1
|
Suari Y, Topaz T, Bassa O, Gilboa M, Sedaka H, Sade T, Chefetz B, Yahel G. Nutrient concentration, loads and retention in a semiarid micro-estuary: The relative contribution of baseflow and flood events. Sci Total Environ 2024; 931:172805. [PMID: 38692314 DOI: 10.1016/j.scitotenv.2024.172805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
Estuaries are a significant source of nutrients to the marine environment. The magnitude of this source is a function of nutrients load reaching the estuary and removal (attenuation) within estuaries. Most estuarine research is conducted in large estuaries, which do not reflect the processes in small estuaries in urban and semi-arid regions where flood water is a substantial portion of the annual discharge and the estuarine baseflow is often low and dominated by wastewater. To improve the understanding of nutrient attenuation and load into the Mediterranean, we conducted high-resolution nutrient sampling in the eutrophic Alexander micro-estuary as a test case. We sampled once per month during baseflows (years 2014-2019) and hourly during floods (years 2016-2018). The concentrations of inorganic nutrients (phosphorous (P) and nitrogen (N)) were extremely high during baseflows. Dissolved ammonium and particulate P were the only nutrients that were in the estuary (by 55 % and 30 %, respectively). Floods were rare, occurring ~4 % of the time, but contributed 62 % of the annual water discharge of the Alexander micro-estuary (14.7 ± 3.8 106 m3 y-1). The concentration of all dissolved nutrients decreased during floods but was higher than expected (DIN 584 ± 50 μmol L-1, phosphate 21 ± 2 μmol L-1), accounting for 42 % and 55 % of the overall annual DIN (123.5 ± 44.9-ton yr-1) and P (6.7 ± 1.9 ton yr-1) loads to sea, respectively. The N:P ratios were 16 and 34 during baseflow and flood events, respectively. Previously, nutrient loads were calculated by multiplying baseflow-measured concentrations by the total water volume of baseflow and floods. Our calculations, based on high-resolution sampling, revealed lower annual loads of P and N to the sea that were 56 % and 89 % of previous estimates, which is a considerable difference in an oligotrophic system such as the eastern Mediterranean.
Collapse
Affiliation(s)
- Y Suari
- Ruppin Academic Center, School of Marine Sciences, Israel.
| | - T Topaz
- Ruppin Academic Center, School of Marine Sciences, Israel
| | - O Bassa
- Ruppin Academic Center, School of Marine Sciences, Israel; Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 7610001, Israel
| | - M Gilboa
- Ruppin Academic Center, School of Marine Sciences, Israel
| | - H Sedaka
- Ruppin Academic Center, School of Marine Sciences, Israel
| | - T Sade
- Ruppin Academic Center, School of Marine Sciences, Israel
| | - B Chefetz
- Ruppin Academic Center, School of Marine Sciences, Israel; Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 7610001, Israel
| | - G Yahel
- Ruppin Academic Center, School of Marine Sciences, Israel
| |
Collapse
|
2
|
Peretz-Machluf R, Gilboa M, Bookstein-Peretz S, Segal O, Regev N, Meyer R, Regev-Yochay G, Yinon Y, Toussia-Cohen S. Obstetric and Early Neonatal Outcomes Following Second and Third COVID-19 Vaccination in Pregnancy. Isr Med Assoc J 2024; 26:12-17. [PMID: 38420636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Pregnant women are at higher risk for severe coronavirus disease 2019 (COVID-19). Since the release of the BNT162b2 messenger RNA vaccine (Pfizer/BioNTech), there has been accumulated data about the three vaccine doses. However, information regarding obstetric and neonatal outcomes of pregnant women vaccinated with the third (booster) vaccine is limited and primarily retrospective. OBJECTIVES To evaluate the obstetric and early neonatal outcomes of pregnant women vaccinated during pregnancy with the COVID-19 booster vaccine compared to pregnant women vaccinated only by the first two doses. METHODS We conducted a cross-sectional study of pregnant women who received the BNT162b2 vaccine during pregnancy. Obstetric and neonatal outcomes were compared between pregnant women who received only the first two doses of the vaccine to those who also received the booster dose. RESULTS Overall, 139 pregnant women were vaccinated during pregnancy with the first two doses of the vaccine and 84 with the third dose. The third dose group received the vaccine earlier during their pregnancy compared to the two doses group (212 vs. 315 weeks, respectively, P < 0.001). No differences in obstetric and early neonatal outcomes between the groups were found except for lower rates of urgent cesarean delivery in the third dose group (adjusted odds ratio 0.21; 95% confidence interval 0.048-0.926, P = 0.039). CONCLUSIONS Compared to the first two doses of the BNT162b2 vaccine given in pregnancy, the booster vaccination is safe and not associated with an increased rate of adverse obstetric and early neonatal outcomes.
Collapse
Affiliation(s)
- Ravit Peretz-Machluf
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mayan Gilboa
- Department of Infection Prevention and Control, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiran Bookstein-Peretz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Segal
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Regev
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Regev-Yochay
- Department of Infection Prevention and Control, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Toussia-Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Gilboa M, Baharav N, Melzer E, Regev-Yochay G, Yahav D. Screening for Asymptomatic Clostridioides difficile Carriage Among Hospitalized Patients: A Narrative Review. Infect Dis Ther 2023; 12:2223-2240. [PMID: 37704801 PMCID: PMC10581986 DOI: 10.1007/s40121-023-00856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
Clostridioides difficile infection (CDI) has become the most common healthcare-associated infection in the United States, with considerable morbidity, mortality, and healthcare costs. Assessing new preventive strategies is vital. We present a literature review of studies evaluating a strategy of screening and isolation of asymptomatic carriers in hospital settings. Asymptomatic detection of C. difficile is reported in ~ 10-20% of admitted patients. Risk factors for carriage include recent hospitalization, previous antibiotics, older age, lower functional capacity, immunosuppression, and others. Asymptomatic C. difficile carriers of toxigenic strains are at higher risk for progression to CDI. They are also shedders of C. difficile spores and may contribute to the persistence and transmission of this bacterium. Screening for asymptomatic carriers at hospital admission can theoretically reduce CDI by isolating carriers to reduce transmission, and implementing antibiotic stewardship measures targeting carriers to prevent progression to clinical illness. Several observational studies, summarized in this review, have reported implementing screening and isolation strategies, and found a reduction in CDI rates. Nevertheless, the data are still limited to a few observational studies, and this strategy is not commonly practiced. Studies supporting screening were performed in North America, coinciding with the period of dominance of the 027/BI/NAP1 strain. Additional studies evaluating screening, followed by infection control and antibiotic stewardship measures, are needed.
