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Boschiero MN, Palamim CVC, Ortega MM, Marson FAL. Clinical characteristics and comorbidities of COVID-19 in unvaccinated patients with Down syndrome: first year report in Brazil. Hum Genet 2022; 141:1887-1904. [PMID: 35763088 PMCID: PMC9244024 DOI: 10.1007/s00439-022-02468-3] [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: 02/08/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023]
Abstract
Patients with Down syndrome (DS) are more affected by the Coronavirus Disease (COVID)-19 pandemic when compared with other populations. Therefore, the primary aim of our study was to report the death (case fatality rate) from SARS-CoV-2 infection in Brazilian hospitalized patients with DS from 03 January 2020 to 04 April 2021. The secondary objectives were (i) to compare the features of patients with DS and positive for COVID-19 (G1) to those with DS and with a severe acute respiratory infection (SARI) from other etiological factors (G2) to tease apart the unique influence of COVID-19, and (ii) to compare the features of patients with DS and positive for COVID-19 to those without DS, but positive for COVID-19 (G3) to tease apart the unique influence of DS. We obtained the markers for demographic profile, clinical symptoms, comorbidities, and the clinical features for SARI evolution during hospitalization in the first year of the COVID-19 pandemic in Brazil from a Brazilian open-access database. The data were compared between (i) G1 [1619 (0.4%) patients] and G2 [1431 (0.4%) patients]; and between (ii) G1 and G3 [222,181 (64.8%) patients]. The case fatality rate was higher in patients with DS and COVID-19 (G1: 39.2%), followed by individuals from G2 (18.1%) and G3 (14.0%). Patients from G1, when compared to G2, were older (≥ 25 years of age), presented more clinical symptoms related to severe illness and comorbidities, needed intensive care unit (ICU) treatment and non-invasive mechanical ventilation (MV) more frequently, and presented a nearly two fold-increased chance of death (OR = 2.92 [95% CI 2.44–3.50]). Patients from G1, when compared to G3, were younger (< 24 years of age), more prone to nosocomial infection, presented an increased chance for clinical symptoms related to a more severe illness; frequently needed ICU treatment, and invasive and non-invasive MV, and raised almost a three fold-increased chance of death (OR = 3.96 [95% CI 3.60–4.41]). The high case fatality rate in G1 was associated with older age (≥ 25 years of age), presence of clinical symptoms, and comorbidities, such as obesity, related to a more severe clinical condition. Unvaccinated patients with DS affected by COVID-19 had a high case fatality rate, and these patients had a different profile for comorbidities, clinical symptoms, and treatment (such as the need for ICU and MV) when compared with other study populations.
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Affiliation(s)
- Matheus Negri Boschiero
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil
| | - Camila Vantini Capasso Palamim
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Manoela Marques Ortega
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Fernando Augusto Lima Marson
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil. .,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil.
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Verstegen RHJ, Kusters MAA. Inborn Errors of Adaptive Immunity in Down Syndrome. J Clin Immunol 2020; 40:791-806. [PMID: 32638194 DOI: 10.1007/s10875-020-00805-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Down syndrome fits an immunophenotype of combined immunodeficiency with immunodysregulation, manifesting with increased susceptibility to infections, autoimmunity, autoinflammatory diseases, and hematologic malignancies. Qualitative and quantitative alterations in innate and adaptive immunity are found in most individuals with Down syndrome. However, there is substantial heterogeneity and no correlation between immunophenotype and clinical presentation. Previously, it was thought that the immunological changes in Down syndrome were caused by precocious aging. We emphasize in this review that the immune system in Down syndrome is intrinsically different from the very beginning. The overexpression of specific genes located on chromosome 21 contributes to immunodeficiency and immunodysregulation, but gene expression differs between genes located on chromosome 21 and depends on tissue and cell type. In addition, trisomy 21 results in gene dysregulation of the whole genome, reflecting the complex nature of this syndrome in comparison to well-known inborn errors of immunity that result from monogenic germline mutations. In this review, we provide an updated overview focusing on inborn errors of adaptive immunity in Down syndrome.
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Affiliation(s)
- Ruud H J Verstegen
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada. .,Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Maaike A A Kusters
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,University College London Great Ormond Street Institute of Child Health, London, UK
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Hayden CA, Landrock D, Hung CY, Ostroff G, Fake GM, Walker JH, Kier A, Howard JA. Co-Administration of Injected and Oral Vaccine Candidates Elicits Improved Immune Responses over Either Route Alone. Vaccines (Basel) 2020; 8:E37. [PMID: 31973150 PMCID: PMC7157212 DOI: 10.3390/vaccines8010037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/22/2022] Open
Abstract
Infectious diseases continue to be a significant cause of morbidity and mortality, and although efficacious vaccines are available for many diseases, some parenteral vaccines elicit little or no mucosal antibodies which can be a significant problem since mucosal tissue is the point of entry for 90% of pathogens. In order to provide protection for both serum and mucosal areas, we have tested a combinatorial approach of both parenteral and oral administration of antigens for diseases caused by a viral pathogen, Hepatitis B, and a fungal pathogen, Coccidioides. We demonstrate that co-administration by the parenteral and oral routes is a useful tool to increase the overall immune response. This can include achieving an immune response in tissues that are not elicited when using only one route of administration, providing a higher level of response that can lead to fewer required doses or possibly providing a better response for individuals that are considered poor or non-responders.
