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Hosszu-Fellous K, Vetter P, Agoritsas T, Kaiser L. Which trial do we need? Randomized, placebo-controlled trial of antiviral treatment in patients hospitalized for influenza. Clin Microbiol Infect 2024; 30:567-569. [PMID: 38316358 DOI: 10.1016/j.cmi.2024.01.025] [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: 10/20/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Krisztina Hosszu-Fellous
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Pauline Vetter
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Agoritsas
- Division of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Laurent Kaiser
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
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2
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Pérez-Rodríguez FJ, Cherpillod P, Thomasson V, Vetter P, Schibler M. Identification of a measles variant displaying mutations impacting molecular diagnostics, Geneva, Switzerland, 2023. Euro Surveill 2024; 29. [PMID: 38304951 PMCID: PMC10835752 DOI: 10.2807/1560-7917.es.2024.29.5.2400034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Real-time PCR is one of the most widely used techniques to diagnose measles cases. Here we report measles virus variants with three genetic mutations in the reverse primer annealing site of a widely used PCR. The mutations result in a slight loss of the PCR sensitivity. Variants bearing the three mutations presently circulate in different countries since at least the end of 2021. Our findings highlight the usefulness of molecular surveillance in monitoring if oligonucleotides in diagnostic tests remain adequate.
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Affiliation(s)
- Francisco-Javier Pérez-Rodríguez
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- National Measles and Rubella Reference Laboratory (CNRRR), Geneva University Hospitals, Geneva, Switzerland
- Laboratory of virology, Laboratory Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Pascal Cherpillod
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- National Measles and Rubella Reference Laboratory (CNRRR), Geneva University Hospitals, Geneva, Switzerland
- Laboratory of virology, Laboratory Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Valentine Thomasson
- Laboratory of virology, Laboratory Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of virology, Laboratory Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Manuel Schibler
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- National Measles and Rubella Reference Laboratory (CNRRR), Geneva University Hospitals, Geneva, Switzerland
- Laboratory of virology, Laboratory Medicine Division, Geneva University Hospitals, Geneva, Switzerland
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3
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Courjon J, Portillo V, Yerly S, Vetter P, Schibler M, Mappoura M, Morin S, Giannotti F, Mamez AC, van Delden C, Kaiser L, Chalandon Y, Masouridi-Levrat S, Neofytos D. Hepatitis E Virus Infection Epidemiology in Recipients of Allogeneic Hematopoietic Cell Transplant. Open Forum Infect Dis 2023; 10:ofad595. [PMID: 38094666 PMCID: PMC10716736 DOI: 10.1093/ofid/ofad595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/29/2023] [Accepted: 11/23/2023] [Indexed: 01/25/2024] Open
Abstract
Among 292 recipients of allogeneic hematopoietic cell transplant (2018-2022), 64 (21.9%) tested positive for anti-hepatitis E virus (HEV) immunoglobulin G. Among 208 recipients tested by plasma/serum HEV polymerase chain reaction (2012-2022), 3 (1.4%) primary HEV infections were diagnosed; in 1 patient, plasma HEV polymerase chain reaction relapsed positive for 100 days. HEV infection remains rare albeit associated with persistent viral replication.
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Affiliation(s)
- Johan Courjon
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
- Université Côte d’Azur, Inserm, C3M, Nice, France
| | - Vera Portillo
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Sabine Yerly
- Laboratory of Virology, Division of Laboratory Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, University Hospital of Geneva, Geneva, Switzerland
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Manuel Schibler
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Maria Mappoura
- Division of Hematology, Bone Marrow Transplant Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sarah Morin
- Division of Hematology, Bone Marrow Transplant Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Federica Giannotti
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Anne-Claire Mamez
- Division of Hematology, Bone Marrow Transplant Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian van Delden
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Yves Chalandon
- Division of Hematology, Bone Marrow Transplant Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stavroula Masouridi-Levrat
- Division of Hematology, Bone Marrow Transplant Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dionysios Neofytos
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
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4
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Nehme M, Vetter P, Chappuis F, Kaiser L, Guessous I. Prevalence of Post-Coronavirus Disease Condition 12 Weeks After Omicron Infection Compared With Negative Controls and Association With Vaccination Status. Clin Infect Dis 2023; 76:1567-1575. [PMID: 36519381 DOI: 10.1093/cid/ciac947] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 10/08/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Post-coronovirus disease (COVID) symptoms can persist several months after severe acute respiratory syndrome coronavirus 2 infection. Little is known, however, about the prevalence of post-COVID condition following infections from Omicron variants and how this varies according to vaccination status. This study evaluates the prevalence of symptoms and functional impairment 12 weeks after an infection by Omicron variants (BA.1 and BA.2) compared with negative controls tested during the same period. METHODS Outpatient individuals who tested positive or negative for COVID-19 infection between December 2021 and February 2022 at the Geneva University Hospitals were followed 12 weeks after their test date. RESULTS Overall, 11.7% of Omicron cases had symptoms 12 weeks after the infection compared with 10.4% of individuals who tested negative during the same period (P < .001), and symptoms were much less common in vaccinated versus nonvaccinated individuals with Omicron infection (9.7% vs 18.1%; P < .001). There were no significant differences in functional impairment at 12 weeks between Omicron cases and negative controls, even after adjusting for multiple potential confounders. CONCLUSIONS The differential prevalence of post-COVID symptoms and functional impairment attributed to Omicron BA.1 and BA.2 infection is low when compared with negative controls. Vaccination is associated with lower prevalence of post-COVID symptoms.
