to the change in case prevalence suggest a high proportion of infections were not detected by case-based surveillance during periods of increased transmission. The largest increases in the seroprevalence to case prevalence ratios coincided with the spread of the B.1.1.529 (Omicron) variant and with increased accessibility of home testing. Ratios varied by region and season with the highest ratios in the midwestern and southern United States during winter 2021-2022. Our results demonstrate that reported case counts did not fully capture differing underlying infection rates and demonstrate the value of sero-surveillance in understanding the full burden of infection. Levels of infection-induced antibody seroprevalence, particularly spikes during periods of increased transmission, are important to contextualize vaccine effectiveness data as the susceptibility to infection of the U.S. population changes. Funding This work was supported by the Centers for Disease Control and Prevention, Atlanta, Georgia.
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Affiliation(s)
- Ryan E. Wiegand
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | - Myrna D. Charles
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adi V. Gundlapalli
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam MacNeil
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aron J. Hall
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jefferson Jones
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kristie E.N. Clarke
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Presence of specific SARS-COV2 antibodies in hemodialysis patients and their caregivers after the first wave of COVID-19. Sci Rep 2022; 12:11972. [PMID: 35831388 PMCID: PMC9279503 DOI: 10.1038/s41598-022-15913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/30/2022] [Indexed: 12/02/2022] Open
Abstract
Hemodialysis (HD) patients are at risk for severe COVID-19 and cannot comply with social distancing. SARS-COV2 seroprevalence in French patients and caregivers after the first wave of COVID-19 is unknown. SeroCOVIDial is a prospective study conducted between June and December 2020. SARS-COV2 seroprevalence was evaluated by a rapid serological test (BIOSYNEX) in HD patients and caregivers, and the presence or not of anti-SARS-COV2 neutralizing or non-neutralizing antibodies in patients was also determined by ELISA and seroneutralization. In June 2020, 451 HD patients and 238 caregivers were included. Overall SARS-COV2 seroprevalence was 8.4% (patients) and 6.7% (caregivers), and was 87.1% (patients) and 90.0% (caregivers) in participants with a previously documented SARS-COV2 infection. Overall seroprevalence reached 13.8% (patients) and 12.6% (caregivers) following the second epidemic wave. During the follow-up, 38 (8.4%) patients died (9 of COVID-19). Among the 44 (10.6%) patients who became infected, only two were seropositive at M0. The levels of anti-SARS-COV2 antibodies decreased over time in patients and caregivers. The BIOSYNEX test showed 82.9% sensitivity and 97.7% specificity. Prevalence of anti-SARS-COV2 antibodies was low in HD patients and caregivers after the first epidemic wave but rose after the second wave. A rapid serological test showed good performances and could be useful for future monitoring of anti-SARS-COV2 antibodies.
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4
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Prevalence and Risk Factors for Anti-SARS-CoV-2 Antibody in Chronic Kidney Disease (Dialysis Independent and Not). Pathogens 2022; 11:pathogens11050572. [PMID: 35631093 PMCID: PMC9146774 DOI: 10.3390/pathogens11050572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The evidence in the medical literature regarding the prevalence of antibody towards SARS-CoV-2 in patients with chronic kidney disease is limited, particularly among those at the pre-dialysis stage. Aim: We have prospectively performed a cohort study at a third-level university hospital to evaluate frequency and risk factors for anti-SARS-CoV-2-positive serology among chronic kidney disease patients. Methods: We have tested a cohort of consecutive outpatients with chronic kidney disease on regular follow-up at a major metropolitan hospital, during the SARS-CoV-2 outbreak in Italy. We adopted an enzyme immunoassay for the assessment of IgM/IgG antibodies to SARS-CoV-2 in human serum or plasma (DIA.PRO COVID-19 Serological Assay); the assay detects antibodies against Spike (1/2) and Nucleocapsid proteins of the SARS-CoV-2 genome. Results: There were 199 (65.8%) out of 302 patients with dialysis-independent CKD; 2 patients were anti-SARS-CoV-2 IgM antibody positive, 23 were anti-SARS-CoV-2 IgM/IgG positive and 37 had detectable anti-SARS-CoV-2 IgG antibody in serum. The prevalence of anti-SARS-CoV-2 IgG was 20.5% (60/302). All patients positive for anti-SARS-CoV-2 antibody tested negative by nasopharyngeal swab. A significant and independent relationship between anti-SARS-CoV-2-positive serologic status and serum albumin (a marker of nutritional status) was observed (p < 0.046). The prevalence of anti-SARS-CoV-2 antibody was greater in CKD than in control populations (health care workers and blood donors) attending the hospital a few months before the current study (7.6% and 5.2%, respectively). Conclusions: The great prevalence of anti-SARS-CoV-2 antibody in our study group could be, at least partially, explained with the fact that our patients were living in Milan, an area severely hit by SARS-CoV-2 infection. It seems that a poor nutritional status supports the acquisition of SARS-CoV-2 antibody in CKD patients. Clinical studies to understand the mechanisms responsible for the high frequency of SARS-CoV-2 infection are under way.