Collapse
Affiliation(s)
- Mayan Gilboa
- Infection Prevention Unit, Sheba Medical Center, Ramat-Gan, Israel.
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel.
| | - Nadav Baharav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Eyal Melzer
- Infection Prevention Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Gili Regev-Yochay
- Infection Prevention Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Dafna Yahav
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| |
Collapse
|
4
|
Gilboa M, van Duin D, Yahav D. Which trial do we need? How to treat Pseudomonas aeruginosa bacteraemia-proposal for an umbrella randomized controlled trial. Clin Microbiol Infect 2023; 29:829-831. [PMID: 37004748 DOI: 10.1016/j.cmi.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/12/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Mayan Gilboa
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Israel
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Israel.
| |
Collapse
|
5
|
Gilboa M, Gonen T, Barda N, Cohn S, Indenbaum V, Weiss-Ottolenghi Y, Amit S, Asraf K, Joseph G, Levin T, Kanaaneh Y, Aydenzon A, Canetti M, Freedman L, Zuckerman N, Mendelson E, Doolman R, Kreiss Y, Regev-Yochay G, Lustig Y. Factors Associated With Protection From SARS-CoV-2 Omicron Variant Infection and Disease Among Vaccinated Health Care Workers in Israel. JAMA Netw Open 2023; 6:e2314757. [PMID: 37219906 DOI: 10.1001/jamanetworkopen.2023.14757] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Importance A correlation between antibody levels and risk of infection has been demonstrated for the wild-type, Alpha, and Delta SARS-COV-2 variants. High rates of breakthrough infections by the Omicron variant emphasized the need to investigate whether the humoral response elicited by mRNA vaccines is also associated with reduced risk of Omicron infection and disease. Objective To investigate whether the high antibody levels in individuals who have received at least 3 doses of an mRNA vaccine are associated with reduced risk of Omicron infection and disease. Design, Setting, and Participants This prospective cohort study used serial real time-polymerase chain reaction (RT-PCR) and serological test data from January and May 2022 to assess the association of preinfection immunoglobin G (IgG) and neutralizing antibody titers with incidence of Omicron variant infection, incidence of symptomatic disease, and infectivity. Participants included health care workers who had received 3 or 4 doses of an mRNA COVID-19 vaccine. Data were analyzed from May to August 2022. Exposures Levels of SARS-CoV-2 anti-receptor binding domain IgG and neutralizing antibodies. Main Outcomes and Measures The main outcomes were incidence of Omicron infection, incidence of symptomatic disease, and infectivity. Outcomes were measured using SARS-COV-2 PCR and antigen testing and daily online surveys regarding symptomatic disease. Results This study included 3 cohorts for 3 different analyses: 2310 participants were included in the protection from infection analysis (4689 exposure events; median [IQR] age, 50 [40-60] years; 3590 [76.6%] among female health care workers), 667 participants (median [IQR] age, 46.28 (37.44,54.8); 516 [77.4%] female) in the symptomatic disease analysis, and 532 participants (median [IQR] age, 48 [39-56] years; 403 [75.8%] female) in the infectivity analysis. Lower odds of infection were observed for each 10-fold increase in preinfection IgG (odds ratio [OR], 0.71; 95% CI, 0.56-0.90) and for each 2-fold increase in neutralizing antibody titers (OR, 0.89; 95% CI, 0.83-0.95). The odds of substantial symptomatic disease were reduced for each 10-fold increase in IgG levels (OR, 0.48; 95% CI, 0.29-0.78) and for each 2-fold increase in neutralizing antibodies levels (OR, 0.86; 95% CI, 0.76-0.96). Infectivity, assessed by mean cycle threshold value, was not significantly decreased with increasing IgG or neutralizing antibodies titers. Conclusions and Relevance In this cohort study of vaccinated health care workers, IgG and neutralizing antibody titer levels were associated with protection against infection with the Omicron variant and against symptomatic disease.
Collapse
Affiliation(s)
- Mayan Gilboa
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tal Gonen
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Barda
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Shelly Cohn
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Ramat-Gan, Israel
| | - Gili Joseph
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Tal Levin
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Yara Kanaaneh
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Alex Aydenzon
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Canetti
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Laurence Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Ram Doolman
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Ramat-Gan, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Ramat Gan, Israel
| | - Gili Regev-Yochay
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
6
|
Canetti M, Barda N, Gilboa M, Indenbaum V, Mandelboim M, Gonen T, Asraf K, Weiss-Ottolenghi Y, Amit S, Doolman R, Mendelson E, Harats D, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Author Correction: Immunogenicity and efficacy of fourth BNT162b2 and mRNA1273 COVID-19 vaccine doses; three months follow-up. Nat Commun 2023; 14:1593. [PMID: 36949080 PMCID: PMC10032242 DOI: 10.1038/s41467-023-37338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
- Michal Canetti
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Mayan Gilboa
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Victoria Indenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Tal Gonen
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Dror Harats
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gili Regev-Yochay
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| |
Collapse
|
7
|
Regev-Yochay G, Lustig Y, Joseph G, Gilboa M, Barda N, Gens I, Indenbaum V, Halpern O, Katz-Likvornik S, Levin T, Kanaaneh Y, Asraf K, Amit S, Rubin C, Ziv A, Koren R, Mandelboim M, Tokayer NH, Meltzer L, Doolman R, Mendelson E, Alroy-Preis S, Kreiss Y. Correlates of protection against COVID-19 infection and intensity of symptomatic disease in vaccinated individuals exposed to SARS-CoV-2 in households in Israel (ICoFS): a prospective cohort study. Lancet Microbe 2023; 4:e309-e318. [PMID: 36963419 PMCID: PMC10030121 DOI: 10.1016/s2666-5247(23)00012-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Identifying COVID-19 correlates of protection and immunity thresholds is important for policy makers and vaccine development. We aimed to identify correlates of protection of BNT162b2 (Pfizer-BioNTech) vaccination against COVID-19. METHODS In this prospective cohort study, households within a radius of 40 km of the Sheba Medical Center in Israel in which a new SARS-CoV-2 infection (defined as the index case) was detected within the previous 24 h were approached between July 25 and Nov 15, 2021. We included adults (aged >18 years) who had received one or two vaccine doses, had an initial negative SARS-CoV-2 PCR and no previous infection reported, and had a valid IgG and neutralising antibody result. The exposure of interest was baseline immune status, including IgG antibody concentration, neutralising antibody titre, and T-cell activation. The outcomes of interest were PCR-positive SARS-CoV-2 infection between day 2 and day 21 of follow-up and intensity of disease symptoms (self-reported via a telephone questionnaire) among participants who had a confirmed infection. Multivariable logistic and ordered logit ordinal regressions were used for the adjusted analysis. To identify immunological thresholds for clinical protection, we estimated the conditional probability of infection and moderate or severe disease for individuals with pre-exposure IgG and neutralising antibody concentrations above each value observed in the study data. FINDINGS From 16 675 detected index cases in the study region, 5718 household members agreed to participate, 1461 of whom were eligible to be included in our study. 