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Affiliation(s)
- Celine A. Hayden
- Applied Biotechnology Institute, Cal Poly Tech Park, San Luis Obispo, CA 93407, USA; (C.A.H.); (G.M.F.)
| | - Danilo Landrock
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A & M University, College Station, TX 77843, USA; (D.L.); (A.K.)
| | - Chiung Yu Hung
- Department of Biology, University of Texas San Antonio, One UTSA Circle, San Antonio, TX 78249, USA;
| | - Gary Ostroff
- Program in Molecular Medicine, University of Massachusetts Medical School, 373 Plantation St. Biotech 2, Suite 113, Worcester, MA 01605, USA;
| | - Gina M. Fake
- Applied Biotechnology Institute, Cal Poly Tech Park, San Luis Obispo, CA 93407, USA; (C.A.H.); (G.M.F.)
| | - John H. Walker
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA 93407, USA;
| | - Ann Kier
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A & M University, College Station, TX 77843, USA; (D.L.); (A.K.)
| | - John A. Howard
- Applied Biotechnology Institute, Cal Poly Tech Park, San Luis Obispo, CA 93407, USA; (C.A.H.); (G.M.F.)
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De Matteo A, Vajro P. Down Syndrome and Pediatric Nonalcoholic Fatty Liver Disease: A Causal or Casual Relationship? J Pediatr 2017; 189:11-13. [PMID: 28751123 DOI: 10.1016/j.jpeds.2017.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Antonia De Matteo
- Pediatrics Section Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana" University of Salerno Baronissi, SA, Italy
| | - Pietro Vajro
- Pediatrics Section Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana" University of Salerno Baronissi, SA, Italy.
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Eijsvoogel NB, Hollegien MI, Bok VLA, Derksen Lubsen AG, Dikken FPJ, Leenders SACAP, Pijning A, Post E, Wojciechowski M, Hilbink M, de Vries E. Declining antibody levels after hepatitis B vaccination in Down syndrome: A need for booster vaccination? J Med Virol 2017; 89:1682-1685. [PMID: 28322457 DOI: 10.1002/jmv.24813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/24/2017] [Indexed: 11/07/2022]
Abstract
We determined the anti-HBs titer in 227 children of all ages with Down syndrome (DS). Only 48.1% (95%CI: 35.1-61.3) of the DS children aged 7-10 years and 31.9% (95%CI: 22.1-43.6) of the DS children aged >10 years had a protective anti-HBs titer (≥10 IU/L). The geometric mean anti-HBs titer was significantly lower in the DS children; this suggests booster vaccination for HBV may be needed.
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Affiliation(s)
- Noortje B Eijsvoogel
- Department of Pediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Mirjam I Hollegien
- Department of Pediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Vinus L A Bok
- Department of Pediatrics, Màxima Medical Centre, Veldhoven, The Netherlands
| | - Arda G Derksen Lubsen
- Department of Pediatrics, Juliana Children's Hospital/Haga Hospital, The Hague, The Netherlands
| | - Felix P J Dikken
- Department of Pediatrics, Gelre Hospital, Zutphen, The Netherlands
| | - Sander A C A P Leenders
- Department of Medical Microbiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Arjan Pijning
- Department of Pediatrics, Slingeland Hospital, Doetinchem, The Netherlands
| | - Erica Post
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marek Wojciechowski
- Department of Pediatrics, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Mirrian Hilbink
- Jeroen Bosch Academy, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Esther de Vries
- Department of Pediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Department Tranzo, Tilburg University, Tilburg, The Netherlands
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Salehi-Vaziri M, Sadeghi F, Almasi Hashiani A, Gholami Fesharaki M, Alavian SM. Hepatitis B Virus Infection in the General Population of Iran: An Updated Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2016; 16:e35577. [PMID: 27257428 PMCID: PMC4888501 DOI: 10.5812/hepatmon.35577] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT The hepatitis B virus (HBV) is a major global public health problem, affecting more than 2 billion people worldwide. Accurate and updated data on HBV prevalence is important for further planning to control the infection. The aim of this study was to update the prevalence estimate of HBV infection in the general population of Iran. EVIDENCE ACQUISITION A systematic review was done for data on the prevalence of HBV infection in the general Iranian population published between Jan. 1, 1990, and Jan. 1, 2016, in both international and national databases, including PubMed, Scopus, Web of Science, Scientific Information Database, IranMedex, and Magiran. All papers with clearly described time and location of the study, proper sampling strategies, and proper analysis methods were included in the present study. Data were extracted by two independent reviewers. Prevalence of HBV infection with a 95% confidence interval (CI) was calculated using Stata software, version 13. RESULTS The polled estimated prevalence of HBV infection in the general population of Iran was 2.2 % (95% CI: 1.9% - 2.6%). The highest prevalence of HBV infection (8.9%, 95% CI: 7.6% - 10.2%) was reported from Golestan province, and the lowest prevalence (0.7%, 95% CI: 0.4% - 1.1%) was seen in Kermanshah province. The prevalence of HBV infection was estimated at 3% (95% CI: 2.2% - 3.8%) for Iranian males and 1.7% (95% CI: 1.2% - 2.3%) for Iranian females. The prevalence of HBV infection in the general population of Iran was 2.9% (95% CI: 2.5% - 3.4%) before 2010 and 1.3% (95% CI: 0.9% - 1.7%) after 2010. CONCLUSIONS In total, Iran was classified within the low-intermediate HBV prevalence areas (2% - 4%), while according to recent data (after 2010), Iran was classified within the low HBV prevalence areas (< 2%), indicating that preventive measures conducted in Iran have been effective.