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Affiliation(s)
- Mayssam Nehme
- Division of Primary Care Medicine of the Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Laboratory Medicine, Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Laboratory Medicine, Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine of the Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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5
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Marti C, Gaudet-Blavignac C, Martin J, Lovis C, Stirnemann J, Grosgurin O, Novotny F, Iten A, Mendes A, Prendki V, Serratrice C, Farhoumand PD, Abidi N, Vetter P, Carballo S, Reny JL, Berner A, Gayet-Ageron A. Trends in management and outcomes of COVID patients admitted to a Swiss tertiary care hospital. Sci Rep 2023; 13:6013. [PMID: 37045983 PMCID: PMC10096110 DOI: 10.1038/s41598-023-32954-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/05/2023] [Indexed: 04/14/2023] Open
Abstract
Two successive COVID-19 flares occurred in Switzerland in spring and autumn 2020. During these periods, therapeutic strategies have been constantly adapted based on emerging evidence. We aimed to describe these adaptations and evaluate their association with patient outcomes in a cohort of COVID-19 patients admitted to the hospital. Consecutive patients admitted to the Geneva Hospitals during two successive COVID-19 flares were included. Characteristics of patients admitted during these two periods were compared as well as therapeutic management including medications, respiratory support strategies and admission to the ICU and intermediate care unit (IMCU). A mutivariable model was computed to compare outcomes across the two successive waves adjusted for demographic characteristics, co-morbidities and severity at baseline. The main outcome was in-hospital mortality. Secondary outcomes included ICU admission, Intermediate care (IMCU) admission, and length of hospital stay. A total of 2'983 patients were included. Of these, 165 patients (16.3%, n = 1014) died during the first wave and 314 (16.0%, n = 1969) during the second (p = 0.819). The proportion of patients admitted to the ICU was lower in second wave compared to first (7.4 vs. 13.9%, p < 0.001) but their mortality was increased (33.6% vs. 25.5%, p < 0.001). Conversely, a greater proportion of patients was admitted to the IMCU in second wave compared to first (26.6% vs. 22.3%, p = 0.011). A third of patients received lopinavir (30.7%) or hydroxychloroquine (33.1%) during the first wave and none during second wave, while corticosteroids were mainly prescribed during second wave (58.1% vs. 9.1%, p < 0.001). In the multivariable analysis, a 25% reduction of mortality was observed during the second wave (HR 0.75; 95% confidence interval 0.59 to 0.96). Among deceased patients, 82.3% (78.2% during first wave and 84.4% during second wave) died without beeing admitted to the ICU. The proportion of patients with therapeutic limitations regarding ICU admission increased during the second wave (48.6% vs. 38.7%, p < 0.001). Adaptation of therapeutic strategies including corticosteroids therapy and higher admission to the IMCU to receive non-invasive respiratory support was associated with a reduction of hospital mortality in multivariable analysis, ICU admission and LOS during the second wave of COVID-19 despite an increased number of admitted patients. More patients had medical decisions restraining ICU admission during the second wave which may reflect better patient selection or implicit triaging.