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Wu W, Gremel GW, He K, Messana JM, Sen A, Segal JH, Dahlerus C, Hirth RA, Kang J, Wisniewski K, Nahra T, Padilla R, Tong L, Gu H, Wang X, Slowey M, Eckard A, Ding X, Borowicz L, Du J, Frye B, Kalbfleisch JD. The Impact of COVID-19 on Postdischarge Outcomes for Dialysis Patients in the United States: Evidence from Medicare Claims Data. KIDNEY360 2022; 3:1047-1056. [PMID: 35845326 PMCID: PMC9255877 DOI: 10.34067/kid.0000242022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/15/2022] [Indexed: 01/10/2023]
Abstract
Background Recent investigations have shown that, on average, patients hospitalized with coronavirus disease 2019 (COVID-19) have a poorer postdischarge prognosis than those hospitalized without COVID-19, but this effect remains unclear among patients with end-stage kidney disease (ESKD) who are on dialysis. Methods Leveraging a national ESKD patient claims database administered by the US Centers for Medicare and Medicaid Services, we conducted a retrospective cohort study that characterized the effects of in-hospital COVID-19 on all-cause unplanned readmission and death within 30 days of discharge for patients on dialysis. Included in this study were 436,745 live acute-care hospital discharges of 222,154 Medicare beneficiaries on dialysis from 7871 Medicare-certified dialysis facilities between January 1 and October 31, 2020. Adjusting for patient demographics, clinical characteristics, and prevalent comorbidities, we fit facility-stratified Cox cause-specific hazard models with two interval-specific (1-7 and 8-30 days after hospital discharge) effects of in-hospital COVID-19 and effects of prehospitalization COVID-19. Results The hazard ratios due to in-hospital COVID-19 over the first 7 days after discharge were 95% CI, 1.53 to 1.65 for readmission and 95% CI, 1.38 to 1.70 for death, both with P<0.001. For the remaining 23 days, the hazard ratios were 95% CI, 0.89 to 0.96 and 95% CI, 0.86 to 1.07, with P<0.001 and P=0.50, respectively. Effects of prehospitalization COVID-19 were mostly nonsignificant. Conclusions In-hospital COVID-19 had an adverse effect on both postdischarge readmission and death over the first week. With the surviving patients having COVID-19 substantially selected from those hospitalized, in-hospital COVID-19 was associated with lower rates of readmission and death starting from the second week.