333 (22·8%) of 1461 household members who were not infected with SARS-CoV-2 at baseline were infected within 21 days of follow-up. The baseline (pre-exposure) IgG and neutralising antibodies were higher in participants who remained uninfected than in those who became infected (geometric mean IgG antibody concentration 168·2 binding antibody units [BAU] per mL [95% CI 158·3-178·7] vs 130·5 BAU/mL [118·3-143·8] and geometric mean neutralising antibody titre 197·5 [181·9-214·4] vs 136 ·7 [120·3-155·4]). Increasing IgG and neutralising antibody concentrations were also significantly associated with a reduced probability of increasing disease severity. Odds of infection were significantly reduced each time baseline IgG antibody concentration increased by a factor of ten (odds ratio [OR] 0·43 [95% CI 0·26-0·70]) and each time baseline neutralising antibody titre increased by a factor of two (0·82 [0·74-0·92]). In our cohort, the probability of infection if IgG antibody concentrations were higher than 500 BAU/mL was 11% and the probability of moderate disease severity was 1%; the probability of infection if neutralising antibody titres were above or equal to 1024 was 8% and the probability of moderate disease severity was 2%. T-cell activation rates were not significantly associated with reduced probability of infection (OR 1·04, 95% CI 0·83-1·30). INTERPRETATION Both IgG and neutralising antibodies are correlates of protection against SARS-CoV-2 infection. Our data suggest that IgG concentrations higher than 500 BAU/mL and neutralising antibody titres of 1024 or more are thresholds for immunological protection from SARS-CoV-2 delta variant infection. Potentially, updated protective thresholds against emerging variants of concern could be calculated, which could support decision makers on administration of new vaccination strategies and on the optimal period between vaccine doses. FUNDING Israeli Ministry of Health.
Collapse
Affiliation(s)
- Gili Regev-Yochay
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Gili Joseph
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Mayan Gilboa
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel; Department of Software and Information Systems Engineering, and Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ilana Gens
- Public Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Osnat Halpern
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Shiri Katz-Likvornik
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Tal Levin
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Yara Kanaaneh
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel; Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
| | - Carmit Rubin
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Arnona Ziv
- Data Management Unit, Gerner Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Ravit Koren
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Noam H Tokayer
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Lilac Meltzer
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Ram Doolman
- Data Management Unit, Gerner Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | | | - Yitshak Kreiss
- General Management, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Meltzer L, Amit S, Gilboa M, Tal I, Mechnik B, Irony A, Engelrad H, Epstein A, Frenkel-Nir Y, Levy Y, Kreiss Y, Regev-Yochay G. The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool. Microorganisms 2023; 11:microorganisms11020284. [PMID: 36838249 PMCID: PMC9961521 DOI: 10.3390/microorganisms11020284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
The emergency department (ED) is the initial point of contact between hospital staff and patients potentially infected with SARS-CoV-2, thus, prevention of inadvertent exposure to other patients is a top priority. We aimed to assess whether the introduction of antigen-detecting rapid diagnostic tests (Ag-RDTs) to the ED affected the likelihood of unwanted SARS-CoV-2 exposures. In this retrospective single-center study, we compared the rate of unwarranted exposure of uninfected adult ED patients to SARS-CoV-2 during two separate research periods; one before Ag-RDTs were introduced, and one with Ag-RDT used as a decision-support tool. The introduction of Ag-RDTs to the ED significantly decreased the relative risk of SARS-CoV-2-negative patients being incorrectly assigned to the COVID-19 designated site ("red ED"), by 97%. There was no increase in the risk of SARS-CoV-2-positive patients incorrectly assigned to the COVID-19-free site ("green ED"). In addition, duration of ED admission was reduced in both the red and the green ED. Therefore, implementing the Ag-RDT-based triage protocol proved beneficial in preventing potential COVID-19 nosocomial transmission.
Collapse
Affiliation(s)
- Lilac Meltzer
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Mayan Gilboa
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilana Tal
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Bella Mechnik
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Avi Irony
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Emergency Department, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Hindi Engelrad
- Emergency Department, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Avi Epstein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Emergency Department, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yael Frenkel-Nir
- The General Management, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yuval Levy
- The General Management, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The General Management, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Gili Regev-Yochay
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +97-25-2666-6197
| |
Collapse
|
9
|
Canetti M, Barda N, Gilboa M, Indenbaum V, Mandelboim M, Gonen T, Asraf K, Weiss-Ottolenghi Y, Amit S, Doolman R, Mendelson E, Harats D, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Immunogenicity and efficacy of fourth BNT162b2 and mRNA1273 COVID-19 vaccine doses; three months follow-up. Nat Commun 2022; 13:7711. [PMID: 36513665 PMCID: PMC9745767 DOI: 10.1038/s41467-022-35480-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Booster doses for the ongoing COVID-19 pandemic are under consideration in many countries. We report a three-month follow-up of 700 participants in a fourth vaccine dose study, comparing BNT162b2 and mRNA1273, administered four months after a third BNT162b2 dose. The primary outcomes are the levels of IgG, neutralizing antibodies, and microneutralization and the secondary outcomes are the levels of IgA and T cell activation, and clinical outcomes of SARS-CoV-2 infection and substantial symptomatic disease. Waning of the immune response is evident during follow-up, with an 11% (β = 0.89, 95% CI, 0.88-0.9) and 21% (β = 0.79, 95% CI, 0.76-0.82) multiplicative decay per week of IgG and neutralizing antibodies, respectively, in the mRNA1273 group, and of 14% (β = 0.86, 95% CI, 0.86-0.87) and 26% (β = 0.74, 95% CI, 0.72-0.76), respectively, in the BNT162b2 group. Direct neutralization of Omicron variants is low relative to ancestral strains. Cumulatively over the study period, both vaccines show little efficacy against infection but were highly efficacious against substantial symptomatic disease [89% [(IRR 0.11, 95% CI, 0.02-0.37) and 71% (IRR 0.29, 95% CI, 0.13-0.57) for mRNA1273 and BNT162b2, respectively]. These results are informative for further boosting policy-making. Trial registration numbers (clinicaltrials.gov): NCT05231005 and NCT05230953.