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Affiliation(s)
- Christophe Marti
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
| | - Christophe Gaudet-Blavignac
- Division of Medical Information Science, Geneva University Hospitals, Geneva, Switzerland
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jeremy Martin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Science, Geneva University Hospitals, Geneva, Switzerland
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jérôme Stirnemann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Olivier Grosgurin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Fiona Novotny
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Anne Iten
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Aline Mendes
- Division of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Serratrice
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Darbellay Farhoumand
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Nour Abidi
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Jean-Luc Reny
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Amandine Berner
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Angèle Gayet-Ageron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
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6
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Daitch V, Yelin D, Awwad M, Guaraldi G, Milić J, Mussini C, Falcone M, Tiseo G, Carrozzi L, Pistelli F, Nehme M, Guessous I, Kaiser L, Vetter P, Bordas-Martínez J, Durà-Miralles X, Peleato-Catalan D, Gudiol C, Shapira-Lichter I, Abecasis D, Leibovici L, Yahav D, Margalit I. Characteristics of long-COVID among older adults: a cross-sectional study. Int J Infect Dis 2022; 125:287-293. [PMID: 36191820 DOI: 10.1016/j.ijid.2022.09.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 07/14/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To describe long-COVID symptoms among older adults and to assess the risk factors for two common long-COVID symptoms: fatigue and dyspnea. METHODS This is a multicenter, prospective cohort study conducted in Israel, Switzerland, Spain, and Italy. Individuals were included at least 30 days after their COVID-19 diagnosis. We compared long-COVID symptoms between elderly (aged >65 years) and younger individuals (aged 18-65 years) and conducted univariate and multivariable analyses for the predictors of long-COVID fatigue and dyspnea. RESULTS A total of 2333 individuals were evaluated at an average of 5 months (146 days [95% confidence interval 142-150]) after COVID-19 onset. The mean age was 51 years, and 20.5% were aged >65 years. Older adults were more likely to be symptomatic, with the most common symptoms being fatigue (38%) and dyspnea (30%); they were more likely to complain of cough and arthralgia and have abnormal chest imaging and pulmonary function tests. Independent risk factors for long-COVID fatigue and dyspnea included female gender, obesity, and closer proximity to COVID-19 diagnosis; older age was not an independent predictor. CONCLUSION Older individuals with long-COVID have different persisting symptoms, with more pronounced pulmonary impairment. Women and individuals with obesity are at risk. Further research is warranted to investigate the natural history of long-COVID among the elderly population and to assess possible interventions aimed at promoting rehabilitation and well-being.
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Affiliation(s)
- Vered Daitch
- COVID recovery clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Dana Yelin
- COVID recovery clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Muhammad Awwad
- Internal medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Giovanni Guaraldi
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Jovana Milić
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Francesco Pistelli
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Mayssam Nehme
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Xavier Durà-Miralles
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital. Institut Català d'Oncologia (ICO), Hospital Duran I Reynals. IDIBELL, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Irit Shapira-Lichter
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Donna Abecasis
- Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Leonard Leibovici
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Ili Margalit
- COVID recovery clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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7
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Nehme M, Vieux L, Courvoisier DS, Braillard O, Spechbach H, Jacquerioz F, Salamun J, Assal F, Lador F, Coen M, Agoritsas T, Reny JL, Graf C, Benzakour L, Favale R, Soccal PM, Bondolfi G, Tardin A, Zekry D, Stringhini S, Baggio S, Genevay S, Lauper K, Meyer P, Kwabena Poku N, Landis BN, Grira M, Sandoval J, Ehrsam J, Regard S, Genecand C, Kopp G, Guerreiro I, Allali G, Vetter P, Kaiser L, Chappuis F, Chenaud C, Guessous I. The pandemic toll and post-acute sequelae of SARS-CoV-2 in healthcare workers at a Swiss University Hospital. Prev Med Rep 2022; 29:101899. [PMID: 35822203 PMCID: PMC9263685 DOI: 10.1016/j.pmedr.2022.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population. The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models. Healthcare workers (n = 3083) suffered mostly from fatigue (25.5 %), headache (10.0 %), difficulty concentrating (7.9 %), exhaustion/burnout (7.1 %), insomnia (6.2 %), myalgia (6.7 %) and arthralgia (6.3 %). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n = 3556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76–2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59–5.60). Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19.
