Balancing Benefits and Harms of COVID-19 Vaccines: Lessons from the Ongoing Mass Vaccination Campaign in Lombardy, Italy

Background. Limited evidence exists on the balance between the benefits and harms of the COVID-19 vaccines. The aim of this study is to compare the benefits and safety of mRNA-based (Pfizer-BioNTech and Moderna) and adenovirus-vectored (Oxford-AstraZeneca) vaccines in subpopulations defined by age and sex. Methods. All citizens who are newly vaccinated from 27 December 2020 to 3 May 2021 are matched to unvaccinated controls according to age, sex, and vaccination date. Study outcomes include the events that are expected to be avoided by vaccination (i.e., hospitalization and death from COVID-19) and those that might be increased after vaccine inoculation (i.e., venous thromboembolism). The incidence rate ratios (IRR) of vaccinated and unvaccinated citizens are separately estimated within strata of sex, age category and vaccine type. When suitable, number needed to treat (NNT) and number needed to harm (NNH) are calculated to evaluate the balance between the benefits and harm of vaccines within each sex and age category. Results. In total, 2,351,883 citizens are included because they received at least one dose of vaccine (755,557 Oxford-AstraZeneca and 1,596,326 Pfizer/Moderna). A reduced incidence of COVID-19-related outcomes is observed with a lowered incidence rate ranging from 55% to 89% and NNT values ranging from 296 to 3977. Evidence of an augmented incidence of harm-related outcomes is observed only for women aged <50 years within 28 days after Oxford-AstraZeneca (being the corresponding adjusted IRR of 2.4, 95% CI 1.1−5.6, and NNH value of 23,207, 95% CI 10,274−89,707). Conclusions. A favourable balance between benefits and harms is observed in the current study, even among younger women who received Oxford-AstraZeneca.

Protective action of natural and induced immunization against the occurrence of delta or alpha variants of SARS-CoV-2 infection: a test-negative case-control study

BACKGROUND

The evolution of SARS-CoV-2 has led to the emergence of several new variants, and few data are available on the impact of vaccination on SARS-CoV-2 variants. We aimed to assess the association between natural (previous infection) and induced (partial or complete vaccination) exposure to SARS-CoV-2 and the onset of new infection supported by the delta variant, and of comparing it with that supported by alpha.

METHODS

We performed a test-negative case-control study, by linking population-based registries of confirmed diagnoses of infection with SARS-CoV-2, vaccinations against Covid-19 and healthcare utilization databases of the Italian Lombardy Region. Four hundred ninety-six persons who between 27 December 2020 and 16 July 2021 had an infection by the delta variant were 1:1 matched with citizens affected by alphavariant and 1:10 matched with persons who had a negative molecular test, according to gender, age and date of molecular ascertainment. We used a conditional logistic regression for estimating relative risk reduction of either variants associated with natural and/or induced immunization and corresponding 95% confidence interval (CI).

RESULTS

Previous infection was associated with 91% (95% CI 85% to 95%) reduced relative risk of reinfection, without evidence of significant differences between delta and alpha cases (p=0.547). Significant lower vaccinal protection against delta than alpha variant infection was observed with reduced relative risk associated with partial vaccination respectively of 29% (7% to 45%), and 62% (48% to 71%) (p=0.001), and with complete vaccination respectively of 75% (66% to 82%) and 90% (85% to 94%) (p=0.003).

CONCLUSIONS

Lower protection towards infections caused by the delta variant with respect to alpha variant was noticed, even after the completion of the vaccination cycle. This finding would support efforts to maximize both vaccine uptake with two doses and fulfilment with individual protection measures, especially as the delta variant is rampant worldwide presently.

Infectious diseases other than Covid-19 in 2020, a report from Lombardy Region

Background

Non pharmaceutical interventions (NPIs) put in place to reduce the spread of Sars-Cov-2 had an impact also on other infections. Aim of this research is to describe the incidence of other infections and vaccination coverage rate (VCR) in Lombardy region from 2018 to 2020.

Methods

We analysed data coming from the regional surveillance system of notifiable infectious diseases and vaccination registry from 2018 to 2020.