Collapse
Affiliation(s)
- Michal Canetti
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Mayan Gilboa
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Victoria Indenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Tal Gonen
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Dror Harats
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gili Regev-Yochay
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| |
Collapse
|
10
|
Canetti M, Barda N, Gilboa M, Indenbaum V, Asraf K, Gonen T, Weiss-Ottolenghi Y, Amit S, Doolman R, Mendelson E, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Six-Month Follow-up after a Fourth BNT162b2 Vaccine Dose. N Engl J Med 2022; 387:2092-2094. [PMID: 36351266 PMCID: PMC9730934 DOI: 10.1056/nejmc2211283] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Noam Barda
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Mayan Gilboa
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | - Keren Asraf
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Tal Gonen
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | - Sharon Amit
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | | | | | | | | |
Collapse
|
11
|
Joseph G, Klein E, Lustig Y, Weiss-Ottolenghi Y, Asraf K, Indenbaum V, Amit S, Kriger O, Gilboa M, Levy Y, Pessach IM, Kreiss Y, Regev-Yochay G, Stein M. Real-World Immunogenicity and Reactogenicity of Two Doses of Pfizer-BioNTech COVID-19 Vaccination in Children Aged 5-11 Years. Vaccines (Basel) 2022; 10:1954. [PMID: 36423049 PMCID: PMC9693260 DOI: 10.3390/vaccines10111954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 07/30/2023] Open
Abstract
There are limited data concerning the immunogenicity and reactogenicity of COVID-19 vaccines in children. A total of 110 children, 5-11 years old were vaccinated with two doses (with a 3-week interval between doses) of the Pfizer-BioNTech COVID-19 vaccine and were followed for 21, 90, and 180 days after vaccination for immunogenicity, adverse events, and breakthrough infections. Ninety days after the first vaccine dose, the GeoMean (CI 95%) of IgG ascended to 1291.0 BAU (929.6-1790.2) for uninfected children and 1670.0 BAU (1131.0-2466.0) for Infected children. One hundred and eighty days after receiving the first dose of the vaccine, the titers decreased to 535.5 BAU (288.4-993.6) for the uninfected children, while only a small decline was detected among infected children-1479.0 (878.2-2490.0). The neutralizing antibodies titer almost did not change over time in the uninfected children, and even elevated for the infected children. Of the 110 vaccinated children, 75.5% were infected, with only mild COVID-19 infection symptoms. Child vaccination was found to be safe, with mild, mostly local, and of short duration, reported AEs. No serious adverse events (SAEs) were reported after vaccination. The durability of two doses of vaccine in children is longer, thus a booster may not be needed as early as in adults.
Collapse
Affiliation(s)
- Gili Joseph
- The Sheba Pandemic Preparedness Research Institute (SPRI), and Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Elisheva Klein
- The Sheba Pandemic Preparedness Research Institute (SPRI), and Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Yael Weiss-Ottolenghi
- The Sheba Pandemic Preparedness Research Institute (SPRI), and Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Or Kriger
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Mayan Gilboa
- The Sheba Pandemic Preparedness Research Institute (SPRI), and Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Yuval Levy
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Itai M. Pessach
- Pediatric Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Gili Regev-Yochay
- The Sheba Pandemic Preparedness Research Institute (SPRI), and Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Michal Stein
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Pediatric Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| |
Collapse
|
12
|
Barda N, Canetti M, Gilboa M, Asraf K, Indenboim V, Weiss-Ottolenghi Y, Amit S, Zubli D, Doolman R, Mendelson E, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. The Association Between Pre-Booster Vaccination Antibody Levels and the Risk of SARS-CoV-2 Infection. Clin Infect Dis 2022; 76:1315-1317. [PMID: 36366729 DOI: 10.1093/cid/ciac886] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The correlation between Anti-SARS-CoV-2 antibody levels and infection was reported. Here, we estimated the role of pre-fourth-dose levels using data from 1,098 health-care-workers. The risk of infection was reduced by 46% (95% CI: 29-59%) with a 10-fold increase in pre-booster levels. Pre-booster antibody levels could be used to optimally time boosters.
Collapse
Affiliation(s)
- Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be’er Sheva , Israel
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Michal Canetti
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Mayan Gilboa
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan , Israel
| | - Victoria Indenboim
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health , Tel-Hashomer, Ramat Gan , Israel
| | - Yael Weiss-Ottolenghi
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Daniel Zubli
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health , Tel-Hashomer, Ramat Gan , Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan , Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research , Sheba Medical Center, Tel Hashomer , Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- General Management , Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health , Tel-Hashomer, Ramat Gan , Israel
| | - Gili Regev-Yochay
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| |
Collapse
|
13
|
Barda N, Canetti M, Gilboa M, Indenboim V, Asraf K, Weiss-Ottolenghi Y, Amit S, Zibly D, Doolman R, Mendelson E, Harats D, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Comparing immunogenicity and efficacy of two different mRNA-based COVID-19 vaccines as a fourth dose; six-month follow-up, Israel, 27 December 2021 to 24 July 2022. Euro Surveill 2022; 27:2200701. [PMID: 36177870 PMCID: PMC9524052 DOI: 10.2807/1560-7917.es.2022.27.39.2200701] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 06/01/2023] Open
Abstract
We assess the immunogenicity and efficacy of Spikevax and Comirnaty as fourth dose COVID-19 vaccines. Six months post-fourth-dose, IgG levels were higher than pre-fourth dose at 1.58-fold (95% CI: 1.27-1.97) in Spikevax and 1.16-fold (95% CI: 0.98-1.37) in Comirnaty vaccinees. Nearly 60% (159/274) of vaccinees contracted SARS-CoV-2. Infection hazard ratios (HRs) for Spikevax (0.82; 95% CI: 0.62-1.09) and Comirnaty (0.86; 95% CI: 0.65-1.13) vaccinees were similar, as were substantial-disease HRs, i.e. 0.28 (95% CI: 0.13-0.62) and 0.51 (95% CI: 0.27-0.96), respectively.