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Affiliation(s)
- Mayssam Nehme
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland
| | - Laure Vieux
- Division of Occupational Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Delphine S Courvoisier
- Quality of Care Division, Medical Directorate, Geneva University Hospitals, Geneva, Switzerland.,Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Olivia Braillard
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland
| | - Hervé Spechbach
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland
| | - Frederique Jacquerioz
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Salamun
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Assal
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Lador
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Matteo Coen
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Agoritsas
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Lamyae Benzakour
- Division of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Riccardo Favale
- Division of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Paola M Soccal
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Guido Bondolfi
- Division of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Aglaé Tardin
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Dina Zekry
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Kim Lauper
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Meyer
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nana Kwabena Poku
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Basile N Landis
- Division of Otolaryngology, Geneva University Hospitals, Geneva, Switzerland
| | - Marwène Grira
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland
| | - José Sandoval
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Ehrsam
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland.,Department of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - Simon Regard
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland.,Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Camille Genecand
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Garance Kopp
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ivan Guerreiro
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland.,Leenaards Memory Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.,Division of Laboratory Medicine, Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.,Division of Laboratory Medicine, Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Catherine Chenaud
- Division of Occupational Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary care Medicine of the Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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8
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Bekliz M, Adea K, Vetter P, Eberhardt CS, Hosszu-Fellous K, Vu DL, Puhach O, Essaidi-Laziosi M, Waldvogel-Abramowski S, Stephan C, L'Huillier AG, Siegrist CA, Didierlaurent AM, Kaiser L, Meyer B, Eckerle I. Neutralization capacity of antibodies elicited through homologous or heterologous infection or vaccination against SARS-CoV-2 VOCs. Nat Commun 2022; 13:3840. [PMID: 35787633 PMCID: PMC9253337 DOI: 10.1038/s41467-022-31556-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/22/2022] [Indexed: 12/30/2022] Open
Abstract
Emerging SARS-CoV-2 variants raise questions about escape from previous immunity. As the population immunity to SARS-CoV-2 has become more complex due to prior infections with different variants, vaccinations or the combination of both, understanding the antigenic relationship between variants is needed. Here, we have assessed neutralizing capacity of 120 blood specimens from convalescent individuals infected with ancestral SARS-CoV-2, Alpha, Beta, Gamma or Delta, double vaccinated individuals and patients after breakthrough infections with Delta or Omicron-BA.1. Neutralization against seven authentic SARS-CoV-2 isolates (B.1, Alpha, Beta, Gamma, Delta, Zeta and Omicron-BA.1) determined by plaque-reduction neutralization assay allowed us to map the antigenic relationship of SARS-CoV-2 variants. Highest neutralization titers were observed against the homologous variant. Antigenic cartography identified Zeta and Omicron-BA.1 as separate antigenic clusters. Substantial immune escape in vaccinated individuals was detected for Omicron-BA.1 but not Zeta. Combined infection/vaccination derived immunity results in less Omicron-BA.1 immune escape. Last, breakthrough infections with Omicron-BA.1 lead to broadly neutralizing sera. Emerging SARS-CoV-2 variants raise concerns on protective immunity. Here the authors show that convalescent sera from people infected with Alpha, Beta, Gamma or Delta show a significant drop of Omicron-BA.1 neutralization and that vaccine-breakthrough infections with Omicron-BA.1 or Delta result in robust neutralization for both Delta and Omicron-BA.1.
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Affiliation(s)
- Meriem Bekliz
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland
| | - Kenneth Adea
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christiane S Eberhardt
- Center for Vaccinology and Neonatal Immunology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.,Division of General Pediatrics, Department of Woman, Child and Adolescent Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Center for Vaccinology, Geneva University Hospitals, Geneva, Switzerland
| | - Krisztina Hosszu-Fellous
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Diem-Lan Vu
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Olha Puhach
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland
| | - Manel Essaidi-Laziosi
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland
| | | | - Caroline Stephan
- Transfusion Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Center for Vaccinology and Neonatal Immunology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Arnaud M Didierlaurent
- Center for Vaccinology and Neonatal Immunology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin Meyer
- Center for Vaccinology and Neonatal Immunology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.