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Affiliation(s)
- Wenbo Wu
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan,Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Garrett W. Gremel
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Kevin He
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Joseph M. Messana
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Division of Nephrology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ananda Sen
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan,Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan H. Segal
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Division of Nephrology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Claudia Dahlerus
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Division of Nephrology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Richard A. Hirth
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Health Policy and Management, University of Michigan, Ann Arbor, Michigan
| | - Jian Kang
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Karen Wisniewski
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Tammie Nahra
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Robin Padilla
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Lan Tong
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Haoyu Gu
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Xi Wang
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Megan Slowey
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Ashley Eckard
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Xuemei Ding
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Lisa Borowicz
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Juan Du
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Brandon Frye
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - John D. Kalbfleisch
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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Brunelli SM, Sibbel S, Karpinski S, Marlowe G, Walker AG, Giullian J, Van Wyck D, Kelley T, Lazar R, Zywno ML, Connaire JJ, Young A, Tentori F. Comparative Effectiveness of mRNA-Based BNT162b2 Vaccine versus Adenovirus Vector-Based Ad26.COV2.S Vaccine for Prevention of COVID-19 among Dialysis Patients. J Am Soc Nephrol 2022; 33:688-697. [PMID: 35135894 PMCID: PMC8970445 DOI: 10.1681/asn.2021101395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022] Open
Abstract
Background Studies have demonstrated that mRNA-based SARS-CoV-2 vaccines are highly effective among dialysis patients. Because individual vaccines may be differentially available or acceptable to patients, it is important to understand comparative effectiveness relative to other vaccines, such those based on adenovirus technologies.
Methods In this retrospective study, we compared the clinical effectiveness of adenovirus vector-based Ad26.COV2.S (Janssen/Johnson & Johnson) to mRNA-based BNT162b2 (Pfizer/BioNTech) in a contemporary cohort of dialysis patients. Patients who received a first BNT162b2 dose were matched 1:1 to Ad26.COV2.S recipients based on date of first vaccine receipt, US state of residence, site of dialysis care (in-center versus home), prior history of COVID-19, and propensity score. The primary outcome was the comparative rate of COVID-19 diagnoses starting in the seventh week postvaccination. In a subset of consented Ad26.COV2.S patients, blood samples were collected ≥28 days after vaccination and anti-SARS-Cov-2 immunoglobulin G antibodies were measured
Results A total of 2572 matched pairs of patients qualified for analysis. Cumulative incidence rates of COVID-19 did not differ for BNT162b2 versus Ad26.COV2.S. No differences were observed in peri-COVID-19 hospitalizations and deaths among patients receiving BNT162b2 versus Ad26.COV2.S who were diagnosed with COVID-19 during follow-up. Results were similar when excluding patients with prior history of COVID-19, in subgroup analyses restricted to patients who completed the two-dose BNT162b2 regimen, and in patients receiving in-center hemodialysis. SARS-CoV-2 antibodies were detected in 59.4% of 244 patients who received Ad26.COV2.S.
Conclusions In a large real-world cohort of dialysis patients, no difference was detected in clinical effectiveness of BNT162b2 and Ad26.COV2.S over the first 6 months postvaccination, despite an inconsistent antibody response to the latter.
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Affiliation(s)
| | - Scott Sibbel
- DaVita Clinical Research, Minneapolis, Minnesota
| | | | | | | | | | | | - Tara Kelley
- DaVita Clinical Research, Minneapolis, Minnesota
| | | | | | | | - Amy Young
- DaVita Clinical Research, Minneapolis, Minnesota