Results

13206 infectious diseases' cases were notified in 2020 compared to 36847 in 2019 and 42610 in 2018, this corresponding to, respectively, a 64.1% and 69% decrease. Some interesting data:

measles; 24 cases in 2020, 542 in 2019 and 220 in 2018, with an incidence rate (IR) per 100.000 respectively of 0,2; 5,4 and 2,2; chicken pox; 2357 cases in 2020, 13478 in 2019 and 19463 in 2018 (IR 23,5; 134,3; 193,9) tubercolosis; 586 in 2020, 857 in 2019 and 945 in 2018 (IR 5,8; 8,6; 9,4) invasive bacterial diseases; 378 in 2020, 890 in 2019 and 882 in 2018 (IR 3,7;8,8;8,7) infectious diarrhea; 2080 in 2020, 3716 in 2019 and 4347 in 2018 (IR 20,7; 37,1; 43,3) legionellosis cases; 806 in 2020, 1051 in 2019 and 1096 in 2018 (IR 8; 10,5; 10,9) arbovirus infections (chikunguya, dengue, west nile, zika) were 118, in 2020, 126 in 2019 and 8 in 2018 (IC 1,2; 1,3; 0,1)

In 2020 VCR at 24 months of age remained above 95% for hexavalent and measles-mumps-rubella vaccination while there was a decline for others vaccines.

Conclusions

During the COVID-19 outbreak in 2020 there was a decline in all notified infectious diseases compared to the previous years, likely due to massive NPIs adoption, as well as, possibly, to decreased access to care and preventive services that caused difficulties to the surveillance system to detect notifiable infectious diseases. VCRs were still high for most important vaccines while there was a decline for other vaccines as evidence of the impact of the pandemic on vaccination activities.

Key messages

NPIs had a deep impact on the reduction of airborne diseases. The decline for non-airborne infections is likely due to NPIs and limitations in the access to the healthcare system.

Comparison of Solid-Phase Extraction and Micro-Solid-Phase Extraction for Liquid Chromatography/Mass Spectrometry Analysis of Pesticides in Water Samples

Our recent on-line solid-phase extraction (SPE) device for micro-liquid chromatography, known as micro-solid-phase extraction (μSPE), was compared with traditional SPE for the analysis, from aqueous samples, of 4 pesticides belonging to different classes. Two different kinds of adsorbents, C18 and graphitized carbon black, were tested. A 2-stage ion trap mass spectrometer, equipped with homemade microflow electrospray ion (ESI) source, was used. Detection limits with a signal-to-noise ratio of 3:1 for both extraction methods were in the range of 0.1 μg/L for all compounds. However, better recoveries were obtained when μSPE traps were used.

Patient mobility for bone marrow transplant: the experience of the Perugia Hospital, years 2000-2013

INTRODUCTION

Patient mobility, driven by patient preference is an indirect indicator of perception of hospital quality. Patients' choices depend on their previous healthcare experiences, the reputation of the hospital staff and the network of relationships between the patient, hospital doctors, general practitioners/reference specialists, etc. Therefore, the analysis of patient preferences provides an idea of hospital quality as well as qualitative and quantitative lack of services. The aim of the present research was to describe and analyze patient mobility for bone marrow transplantation regarding the Hospital of Perugia, which represents the second most important structure for bone marrow transplant in Italy.

METHODS

Data have been collected from hospital discharge records in the ordinary regime related to the Diagnosis Related Group 481 "bone marrow transplant" since 2000 to 2013. We included autologous and allogenic transplant, in the adult and the child. Analysis of escaped, attracted and resident patients flows was undertaken using Gandy's nomogram which detects, through repeated time investigations, patients' movement inside and outside their catchment area.

RESULTS

Between 2000 and 2013, 1782 patients were admitted to hospital with a DRG 481 "bone marrow transplant". Nine hundred and nineteen (51,5%) were resident in Umbria region, 799 (44,8%) in other regions, 64 (0,3%) abroad. Escapes were 158. The high percentage of admissions represented by patients that live out of Umbria, shows a high attractive power of the hospital. For "distant regions" this situation was maintained from 2000 to 2003, with a mild decrease from 2004 and, from 2010, the situation is stable. Only for "bordering regions" the attraction, which was stable up to 2010, seems to decrease. Gandy's nomogram shows also that the hospital was able to satisfy the health needs of the Umbria residents between 2004 and 2009 with a reductions in the escapes; then, in the last four years there is an increase in Umbria residents who seek care outside the catchment area and, in the last two years a reduction in the attraction power also.