Collapse
Affiliation(s)
- Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Michal Canetti
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mayan Gilboa
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Victoria Indenboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Daniel Zibly
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Dror Harats
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Gili Regev-Yochay
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Gilboa M, Regev-Yochay G, Mandelboim M, Indenbaum V, Asraf K, Fluss R, Amit S, Mendelson E, Doolman R, Afek A, Freedman LS, Kreiss Y, Lustig Y. Durability of Immune Response After COVID-19 Booster Vaccination and Association With COVID-19 Omicron Infection. JAMA Netw Open 2022; 5:e2231778. [PMID: 36107426 PMCID: PMC9478782 DOI: 10.1001/jamanetworkopen.2022.31778] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE The BNT162b2 two-dose vaccine (BioNTech/Pfizer) has high effectiveness that wanes within several months. The third dose is effective in mounting a significant immune response, but its durability is unknown. OBJECTIVE To compare antibody waning after second and third doses and estimate the association of antibody kinetics with susceptibility to infection with the Omicron variant of SARS-CoV-2. DESIGN, SETTING, AND PARTICIPANTS In a prospective longitudinal cohort study in a tertiary medical center in Israel, health care workers who received the BNT162b2 vaccine were followed up monthly for IgG and neutralizing antibody levels. Linear mixed models were used to compare antibody titer waning of second and third doses and to assess whether antibody dynamics were associated with Omicron transmission. Avidity, T cell activation, and microneutralization of sera against different variants of concern were assessed for a subgroup. EXPOSURE Vaccination with a booster dose of the BNT162b2 vaccine. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of antibody titer change over time, and the secondary outcome was SARS-CoV-2 Omicron variant infection, as confirmed by reverse transcriptase-polymerase chain reaction. RESULTS Overall, 4868 health care workers (mean [SD] age, 46.9 [13.7] years; 3558 [73.1%] women) and 3972 health care workers (mean [SD] age, 48.5 [14.1] years; 996 [74.9%] women) were followed up for 5 months after their second and third vaccine doses, respectively. Waning of IgG levels was slower after the third compared with the second dose (1.32%/d [95% CI, 1,29%/d to 1.36%/d] vs 2.26% [95% CI, 2.13%/d 2.38%/d]), as was waning of neutralizing antibody levels (1.32%/d [95% CI, 1.21%/d to 1.43%/d] vs 3.34%/d [95% CI, 3.11%/d to 3.58%/d]). Among 2865 health care workers assessed for Omicron incidence during an additional 2 months of follow-up, lower IgG peak (ratio of means 0.86 [95% CI, 0.80-0.91]) was associated with Omicron infection, and among participants aged 65 years and older, faster waning of IgG and neutralizing antibodies (ratio of mean rates, 1.40; [95% CI, 1.13-1.68] and 3.58 [95% CI, 1.92-6.67], respectively) were associated with Omicron infection. No waning in IgG avidity was observed 112 days after the third dose. Live neutralization of Omicron was lower compared with previous strains, with a geometric mean titer at the peak of 111 (95% CI, 75-166), compared with 942 (95% CI, 585-1518) for WT, 410 (95% CI, 266-634) for Delta; it demonstrated similar waning to 26 (95% CI, 16-42) within 4 months. Among 77 participants tested for T cell activity, mean (SD) T cell activity decreased from 98 (5.4) T cells/106 peripheral blood mononuclear cells to 59 (9.3) T cells/106 peripheral blood mononuclear cells. CONCLUSIONS AND RELEVANCE This study found that the third vaccine dose was associated with greater durability than the second dose; however, Omicron was associated with greater resistance to neutralization than wild type and Delta variants of concern. Humoral response dynamics were associated with susceptibility to Omicron infection.
Collapse
Affiliation(s)
- Mayan Gilboa
- Infection Prevention and Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gili Regev-Yochay
- Infection Prevention and Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Victoria Indenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ronen Fluss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Laurence S. Freedman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
Goldenfeld M, Cohen C, Gilboa M, Pessach IM, Mehnick B, Tal I, Meltzer L, Amit S, Gonen T, Afek A, Kreiss Y, Regev-Yochay G. Rapid Antigen Tests For Safe School Opening in the COVID-19 Pandemic Era. Pediatr Infect Dis J 2022; 41:e312-e317. [PMID: 35544718 PMCID: PMC9281426 DOI: 10.1097/inf.0000000000003569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the beginning of the Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, school closure as a mitigating measure was at the center of a public and professional debate. While the negative effects of school closure cannot be ignored, accumulating data suggested that it is necessary for reducing community transmission. Our study presents an optional strategy for safe school opening during a pandemic, implemented in selected Israeli high schools by a special task force constructed by the Sheba Medical Center (SMC). METHODS The study took place between November 2020 and April 2021. Three schools from different areas of Israel were enrolled. The participants were asked to undergo bi-weekly SARS-CoV-2 rapid diagnostic antigen tests (Ag-RDT). Those who tested positive were requested to self-isolate, whereas their school contacts were tested daily by Ag-RDT. Participants with a previously documented SARS-CoV-2 infection or who were found to be SARS-CoV-2 seropositive upon enrollment were exempted from screening. RESULTS Of a total of 361 participants who enrolled in the study, 12.3% were found to be seropositive. Fourteen SARS-CoV-2 cases were detected (3.5%), 12 of them in one single school located in an endemic area for SARS-CoV-2. The 14 cases resulted in 84 days of COVID-19-related absence from school, comparing with 1775 potential days of COVID-19-related absence under a strategy implementing self-isolation instead of testing. CONCLUSIONS Safe continuation of academic routine during the pandemic is possible when using rapid Ag-RDT as a screening tool, while allowing swab collection by trained students and teachers.