| | - Isabella Eckerle
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland. .,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland. .,Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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9
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Puhach O, Adea K, Hulo N, Sattonnet P, Genecand C, Iten A, Jacquérioz F, Kaiser L, Vetter P, Eckerle I, Meyer B. Infectious viral load in unvaccinated and vaccinated individuals infected with ancestral, Delta or Omicron SARS-CoV-2. Nat Med 2022. [PMID: 35395151 DOI: 10.1101/2022.01.10.22269010] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Infectious viral load (VL) expelled as droplets and aerosols by infected individuals partly determines transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RNA VL measured by qRT-PCR is only a weak proxy for infectiousness. Studies on the kinetics of infectious VL are important to understand the mechanisms behind the different transmissibility of SARS-CoV-2 variants and the effect of vaccination on transmission, which allows guidance of public health measures. In this study, we quantified infectious VL in individuals infected with SARS-CoV-2 during the first five symptomatic days by in vitro culturability assay in unvaccinated or vaccinated individuals infected with pre-variant of concern (pre-VOC) SARS-CoV-2, Delta or Omicron BA.1. Unvaccinated individuals infected with pre-VOC SARS-CoV-2 had lower infectious VL than Delta-infected unvaccinated individuals. Full vaccination (defined as >2 weeks after receipt of the second dose during the primary vaccination series) significantly reduced infectious VL for Delta breakthrough cases compared to unvaccinated individuals. For Omicron BA.1 breakthrough cases, reduced infectious VL was observed only in boosted but not in fully vaccinated individuals compared to unvaccinated individuals. In addition, infectious VL was lower in fully vaccinated Omicron BA.1-infected individuals compared to fully vaccinated Delta-infected individuals, suggesting that mechanisms other than increased infectious VL contribute to the high infectiousness of SARS-CoV-2 Omicron BA.1. Our findings indicate that vaccines may lower transmission risk and, therefore, have a public health benefit beyond the individual protection from severe disease.
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Affiliation(s)
- Olha Puhach
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kenneth Adea
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Hulo
- Service for Biomathematical and Biostatistical Analyses, Institute of Genetics and Genomics, University of Geneva, Geneva, Switzerland
| | - Pascale Sattonnet
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Camille Genecand
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Jacquérioz
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Isabella Eckerle
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.
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10
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Nehme M, Braillard O, Chappuis F, Courvoisier DS, Kaiser L, Soccal PM, Reny JL, Assal F, Bondolfi G, Tardin A, Graf C, Zekry D, Stringhini S, Spechbach H, Jacquerioz F, Salamun J, Lador F, Coen M, Agoritsas T, Benzakour L, Favale R, Genevay S, Lauper K, Meyer P, Poku NK, Landis BN, Baggio S, Grira M, Sandoval J, Ehrsam J, Regard S, Genecand C, Kopp G, Guerreiro I, Allali G, Vetter P, Guessous I, Genecand C, Kopp G, Guerreiro I, Allali G, Vetter P. One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals. J Intern Med 2022; 292:103-115. [PMID: 35555926 PMCID: PMC9115262 DOI: 10.1111/joim.13482] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.
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Affiliation(s)
- Mayssam Nehme
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - François Chappuis
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland.,Quality of Care Division, Medical Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.,Division of Laboratory Medicine, Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Paola M Soccal
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Assal
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Guido Bondolfi
- Division of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Aglaé Tardin
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Dina Zekry
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Hervé Spechbach
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frederique Jacquerioz
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Salamun
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Lador
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Matteo Coen
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Agoritsas
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Lamyae Benzakour
- Division of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Riccardo Favale
- Division of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Kim Lauper
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Meyer
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nana K Poku
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Basile N Landis
- Division of Otolaryngology, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphanie Baggio
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
| | - Marwène Grira
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - José Sandoval
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Ehrsam
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - Simon Regard
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland.,Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Camille Genecand
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Garance Kopp
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ivan Guerreiro