CONCLUSIONS

During the analyzed period of time, the Hospital of Perugia has been a choice for patients needing a bone marrow transplant. In the last period of the analysis it seems that patients preferences have changed. The increased availability of new hematologic centers explains two phenomena: on the one hand patients tend to not move for the examined DRG, so that there is a reduction in incoming patients from bordering regions; on the other hand the competition to attract patients from the catchment area leads to an increase in the quality of the service.

Direct-EI in LC-MS: towards a universal detector for small-molecule applications

This review article will give an up-to-date and exhaustive overview on the efficient use of electron ionization (EI) to couple liquid chromatography and mass spectrometry (LC-MS) with an innovative interface called Direct-EI. EI is based on the gas-phase ionization of the analytes, and it is suitable for many applications in a wide range of LC-amenable compounds. In addition, thanks to its operating principles, it prevents unwelcome matrix effects (ME). In fact, although atmospheric pressure ionization (API) methodologies have boosted the use of LC-MS, the related analytical methods are sometime affected by inaccurate quantitative results, due to unavoidable and unpredictable ME. In addition, API's soft ionization spectra always demand for costly and complex tandem mass spectrometry (MS/MS) instruments, which are essential to acquire an "information-rich" spectrum and to obtain accurate quantitative information. In EI a one-stage analyzer is sufficient for a qualitative investigation and MS/MS detection is only used to improve sensitivity and to cut chemical noise. The technology illustrated here provides a robust and straightforward access to classical, well-characterized EI data for a variety of LC applications, and readily interpretable spectra for a wide range of areas of research. The Direct-EI interface can represent the basis for a forthcoming universal LC-MS detector for small molecules.

Overcoming matrix effects in liquid chromatography-mass spectrometry

A major limitation in quantitative analysis with electrospray ionization mass spectrometry (ESI-MS) is represented by the so-called matrix effects in which the matrix coextracted with the analytes can alter the signal response, causing either suppression or enhancement, resulting in poor analytical accuracy, linearity, and reproducibility. In the direct electron ionization liquid chromatography-mass spectrometry (direct-EI LC-MS) interface the ionization process is based on electron impact ionization, and it occurs in the gas phase and is not influenced by coeluted matrix compounds. In this work we quantitatively evaluated matrix effects on enriched environmental and biological samples, with different extraction procedures, using ESI and direct-EI LC-MS. As expected, the samples analyzed with direct-EI were not affected by matrix composition, whereas with ESI we observed either signal suppression or enhancement, depending on the sample nature.

Organochlorine pesticides by LC-MS

Contamination of water resources by organochlorine pesticides (OCPs) continues to receive widespread attention because of the increasing concern regarding their high persistence and bioaccumulation. These organic pollutants are not amenable by liquid chromatography (LC) coupled to atmospheric pressure ionization-mass spectrometry, which represents the method of choice for the characterization of pesticide residues in water. Gas chromatography-mass spectrometry provides excellent response for OCPs, but it falls short when complex, multiresidue analyses are required. As recently demonstrated, an efficient EI-based LC-MS interface can generate very good spectra for an extremely wide range of small-medium molecular weight molecules of different polarity and can represent a valid tool in solving the analytical challenge of analyzing OCPs by LC-MS. Based on this assumption, we present a new approach for the determination of 12 OCPs in water samples. The method requires a solid-phase extraction preconcentration step followed by nanoscale liquid chromatography coupled to a direct-electron ionization direct interface (Direct-EI). Direct-EI is a miniaturized interface for efficiently coupling a liquid chromatograph with an EI mass spectrometer. The capability to acquire high-quality EI spectra in a wide range of concentrations, and to operate in selected ion monitoring mode during analyses, allowed a precise quantification of the OCPs. Without sample injection enrichment, limits of detection of the method span from 0.044 to 0.33 microg/L, corresponding to an instrumental detection limit of 120-850 pg. In addition, a careful evaluation of the matrix effect showed that the response of the Direct-EI interface was never affected by sample interferences. From our knowledge, the proposed method represents the first application of LC-MS in the analysis of organochlorine pesticides.