Collapse
Affiliation(s)
- Miki Goldenfeld
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmit Cohen
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Mayan Gilboa
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai M. Pessach
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Bella Mehnick
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Ilana Tal
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Lilac Meltzer
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
| | - Tal Gonen
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Afek
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- The General Management, Sheba Medical Center, Ramat Gan, Israel
| | - Yitshak Kreiss
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- The General Management, Sheba Medical Center, Ramat Gan, Israel
| | - Gili Regev-Yochay
- From the Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
16
|
Kliker L, Zuckerman N, Atari N, Barda N, Gilboa M, Nemet I, Abd Elkader B, Fratty IS, Jaber H, Mendelson E, Alroy-Preis S, Kreiss Y, Regev-Yochay G, Mandelboim M. COVID-19 vaccination and BA.1 breakthrough infection induce neutralising antibodies which are less efficient against BA.4 and BA.5 Omicron variants, Israel, March to June 2022. Euro Surveill 2022; 27:2200559. [PMID: 35904058 PMCID: PMC9336169 DOI: 10.2807/1560-7917.es.2022.27.30.2200559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This work evaluated neutralising antibody titres against wild type (WT) SARS-CoV-2 and four Omicron variants (BA.1, BA.2, BA.4 and BA.5) in healthcare workers who had breakthrough BA.1 infection. Omicron breakthrough infection in individuals vaccinated three or four times before infection resulted in increased neutralising antibodies against the WT virus. The fourth vaccine dose did not further improve the neutralising efficiency over the third dose against all Omicron variants, especially BA.4 and BA.5. An Omicron-specific vaccine may be indicated.
Collapse
Affiliation(s)
- Limor Kliker
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Nofar Atari
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Noam Barda
- Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Ital Nemet
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Bayan Abd Elkader
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Ilana S Fratty
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Ella Mendelson
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Gili Regev-Yochay
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
17
|
Regev-Yochay G, Gonen T, Gilboa M, Mandelboim M, Indenbaum V, Amit S, Meltzer L, Asraf K, Cohen C, Fluss R, Biber A, Nemet I, Kliker L, Joseph G, Doolman R, Mendelson E, Freedman LS, Harats D, Kreiss Y, Lustig Y. Efficacy of a Fourth Dose of Covid-19 mRNA Vaccine against Omicron. N Engl J Med 2022; 386:1377-1380. [PMID: 35297591 PMCID: PMC9006792 DOI: 10.1056/nejmc2202542] [Citation(s) in RCA: 255] [Impact Index Per Article: 127.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Tal Gonen
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Mayan Gilboa
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | | | - Sharon Amit
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Lilac Meltzer
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Keren Asraf
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Carmit Cohen
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Ronen Fluss
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Asaf Biber
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | | | - Gili Joseph
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | | | - Dror Harats
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | | |
Collapse
|
18
|
Layan M, Gilboa M, Gonen T, Goldenfeld M, Meltzer L, Andronico A, Hozé N, Cauchemez S, Regev-Yochay G. Impact of BNT162b2 Vaccination and Isolation on SARS-CoV-2 Transmission in Israeli Households: An Observational Study. Am J Epidemiol 2022; 191:1224-1234. [PMID: 35238329 PMCID: PMC8903452 DOI: 10.1093/aje/kwac042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/02/2022] [Accepted: 03/01/2022] [Indexed: 01/26/2023] Open
Abstract
Several studies have characterized the effectiveness of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. However, estimates of their impact on transmissibility remain limited. Here, we evaluated the impact of isolation and vaccination (7 days after the second dose) on SARS-CoV-2 transmission within Israeli households. From December 2020 to April 2021, confirmed cases were identified among health-care workers of the Sheba Medical Centre and their family members. Recruited households were followed up with repeated PCR for at least 10 days after case confirmation. Data were analyzed using a data augmentation Bayesian framework. A total of 210 households with 215 index cases were enrolled; 269 out of 667 (40%) susceptible household contacts developed a SARS-CoV-2 infection. Of those, 170 (63%) developed symptoms. Compared with unvaccinated and unisolated adult/teenager (aged >12 years) contacts, vaccination reduced the risk of infection among unisolated adult/teenager contacts (relative risk (RR) = 0.21, 95% credible interval (CrI): 0.08, 0.44), and isolation reduced the risk of infection among unvaccinated adult/teenager (RR = 0.12, 95% CrI: 0.06, 0.21) and child contacts (RR = 0.17, 95% CrI: 0.08, 0.32). Infectivity was reduced in vaccinated cases (RR = 0.25, 95% CrI: 0.06, 0.77). Within households, vaccination reduces both the risk of infection and of transmission if infected. When contacts were unvaccinated, isolation also led to important reductions in the risk of transmission.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Simon Cauchemez
- Correspondence to Dr. Simon Cauchemez, Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 25-28 rue du Docteur Roux, 75014 Paris, France (e-mail: ); or Dr. Gili Regev-Yochay, Infection Prevention and Control Unit, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel (e-mail: )
| | - Gili Regev-Yochay
- Correspondence to Dr. Simon Cauchemez, Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 25-28 rue du Docteur Roux, 75014 Paris, France (e-mail: ); or Dr. Gili Regev-Yochay, Infection Prevention and Control Unit, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel (e-mail: )
| |
Collapse
|
19
|
Gilboa M, Mandelboim M, Indenbaum V, Lustig Y, Cohen C, Rahav G, Asraf K, Amit S, Jaber H, Nemet I, Kliker L, Bar-Haim E, Mendelson E, Doolman R, Rubin C, Regev-Yochay G, Kreiss Y. Early Immunogenicity and safety of the third dose of BNT162b2 mRNA Covid-19 vaccine among adults older than 60 years; real world experience. J Infect Dis 2021; 225:785-792. [PMID: 34850049 DOI: 10.1093/infdis/jiab584] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite high vaccine coverage, an increase in breakthrough COVID-19 infections, prompted administration of a third BNT162b2 dose to people>60 years in Israel since July 2021. Here, we report real-world immunogenicity following third dose. METHODS Overall, 208 healthcare workers aged>60 were included. Paired pre- and post-second and/or -third dose IgG and neutralizing-antibody titers were compared. A subpopulation of low-responders to the second dose were also tested for T-cell activation. For 25 paired serum samples we tested neutralization of wild-type vs. neutralization of delta and lambda variants, pre- and post-third dose. Active surveillance of vaccine adverse-events was conducted through surveys. RESULTS A pronounced immune response was observed following the third dose, including a 33-fold and 51-fold increase in IgG and neutralizing ab, respectively. The neutralizing antibody levels post-third-dose were 9.34 times higher than post-second-dose (GMT 2598 95%CI 2085-3237 vs. 207 95%CI 126-339). Nine previously low-responders, had a significant antibody increase post-third-dose, and 7/9 showed increase in T cell activation. Additionally, sera obtained post-third-dose, highly and comparably neutralized the wild-type, delta and lambda variants. Of 1056 responders to the adverse-event survey, none had serious events. CONCLUSIONS We demonstrate a rapid and broad immune response to the third BNT162b2 dose in individuals>60 years.