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Sibbel S, McKeon K, Luo J, Wendt K, Walker AG, Kelley T, Lazar R, Zywno ML, Connaire JJ, Tentori F, Young A, Brunelli SM. Real-World Effectiveness and Immunogenicity of BNT162b2 and mRNA-1273 SARS-CoV-2 Vaccines in Patients on Hemodialysis. J Am Soc Nephrol 2022; 33:49-57. [PMID: 34789546 PMCID: PMC8763185 DOI: 10.1681/asn.2021060778] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/01/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patients on hemodialysis have an elevated risk for COVID-19 but were not included in efficacy trials of SARS-CoV-2 vaccines. METHODS We conducted a retrospective, observational study to estimate the real-world effectiveness and immunogenicity of two mRNA SARS-CoV-2 vaccines in a large, representative population of adult hemodialysis patients in the United States. In separate, parallel analyses, patients who began a vaccination series with BNT162b2 or mRNA-1273 in January and February 2021 were matched with unvaccinated patients and risk for outcomes were compared for days 1-21, 22-42, and ≥43 after first dose. In a subset of consented patients, blood samples were collected approximately 28 days after the second dose and anti-SARS-CoV-2 immunoglobulin G was measured. RESULTS A total of 12,169 patients received the BNT162b2 vaccine (matched with 44,377 unvaccinated controls); 23,037 patients received the mRNA-1273 vaccine (matched with 63,243 unvaccinated controls). Compared with controls, vaccinated patients' risk of being diagnosed with COVID-19 postvaccination became progressively lower during the study period (hazard ratio and 95% confidence interval for BNT162b2 was 0.21 [0.13, 0.35] and for mRNA-1273 was 0.27 [0.17, 0.42] for days ≥43). After a COVID-19 diagnosis, vaccinated patients were significantly less likely than unvaccinated patients to be hospitalized (for BNT162b2, 28.0% versus 43.4%; for mRNA-1273, 37.2% versus 45.6%) and significantly less likely to die (for BNT162b2, 4.0% versus 12.1%; for mRNA-1273, 5.6% versus 14.5%). Antibodies were detected in 98.1% (309/315) and 96.0% (308/321) of BNT162b2 and mRNA-1273 patients, respectively. CONCLUSIONS In patients on hemodialysis, vaccination with BNT162b2 or mRNA-1273 was associated with a lower risk of COVID-19 diagnosis and lower risk of hospitalization or death among those diagnosed with COVID-19. SARS-CoV-2 antibodies were detected in nearly all patients after vaccination. These findings support the use of these vaccines in this population.
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Affiliation(s)
- Scott Sibbel
- DaVita Clinical Research, Minneapolis, Minnesota
| | | | - Jiacong Luo
- DaVita Clinical Research, Minneapolis, Minnesota
| | - Karl Wendt
- DaVita Clinical Research, Minneapolis, Minnesota
| | | | - Tara Kelley
- DaVita Clinical Research, Minneapolis, Minnesota
| | | | | | | | | | - Amy Young
- DaVita Clinical Research, Minneapolis, Minnesota
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Paal M, Arend FM, Lau T, Hasmann S, Soreth-Rieke D, Sorodoc-Otto J, Beuthien W, Krappe J, Toepfer M, von Gersdorff G, Thaller N, Rau S, Northoff B, Teupser D, Bruegel M, Fischereder M, Schönermarck U. Antibody response to mRNA SARS-CoV-2 vaccines in haemodialysis patients. Clin Kidney J 2021; 14:2234-2238. [PMID: 34603700 PMCID: PMC8394831 DOI: 10.1093/ckj/sfab127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Some studies have shown an attenuated immune response in haemodialysis patients after vaccination. The present study examines the humoral response after mRNA vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large population of haemodialysis patients from different outpatient dialysis centres. Methods We retrospectively assessed antibodies against SARS-CoV-2 spike protein and nucleocapsid protein (chemiluminescence immunoassays, Roche diagnostics) 3–6 weeks after the second mRNA vaccine dose in 179 maintenance haemodialysis and 70 non-dialysis patients (control cohort). Differences in anti-SARS-CoV-2 spike protein titers were statistically analysed with respect to patient-relevant factors, including age, gender, previous coronavirus disease 2019 (COVID-19) infection, systemic immunosuppressive therapy and time on dialysis. Results We found a favourable, but profoundly lower SARS-CoV-2 spike protein antibody response in comparison with a non-dialysis cohort (median 253.5 versus 1756 U/mL, P < 0.001). In multivariate analysis, previous COVID-19 infection (P < 0.001) and female gender were associated with a significantly higher vaccine response (P = 0.006) in haemodialysis patients, while there was a significant inverse correlation with increasing patient age and systemic immunosuppression (P < 0.001). There was no statistically significant correlation between the antibody titer and time on dialysis. Immune response in haemodialysis patients with a previous COVID-19 infection led to substantially higher antibody titers that were equal to those of vaccinated non-dialysis individuals with previous infection. Conclusion We strongly argue in favour of regular antibody testing after COVID-19 vaccination in haemodialysis patients. Further studies should elucidate the utility of booster vaccinations to foster a stronger and persistent antibody response.