Application of nano-FIA-Direct-EI-MS to determine diethylene glycol in produced formation water discharges and seawater samples

Diethylene glycol (DEG) is extensively used on offshore gas platforms to prevent the hydrate formation during the gas-water separation process and to inhibit corrosion events. This chemical might enter in the marine environment via the produced formation water (PFW) discharge. In this study, a new approach was applied to the investigation of the DEG content in PFW discharges and seawater samples from four gas installation platforms in the Adriatic Sea (Italy). The method includes an off-line solid-phase extraction/pre-concentration technique, followed by a nanoscale flow injection/direct-electron ionization (EI) mass spectrometric analysis. Direct-EI is a novel and miniaturized interface for directly coupling a liquid chromatograph with an electron ionization mass spectrometer. The capability to acquire EI spectra, and to operate in selected ion monitoring mode during actual sample analyses, allowed a precise quantification of DEG with a method limit of detection of 31microg/l. In addition, a careful evaluation of the matrix effect showed that, as opposed to electrospray ionization, the response of the Direct-EI interface was not affected by sample interferences.

Study on the oligosaccharides composition of the water-soluble fraction of marine mucilage by electrospray tandem mass spectrometry

The massive accumulation of organic matter, which periodically occurs in the northern Adriatic Sea, and in other locations worldwide, is presently thought to be the results of the aggregation of dissolved organic matter (DOM) into particulate organic matter (POM). This phenomenon is the result of human activities and propitious weather conditions. Although many aspects of the phenomenon are well understood, the trigger mechanisms leading to mucilage formation have not been clarified yet, probably as a consequence of inadequate analytical approaches. In this context, the recent advancements in LC-MS interfacing might contribute in clarifying the mechanism of mucilage formation. In the present paper, hydrophilic interaction liquid chromatography coupled with electrospray tandem mass spectrometry (HILC-ESI-MS/MS) is proposed as an innovative method for the investigation of underivatized oligosaccharides in mucilage samples. Recent findings suggest that the significant presence of these compounds in seawater can play an important role in the initial steps of the agglomeration processes forming gelatinous material. Our results reveal the presence of several maltodextrines in the water-soluble fraction of mucilage macroaggregates, collected in various locations of the northern Adriatic Sea. In our knowledge, the proposed method is the first application of LC-MS in the investigation of marine mucilage.

Advanced Liquid Chromatography−Mass Spectrometry Interface Based on Electron Ionization

Major progress in interfacing liquid chromatography and electron ionization mass spectrometry is presented. The minimalism of the first prototype, called the Direct-EI interface, has been widely refined, improved, and applied to modern instrumentation. The simple interfacing principle is based on the straight connection between a nanoHPLC system and a mass spectrometer equipped with an EI source forming a solid and reliable unicum resembling the immediacy and straightforwardness of GC/MS. The interface shows a superior performance in the analysis of small-medium molecular weight compounds, especially when compared to its predecessors, and a unique trait that excels particularly in the following aspects: (1) It delivers high-quality, fully library matchable mass spectra of most sub-1 kDa molecules amenable by HPLC. (2) It is a chemical ionization free interface (unless operated intentionally) with accurate reproduction of the expected isotope ion abundances. (3) Response is never influenced by matrix components in the sample or in the mobile phase (nonvolatile salts are also well accepted). A deep evaluation of these aspects is presented and discussed in detail. Other characteristics of the interface performance such as limits of detections, range of linear response, and intra- and interday signal stability were also considered. The usefulness of the interface has been tested in a few real-world applications where matrix components played a detrimental role with other LC/MS techniques.

Fate of enrofloxacin in swine sewage

The fate of enrofloxacin present in raw sewage at a swine-breeding facility was investigated by liquid-liquid extraction and reversed-phase liquid chromatography with photodiode array detection. Samples were collected in the storage pits of each pigsty and in a nonaerated lagoon used to stock the sewage. In the pigsties, the sewage was mixed with 10% olive oil groundwater, following a certified procedure (cod. Cer 020301) which reduces the bad odors and produces a better manure. This sewage treatment for 8 months in the lagoon dramatically reduced the amount of enrofloxacin to levels under the detection limit of 0.6 microg.L(-)(1). The results stress the importance of correct sludge management in limiting the impact of enrofloxacin in the environment.