Collapse
Affiliation(s)
- Mayan Gilboa
- The Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Carmit Cohen
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Galia Rahav
- The Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hanaa Jaber
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ital Nemet
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Limor Kliker
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Erez Bar-Haim
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Nes Ziona, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Carmit Rubin
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gili Regev-Yochay
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| |
Collapse
|
20
|
Schacham NY, Schwarzman A, Brom A, Gilboa M, Groutz A, Justo D. Screening for Asymptomatic Urinary Retention in Older Adult Men at Admission to the Internal Medicine Department: A Prospective Study. Isr Med Assoc J 2021; 23:432-436. [PMID: 34251126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Screening for asymptomatic urinary retention (AUR) in older adult men at hospital admission to the internal medicine department has never been studied. OBJECTIVES To assess the incidence of AUR in older adult men at hospital admission, its risk factors, and its outcome. METHODS The study comprised 111 older adult men aged ≥ 75 years who were admitted to three internal medicine departments. All men underwent post-void residual (PVR) urine volume measurement on the morning following admission by using a portable ultrasound bladder scan. AUR was defined as a PVR urine volume of ≥ 200 ml without symptoms. Men with AUR had a follow-up phone call concerning symptoms and urinary catheter status30 days following hospitalization. RESULTS Seven (6.3%) men had AUR. Relative to the 104 men without AUR, they had significantly higher prevalence of severe dependency (6/7 vs. 33/104, 85.7% vs. 31.7%, (P = 0.007), cognitive impairment (5/7 vs. 19/104, 71.4% vs. 18.3%, P = 0.005), and use of anticholinergic agents (4/7 vs. 19/104, 57.1% vs. 18.3%, P = 0.033). A urinary catheter was inserted in one man (14.3%), but it was removed later during hospitalization. No symptoms were reported and no urinary catheter was inserted following hospitalization in men with AUR. CONCLUSIONS AUR in older adult men at hospital admission is uncommon and has a favorable outcome. Hence, screening for AUR in all older adult men at admission is not recommended, but it may be considered in severely dependent older adult men with cognitive impairment who use anticholinergic agents.
Collapse
Affiliation(s)
- Nadav Yehoshua Schacham
- Department of Geriatrics, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arkady Schwarzman
- Department of Geriatrics, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Brom
- Department of Internal Medicine T, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mayan Gilboa
- Department of Internal Medicine D, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Department of Urogynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Justo
- Department of Geriatrics, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
21
|
Gilboa M, Houri-Levi E, Cohen C, Tal I, Rubin C, Feld-Simon O, Brom A, Eden-Friedman Y, Segal S, Rahav G, Regev-Yochay G. Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study. Clin Microbiol Infect 2020; 26:1052-1057. [PMID: 31904567 DOI: 10.1016/j.cmi.2019.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting. METHODS C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination. RESULTS One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5-99.96 p 0.0195, and 1.19-104.49 p 0.035), respectively. DISCUSSION Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.
Collapse
Affiliation(s)
- M Gilboa
- Internal Medicine D, Sheba Medical Centre, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel.
| | - E Houri-Levi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - C Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - I Tal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - C Rubin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Biostatistics Unit, Gertner Institute, Ramat Gan, Israel
| | - O Feld-Simon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel; Internal Medicine F, Sheba Medical Centre, Ramat Gan, Israel
| | - A Brom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel; Internal Medicine T, Sheba Medical Centre, Ramat Gan, Israel
| | - Y Eden-Friedman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine E, Sheba Medical Centre, Ramat Gan, Israel
| | - S Segal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - G Rahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - G Regev-Yochay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | | |
Collapse
|
22
|
Gilboa M, Koren G, Katz R, Melzer-Cohen C, Shalev V, Grossman E. Anxiolytic treatment but not anxiety itself causes hyponatremia among anxious patients. Medicine (Baltimore) 2019; 98:e14334. [PMID: 30702618 PMCID: PMC6380733 DOI: 10.1097/md.0000000000014334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to define whether anxiety itself or only the treatment with anxiolytic medication is risk factor for hyponatremia and overhydration.A case-control study of patients with a diagnosis of anxiety who received a selective serotonin reuptake inhibitor (SSRI). Serum sodium, urea to creatinine ratio, and odds ratio (OR) of hyponatremia and overhydration before initiation of treatment were compared to those of a control group of participants. Laboratory tests were also examined for changes following treatment with an SSRI. All blood tests were conducted from January 1, 2001 until December 31, 2017. Subjects were selected from a large electronic database, insuring 2 million Israelis. A total of 7211 patients with a diagnosis of anxiety who have received a prescription for an SSRI were identified; 3634 were excluded mostly due to other conditions that could cause hyponatremia, and 3520 participants were included in the case group. The control group consisted of 6985 age and gender matched participants who did not have a diagnosis of anxiety or any other exclusion criteria.Mean serum sodium levels were elevated in cases before the initiation of SSRIs; sodium: case 139.3 (137.3-141.3), control 139.2 (137.06-141.26) mmol/L (P = .01). The OR of hyponatremia was 0.89 for the case group (P = .004). Treatment with SSRIs decreased mean serum sodium (139.3-139.1 mmol/L; P = .0001) and increased by 50% the rate of hyponatremia (2.6-3.9% P = .024).It is the use of SSRIs and not anxiety itself that causes hyponatremia among anxious patients.