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.,Division of Laboratory Medicine, Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | -
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Camille Genecand
- Cantonal Health Service General Directorate for Health Geneva Switzerland
| | - Garance Kopp
- Division of Pulmonary Medicine Geneva University Hospitals Geneva Switzerland
| | - Ivan Guerreiro
- Division of Pulmonary Medicine Geneva University Hospitals Geneva Switzerland
| | - Gilles Allali
- Division of Neurology Geneva University Hospitals Geneva Switzerland
| | - Pauline Vetter
- Division of Infectious diseases Geneva University Hospitals Geneva Switzerland
- Geneva Center for Emerging Viral Diseases Geneva University Hospitals Geneva Switzerland
- Division of Laboratory Medicine, Laboratory of Virology Geneva University Hospitals Geneva Switzerland
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11
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Puhach O, Adea K, Hulo N, Sattonnet P, Genecand C, Iten A, Jacquérioz F, Kaiser L, Vetter P, Eckerle I, Meyer B. Infectious viral load in unvaccinated and vaccinated individuals infected with ancestral, Delta or Omicron SARS-CoV-2. Nat Med 2022. [PMID: 35395151 DOI: 10.1101/2022.01.10.22269010v2] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Infectious viral load (VL) expelled as droplets and aerosols by infected individuals partly determines transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RNA VL measured by qRT-PCR is only a weak proxy for infectiousness. Studies on the kinetics of infectious VL are important to understand the mechanisms behind the different transmissibility of SARS-CoV-2 variants and the effect of vaccination on transmission, which allows guidance of public health measures. In this study, we quantified infectious VL in individuals infected with SARS-CoV-2 during the first five symptomatic days by in vitro culturability assay in unvaccinated or vaccinated individuals infected with pre-variant of concern (pre-VOC) SARS-CoV-2, Delta or Omicron BA.1. Unvaccinated individuals infected with pre-VOC SARS-CoV-2 had lower infectious VL than Delta-infected unvaccinated individuals. Full vaccination (defined as >2 weeks after receipt of the second dose during the primary vaccination series) significantly reduced infectious VL for Delta breakthrough cases compared to unvaccinated individuals. For Omicron BA.1 breakthrough cases, reduced infectious VL was observed only in boosted but not in fully vaccinated individuals compared to unvaccinated individuals. In addition, infectious VL was lower in fully vaccinated Omicron BA.1-infected individuals compared to fully vaccinated Delta-infected individuals, suggesting that mechanisms other than increased infectious VL contribute to the high infectiousness of SARS-CoV-2 Omicron BA.1. Our findings indicate that vaccines may lower transmission risk and, therefore, have a public health benefit beyond the individual protection from severe disease.
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Affiliation(s)
- Olha Puhach
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kenneth Adea
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Hulo
- Service for Biomathematical and Biostatistical Analyses, Institute of Genetics and Genomics, University of Geneva, Geneva, Switzerland
| | - Pascale Sattonnet
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Camille Genecand
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Jacquérioz
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Isabella Eckerle
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.
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12
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Parent T, Skoula E, Vetter P, Prendki V. [Specificities of SARS-CoV-2 infection in elderly patients]. Rev Med Suisse 2022; 18:702-706. [PMID: 35417098 DOI: 10.53738/revmed.2022.18.777.702] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
COVID-19 has strongly impacted the elderly population with a particularly high mortality rate due to several reasons: sometimes difficult and delayed diagnosis, multimorbidity, immunosenescence, frailty, which seems to be a better prognostic marker than age. Treatment includes both therapies specifically directed against SARS CoV-2 (monoclonal antibodies, systemic corticosteroids, tocilizumab, remdesivir) and symptomatic and palliative treatments. Vaccination, especially the booster, is essential to reduce the risk of infection and severe forms. The emergence of variants is a challenge because of their impact on vaccine and treatment efficacy. Specific studies in the elderly are needed to improve their management.
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Affiliation(s)
- Thibault Parent
- Service de médecine interne de l'âgé, Hôpital des Trois-Chêne, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Eirini Skoula
- Service de médecine interne de l'âgé, Hôpital des Trois-Chêne, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Pauline Vetter
- Service des maladies infectieuses, Hôpitaux universitaires de Genève, 1211 Genève 14
- Centre des maladies virales émergentes, Hôpitaux universitaires de Genève, 1205 Genève
| | - Virginie Prendki
- Service de médecine interne de l'âgé, Hôpital des Trois-Chêne, Hôpitaux universitaires de Genève, 1211 Genève 14
- Service des maladies infectieuses, Hôpitaux universitaires de Genève, 1211 Genève 14
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13
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Kaiser L, Vetter P, Calmy A, Manuel O, Calandra T. [Not Available]. Rev Med Suisse 2022; 18:691-692. [PMID: 35417096 DOI: 10.53738/revmed.2022.18.777.691] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Laurent Kaiser
- Médecin-chef de service, Service des maladies infectieuses, Centre des maladies virales émergentes, Département de médecine, HUG, Genève
| | - Pauline Vetter