Comparison of solid-phase extraction and micro-solid-phase extraction for liquid chromatography/mass spectrometry analysis of pesticides in water samples

Our recent on-line solid-phase extraction (SPE) device for micro-liquid chromatography, known as micro-solid-phase extraction (microSPE), was compared with traditional SPE for the analysis, from aqueous samples, of 4 pesticides belonging to different classes. Two different kinds of adsorbents, C18 and graphitized carbon black, were tested. A 2-stage ion trap mass spectrometer, equipped with homemade microflow electrospray ion (ESI) source, was used. Detection limits with a signal-to-noise ratio of 3:1 for both extraction methods were in the range of 0.1 microg/L for all compounds. However, better recoveries were obtained when microSPE traps were used.

Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid-induced osteoporosis: results of a randomized controlled clinical trial

Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis. In this 24-month study, we report changes in bone turnover and bone mass after 12 months of daily injections of human parathyroid hormone 1-34 [hPTH(1-34)] and 12 months off treatment in postmenopausal women (mean age, 63 years) with osteoporosis treated with glucocorticoid and hormone replacement therapy. Response to the treatment was assessed with bone mineral density (BMD) measurements of the lumbar spine by quantitative computed tomography (QCT); BMD measurements of the lumbar spine, hip, and forearm by dual-energy X-ray absorptiometry (DXA); and biochemical markers of bone turnover. The mean (+/-SEM) change in BMD of the lumbar spine by QCT and DXA in the PTH group at 24 months was 45.9+/-6.4% and 12.6+/-2.2% (p < 0.001). The change in total hip and femoral neck BMD was not significant at 12 months but increased to 4.7+/-0.9% (p < 0.01) and 5.2+/-1.3% at 24 months, respectively, as compared with a relatively small change of 1.3+/-0.9% and 2.6+/-1.7% in the estrogen-only group. The mean percent differences in BMD of the lumbar spine by QCT and DXA between the groups at 24 months were 43.1% and 11.9%, respectively (p < 0.001). The mean percent differences over the estrogen-only group in hip BMD were 3.4% for total hip (p < 0.01) and 2.6% for femoral neck at 24 months. Biochemical markers of bone turnover increased to more than 150% during the first 6 months of therapy, remained elevated throughout the 12-month treatment period, and returned to baseline values within 6 months of discontinuing the PTH treatment. These results suggest that PTH dramatically increases bone mass in the lumbar spine and hip in postmenopausal women with glucocorticoid-induced osteoporosis who are taking hormone replacement therapy. However, the maximum effect of this anabolic agent on bone mass at the hip after 12 months of treatment requires at least 6-12 months after the PTH treatment is discontinued.

Evaluation of a dual-sorbent trap for monitoring organic compounds in air

The performance of a new kind of multi-sorbent trap for use in the simultaneous determination of compounds of different volatility and polarity was investigated. The adsorbents employed for this purpose were Carbograph 2 and Carbograph 5. The performance of this trap was evaluated in terms of thermal desorption and solvent extraction recoveries of substances belonging to the main classes of organic compounds, at different amounts and volumes of air sampled corresponding to concentrations ranging from 0.1 to 1000 mg/m3. The tubes examined allowed the trapping of the compounds used and their complete desorption with the procedure best suited to the analytical problem.

Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial

Corticosteroid-induced osteoporosis is the most common secondary cause of osteoporosis. We conducted a 12-mo, randomized clinical trial of human parathyroid hormone 1-34 (hPTH 1-34) in postmenopausal women (mean age was 63 yr) with osteoporosis who were taking corticosteroids and hormone replacement therapy. Response to the treatment was assessed with bone mineral density (BMD) measurements of the lumbar spine by quantitative computed tomography (QCT); BMD measurements of the lumbar spine, hip, and forearm by dual-energy x-ray absorptiometry (DXA); and biochemical markers of bone turnover. The mean (+/-SE) changes in BMD of the lumbar spine by QCT and DXA in the PTH group were 35+/-5.5% and 11+/-1.4%, respectively, compared with a relatively small change of 1.7+/-1.8% and 0+/-0.9% in the estrogen-only group. The differences in mean percentage between the groups at 1 yr were 33.5% for the lumbar spine by QCT (P < 0.001) and 9.8% for the lumbar spine by DXA (P < 0.001). The changes in the hip and forearm were not significantly different between or within the groups. During the first 3 mo of PTH treatment, markers of bone formation increased to nearly 150%, whereas markers of bone resorption increased only 100%, suggesting an early uncoupling of bone turnover in favor of formation. These results suggest that parathyroid hormone dramatically increases bone mass in the central skeleton of postmenopausal women with corticosteroid- induced osteoporosis who are taking hormone replacement.