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Affiliation(s)
- Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Florian M Arend
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Lau
- Dialysezentrum Bad Tölz und Wolfratshausen, Bad Tölz, Germany
| | - Sandra Hasmann
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | | | | | | | - Julia Krappe
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Marcell Toepfer
- Dialysezentrum Garmisch-Partenkirchen-Murnau-Weilheim, Murnau am Staffelsee, Germany
| | - Gero von Gersdorff
- Programm "Qualität in der Nephrologie" (QiN), KfH-Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany
| | | | - Simon Rau
- Dialysezentrum Bad Tölz und Wolfratshausen, Bad Tölz, Germany
| | - Bernd Northoff
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Mathias Bruegel
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
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9
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Alfano G, Ferrari A, Magistroni R, Fontana F, Cappelli G, Basile C. The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review. J Nephrol 2021; 34:1387-1403. [PMID: 34417996 PMCID: PMC8379591 DOI: 10.1007/s40620-021-01136-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients undergoing in-centre haemodialysis (HD) are particularly exposed to the dire consequences of COVID-19. The present systematic scoping review aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance HD: it reports specifically the prevalence of the COVID-19 pandemic in the HD population, implementation of strategies for the prevention, mitigation and containment of the COVID-19 pandemic in HD centres, demographic and clinical characteristics, and outcomes of the pediatric and adult HD patients. METHODS A multi-step systematic search of the literature in Pubmed, Scopus, Ovid Medline, Embase and Web of Science, published between December 1, 2019, and January 30, 2021 was performed. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. A report of the papers that met inclusion criteria was performed; then, a descriptive analysis of the characteristics of the included articles and a narrative synthesis of the results were performed. RESULTS The review process ended with the inclusion of 145 articles. Most of them were based on single-centre experiences, which spontaneously developed best practices. Most studies were conducted in high-income countries (69.7%) and a part of them (9.6%) were not in English. Prevalence of COVID-19 among dialysis patients accounted for 0%-37.6%. Preventive measures were reported in 54% of the included articles, with particular emphasis on education, triage, hygiene, and containment measures. Patients experienced a heterogeneous spectrum of symptoms that led 35%-88.2% of them to hospital admission. Median and mean hospital length of stay ranged from 8 to 28.5 and 16.2 to 22 days, respectively. Admission to intensive care units varied widely across studies (from 2.6% to 70.5%) and was associated with high mortality (42.8%-100%). Overall, prognosis was poor in 0%-47% of the hospitalized patients. CONCLUSIONS This systematic scoping review provides an overview of the current knowledge on the impact of COVID-19 on the frail world of HD patients. Furthermore, it may help to implement the existing strategies of COVID-19 prevention and provide a list of unmet needs (safe transport, testing, shelter). Finally, it may be a stimulus for performing systematic reviews and meta-analyses which will form the basis for evidence-based guidelines.
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Affiliation(s)
- Gaetano Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Annachiara Ferrari
- Nephrology and Dialysis Unit, AUSL Reggio Emilia-IRCCS S. Maria Nuova, Reggio Emilia, Italy
| | - Riccardo Magistroni
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Via Battisti 192, Acquaviva delle Fonti, 74121 Taranto, Italy
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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SARS-CoV-2 vs. Hepatitis Virus Infection Risk in the Hemodialysis Population: What Should We Expect? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115748. [PMID: 34071948 PMCID: PMC8198690 DOI: 10.3390/ijerph18115748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023]
Abstract
Since the dramatic rise of the coronavirus infection disease 2019 (COVID-19) pandemic, patients receiving dialysis have emerged as especially susceptible to this infection because of their impaired immunologic state, chronic inflammation and the high incidence of comorbidities. Although several strategies have thus been implemented to minimize the risk of transmission and acquisition in this population worldwide, the reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence varies across studies but is higher than in the general population. On the contrary, the screening for hepatitis viruses (HBV and HCV) has seen significant improvements in recent years, with vaccination in the case of HBV and effective viral infection treatment for HCV. In this sense, a universal SARS-CoV-2 screening and contact precaution appear to be effective in preventing further transmission. Finally, regarding the progress, an international consensus with updated protocols that prioritize between old and new indicators would seem a reasonable tool to address these unexpended changes for the nephrology community.
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