Collapse
Affiliation(s)
- Mayan Gilboa
- Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer
- Sackler Faculty of Medicine, Tel Aviv University
| | - Gideon Koren
- Maccabi Health Services, Institute of Research and Innovation, Tel Aviv, Israel
| | - Racheli Katz
- Maccabi Health Services, Institute of Research and Innovation, Tel Aviv, Israel
| | - Cheli Melzer-Cohen
- Maccabi Health Services, Institute of Research and Innovation, Tel Aviv, Israel
| | - Varda Shalev
- Sackler Faculty of Medicine, Tel Aviv University
- Maccabi Health Services, Institute of Research and Innovation, Tel Aviv, Israel
| | - Ehud Grossman
- Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer
- Sackler Faculty of Medicine, Tel Aviv University
| |
Collapse
|
23
|
Leibowitz A, Bier A, Gilboa M, Peleg E, Barshack I, Grossman E. Saccharin Increases Fasting Blood Glucose but Not Liver Insulin Resistance in Comparison to a High Fructose-Fed Rat Model. Nutrients 2018; 10:E341. [PMID: 29534506 PMCID: PMC5872759 DOI: 10.3390/nu10030341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/02/2018] [Accepted: 03/08/2018] [Indexed: 01/08/2023] Open
Abstract
Recent data indicate that artificial sweeteners (AS) may have deleterious effects on glucose metabolism. The purpose of this study was to compare the effects of AS and the effects of a high fructose diet (HFrD) on glucose metabolism and insulin resistance (IR) in Sprague-Dawley (SD) rats. SD rats were fed either regular chow, chow with saccharin (Sac) (0.1 mg/mL) placed in their water, or HFrD for seven weeks. Glucose, insulin, and triglycerides (Tg) levels were measured upon completion. A homeostatic model assessment (HOMA)-IR index was used to determine insulin resistance. The liver was stained to detect signs of a fatty liver. Hepatic mRNA expression of glucose metabolism regulation genes, Srepb-1c (sterol regulatory element binding protein) and ChREB (α & β) (carbohydrate response element binding protein), as well as other glycolytic and lipogenic genes including glucose-6-phosphatase (G6pc), were considered IR markers. Both HFrD and Sac significantly increased fasting blood glucose levels compare to the control (140 ± 5 and 137 ± 6 vs. 118 ± 3 mg/dL, respectively, p < 0.05). However, only HFrD increased insulin secretion (0.99 ± 0.12 vs. 0.7 ± 0.1 and 0.6 ± 0.1 ug/L), Tg levels (420 ± 43 vs. 152 ± 20 and 127 ± 13 mg/dL), and the HOMA-IR index (3.4 ± 0.4 vs. 2.3 ± 0.36 and 2.13 ± 0.3) (HFrD vs. control and sac, p < 0.05). Fatty liver changes were only observed in HFrD fed rats. The expression of ChREB β, Srepb-1c, and G6pc mRNA were only significantly elevated (between 2-10 times folds, p < 0.05) in HFrD fed rats. Sac may increase fasting blood glucose but has no effect on liver insulin resistance.
Collapse
Affiliation(s)
- Avshalom Leibowitz
- Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
- Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Ariel Bier
- Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Mayan Gilboa
- Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Edna Peleg
- Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Iris Barshack
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
- Institute of Pathology, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
| | - Ehud Grossman
- Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
- Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
| |
Collapse
|
24
|
Goldenberg D, Gilboa M, Danino J, Flax-Goldenberg R, Miller B, Joachims HZ. A large ethmoido-orbital osteoma presenting with epiphora in an 11-year-old boy. J Pediatr Ophthalmol Strabismus 2000; 37:238-40. [PMID: 10955549 DOI: 10.3928/0191-3913-20000701-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D Goldenberg
- Department of Otolaryngology, Head, and Neck Surgery, Rambam Medical Center and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
| | | | | | | | | | | |
Collapse
|
25
|
Affiliation(s)
- I Beiran
- Department of Ophthalmology, Rambam Medical Center, Haifa, Israel
| | | | | | | |
Collapse
|
26
|
Brun A, Gilboa M, Meeuwisse GW, Nordgren H. The Zellweger syndrome: subcellular pathology, neuropathology, and the demonstration of pneumocystis carinii pneumonitis in two siblings. Eur J Pediatr 1978; 127:229-45. [PMID: 307490 DOI: 10.1007/bf00493539] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The first Scandinavian cases of Zellweger syndrome (ZS) are described. A brother and sister, children of first cousins, had the typical clinical symptoms and pathological findings. Extensive metabolic studies in the boy were negative. Pipecolic acid in the urine was not elevated. Both children died at 14 weeks of age. Two months earlier the girl had suffered severe intestinal bleeding. Both had pneumocystic carinii pneumonia at autopsy although no evidence of immune deficiency had been found in the boy. The girl had used up her visible iron depots while the boy still had abundant but probably physiologic amounts of hemosiderin in the RES. Most of the cerebral abnormalities are unspecfic and possibly related to anoxia or other causes of delayed maturation. The white matter abnormalities in ZS patients may only be quantitatively different from the common "fatty metamorphosis" in infants. Previously reported ultrastructural abnormalities (absence of peroxisomes and very sparse smooth endoplasmic reticulum, as well as mitochondrial abnormalities) which are possibly unique for ZS, are confirmed. It is stressed that these were seen despite phenobarbital treatment which normally stimulates the formation of smooth endoplasmic reticulum.
Collapse
|
27
|
Abstract
Two different stages should be considered in the management of bee and wasp stings to the eye. The first is the acute stage of activity of the specific insect venom on the structures the eye. The reaction of the eye to the particular insult is considered here in regard to the anterior and posterior segments of the eye. The second stage is that of the retained intraocular foreign body, the inert sting. Little is known about the reaction of the eye to the presence of chitinous sting and its effect on the structures of the eye. We report a follow-up study of a sting retained for 28 years, and emphasise the benign and quiescent course of the case. Guidelines for treatment and management in such cases are described.
Collapse
|
28
|
Rochman J, Gilboa M. [Reversal of lactic acidosis induced by phenformin and acetazolamide]. Harefuah 1977; 92:559-60. [PMID: 407135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|