- Service des maladies infectieuses, Centre des maladies virales émergentes, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Alexandra Calmy
- Division des maladies infectieuses, Hôpital cantonal universitaire, 1211 Genève 14
| | - Oriol Manuel
- Département de maladies infectieuses, CHUV et Université de Lausanne, 1011 Lausanne
| | - Thierry Calandra
- Chef de service, Service des maladies infectieuses, Département de médecine, CHUV, Lausanne
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14
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Puhach O, Adea K, Hulo N, Sattonnet P, Genecand C, Iten A, Bausch FJ, Kaiser L, Vetter P, Eckerle I, Meyer B. Infectious viral load in unvaccinated and vaccinated individuals infected with ancestral, Delta or Omicron SARS-CoV-2. Nat Med 2022; 28:1491-1500. [PMID: 35395151 DOI: 10.1038/s41591-022-01816-0] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
Infectious viral load (VL) expelled as droplets and aerosols by infected individuals partly determines SARS-CoV-2 transmission. RNA VL measured by qRT-PCR is only a weak proxy for infectiousness. Studies on the kinetics of infectious VL are important to understand the mechanisms behind the different transmissibility of SARS-CoV-2 variants and the effect of vaccination on transmission, which allows to guide public health measures. In this study we quantified infectious VL in SARS-CoV-2 infected individuals during the first 5 symptomatic days by in vitro culturability assay in unvaccinated or vaccinated individuals infected with pre-variant of concern (pre-VOC) SARS-CoV-2, Delta, or Omicron. Unvaccinated individuals infected with pre-VOC SARS-CoV-2 had lower infectious VL compared to Delta-infected unvaccinated individuals. Full vaccination (defined as >2weeks after reception of 2nd dose during primary vaccination series) significantly reduced infectious VL for Delta breakthrough cases compared to unvaccinated individuals. For Omicron breakthrough cases, reduced infectious VL was only observed in boosted but not in fully vaccinated individuals compared to unvaccinated subjects. In addition, infectious VL was lower in fully vaccinated Omicron- compared to fully vaccinated Delta-infected individuals, suggesting that other mechanisms than increased infectious VL contribute to the high infectiousness of SARS-CoV-2 Omicron. Our findings indicate that vaccines may lower transmission risk and therefore have a public health benefit beyond the individual protection from severe disease.
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Affiliation(s)
- Olha Puhach
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kenneth Adea
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Hulo
- Service for Biomathematical and Biostatistical Analyses, Institute of Genetics and Genomics, University of Geneva, Geneva, Switzerland
| | - Pascale Sattonnet
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Camille Genecand
- Cantonal Health Service, General Directorate for Health, Geneva, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, University Hospital Geneva, HUG, Geneva, Switzerland
| | - Frédérique Jacquérioz Bausch
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.,Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland. .,Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Isabella Eckerle
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland. .,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.
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15
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Carnino L, Vetter P, Peyraud N, Aebischer-Perone S, Chappuis F, Huttner A, Kaiser L, Eperon G. Feasibility and safety of rVSV-ZEBOV vaccination of humanitarian health workers against Ebola virus disease: an observational study. J Travel Med 2021; 28:6299197. [PMID: 34128975 DOI: 10.1093/jtm/taab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND RATIONALE Geneva University Hospitals were granted a temporary authorization to administer the recombinant live vesicular stomatitis virus rVSV-ZEBOV (Ervebo®) vaccine to expatriate humanitarian frontline workers (FLWs) prior to mission deployment. OBJECTIVES Our aims were to assess the feasibility of FLW vaccination before deployment and to report adverse events (AEs). METHODS FLWs received a single injection of rVSV-ZEBOV (>7.2E7 plaque forming unit) during their pre-deployment medical check-up at the Travel Medicine Clinic of the Geneva University Hospitals (Day 0). A safety questionnaire regarding potential AEs was emailed to FLWs on Days 3 and 21. Early and delayed AEs were those starting within 3 or 21 days of vaccination, respectively. RESULTS Between 1 August 2019 and 30 June 2020, 124 FLWs received the rVSV-ZEBOV vaccine. Eighty-six volunteers (86/124; 69%) received a concomitant vaccine. The response rate to the follow-up questionnaire was 88 and 55% at Days 3 and 21, respectively. Most respondents (105/109; 96.3%), experienced at least one AE, with a mean of three (±SD 1.75) AEs per person. The most common AE was injection site pain, followed by fever (53/109; 48.6%), fatigue (51/109; 46.7%) and myalgia (49/109; 44.9%). Most early AEs (360/377; 95.4%) resolved within 3 days, reflecting vaccine reactogenicity. Delayed AEs were reported by 6/69 (7.2%) subjects, the median time to symptom onset was 11 days (range: 5-14); half of them were joint-related AEs (3/6). Four serious adverse events (SAE) were observed: two cases of high grade fever, one rash and one case of arthritis. Two suspected unexpected serious adverse reactions were observed: one case of continuing recurrent transient dizziness and fatigue considered related to the vaccine; and one case of presbyopia that was deemed unrelated. CONCLUSION AEs to rVSV-ZEBOV were common but in general transient and were well tolerated, pre-deployment rVSV-ZEBOV vaccination in FLW is feasible and can be included with pre-mission check-up.