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Affiliation(s)
- Mostafa Salehi-Vaziri
- Department of Arboviruses and Viral Hemorrhagic Fevers, Pasteur Institute of Iran, Tehran, IR Iran
| | - Farzin Sadeghi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran
| | - Amir Almasi Hashiani
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences Tehran, IR Iran. Tel/Fax: +98-2188945186, E-mail:
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Rezaee-Zavareh MS, Einollahi B. Hepatitis B vaccination: needs a revision. HEPATITIS MONTHLY 2014; 14:e17461. [PMID: 24734095 PMCID: PMC3984473 DOI: 10.5812/hepatmon.17461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Mohammad Saeid Rezaee-Zavareh
- Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Disease Center, Tehran, IR Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Behzad Einollahi, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2181262073, E-mail:
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Hayden CA, Smith EM, Turner DD, Keener TK, Wong JC, Walker JH, Tizard IR, Jimenez-Flores R, Howard JA. Supercritical fluid extraction provides an enhancement to the immune response for orally-delivered hepatitis B surface antigen. Vaccine 2014; 32:1240-6. [PMID: 24486361 DOI: 10.1016/j.vaccine.2014.01.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/27/2013] [Accepted: 01/14/2014] [Indexed: 01/27/2023]
Abstract
The hepatitis B virus continues to be a major pathogen worldwide despite the availability of an effective parenteral vaccine for over 20 years. Orally-delivered subunit vaccines produced in maize may help to alleviate the disease burden by providing a low-cost, heat-stable alternative to the parenteral vaccine. Oral subunit vaccination has been an elusive goal due to the large amounts of antigen required to induce an immunologic response when administered through the digestive tract. Here we show that high levels of HBsAg were obtained in maize grain, the grain was formed into edible wafers, and wafers were fed to mice at a concentration of approximately 300 μg/g. When these wafers were made with supercritical fluid extraction (SFE)-treated maize material, robust IgG and IgA responses in sera were observed that were comparable to the injected commercial vaccine (Recombivax(®)). In addition, all mice administered SFE wafers showed high secretory IgA titers in fecal material whereas Recombivax(®) treated mice showed no detectable titer. Increased salivary IgA titers were also detected in SFE-fed mice but not in Recombivax(®) treated mice. Wafers made from hexane-treated or full fat maize material induced immunologic responses, but fecal titers were attenuated relative to those produced by SFE-treated wafers. These responses demonstrate the feasibility of using a two-dose oral vaccine booster in the absence of an adjuvant to induce immunologic responses in both sera and at mucosal surfaces, and highlight the potential limitations of using an exclusively parenteral dosing regime.
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Affiliation(s)
- Celine A Hayden
- Applied Biotechnology Institute, Cal Poly Tech Park, San Luis Obispo, CA 93407, USA
| | - Emily M Smith
- Applied Biotechnology Institute, Cal Poly Tech Park, San Luis Obispo, CA 93407, USA
| | - Debra D Turner
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843, USA
| | - Todd K Keener
- Applied Biotechnology Institute, Cal Poly Tech Park, San Luis Obispo, CA 93407, USA
| | - Jeffrey C Wong
- Horticulture and Crop Science Department, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - John H Walker
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - Ian R Tizard
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843, USA
| | - Rafael Jimenez-Flores
- Dairy Product Technology Center, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - John A Howard
- Applied Biotechnology Institute, Cal Poly Tech Park, San Luis Obispo, CA 93407, USA.
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