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Affiliation(s)
- Luisa Carnino
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva 1205, Switzerland.,University of Geneva, Rue Michel-Servet 1, Geneva 1205, Switzerland
| | - Pauline Vetter
- University of Geneva, Rue Michel-Servet 1, Geneva 1205, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva 1205, Switzerland
| | | | - Sigiriya Aebischer-Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva 1205, Switzerland.,Health Unit, International Committee of the Red Cross (ICRC), Geneva 1205, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva 1205, Switzerland.,University of Geneva, Rue Michel-Servet 1, Geneva 1205, Switzerland
| | - Angela Huttner
- University of Geneva, Rue Michel-Servet 1, Geneva 1205, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva 1205, Switzerland.,Center for Vaccinology, University and University Hospitals of Geneva, Rue Michel-Servet 1, Geneva 1205, Switzerland
| | - Laurent Kaiser
- University of Geneva, Rue Michel-Servet 1, Geneva 1205, Switzerland.,Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva 1205, Switzerland
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva 1205, Switzerland.,University of Geneva, Rue Michel-Servet 1, Geneva 1205, Switzerland
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16
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Roelens M, Martin A, Friker B, Sousa FM, Thiabaud A, Vidondo B, Buchter V, Gardiol C, Vonlanthen J, Balmelli C, Battegay M, Berger C, Buettcher M, Cusini A, Flury D, Heininger U, Niederer-Loher A, Riedel T, Schreiber PW, Sommerstein R, Troillet N, Tschudin-Sutter S, Vetter P, Bernhard-Stirnemann S, Corti N, Gaudenz R, Marschall J, Nussbaumer-Ochsner Y, Senn L, Vuichard-Gysin D, Zimmermann P, Zucol F, Iten A, Keiser O. Evolution of COVID-19 mortality over time: results from the Swiss hospital surveillance system (CH-SUR). Swiss Med Wkly 2021; 151:w30105. [PMID: 34843180 DOI: 10.4414/smw.2021.w30105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When the periods of time during and after the first wave of the ongoing SARS-CoV-2/COVID-19 pandemic in Europe are compared, the associated COVID-19 mortality seems to have decreased substantially. Various factors could explain this trend, including changes in demographic characteristics of infected persons and the improvement of case management. To date, no study has been performed to investigate the evolution of COVID-19 in-hospital mortality in Switzerland, while also accounting for risk factors. METHODS We investigated the trends in COVID-19-related mortality (in-hospital and in-intermediate/intensive-care) over time in Switzerland, from February 2020 to June 2021, comparing in particular the first and the second wave. We used data from the COVID-19 Hospital-based Surveillance (CH-SUR) database. We performed survival analyses adjusting for well-known risk factors of COVID-19 mortality (age, sex and comorbidities) and accounting for competing risk. RESULTS Our analysis included 16,984 patients recorded in CH-SUR, with 2201 reported deaths due to COVID-19 (13.0%). We found that overall in-hospital mortality was lower during the second wave of COVID-19 than in the first wave (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.63- 0.78; p <0.001), a decrease apparently not explained by changes in demographic characteristics of patients. In contrast, mortality in intermediate and intensive care significantly increased in the second wave compared with the first wave (HR 1.25, 95% CI 1.05-1.49; p = 0.029), with significant changes in the course of hospitalisation between the first and the second wave. CONCLUSION We found that, in Switzerland, COVID-19 mortality decreased among hospitalised persons, whereas it increased among patients admitted to intermediate or intensive care, when comparing the second wave to the first wave. We put our findings in perspective with changes over time in case management, treatment strategy, hospital burden and non-pharmaceutical interventions. Further analyses of the potential effect of virus variants and of vaccination on mortality would be crucial to have a complete overview of COVID-19 mortality trends throughout the different phases of the pandemic.
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Affiliation(s)
- Maroussia Roelens
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Alexis Martin
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Switzerland
| | - Brian Friker
- Veterinary Public Health Institute, University of Bern, Switzerland
| | | | - Amaury Thiabaud
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Beatriz Vidondo
- Veterinary Public Health Institute, University of Bern, Switzerland
| | | | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | | | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Ticino, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | | | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland.,Infectious Diseases and Hospital Hygiene Clinic St Anna, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Natascia Corti
- Unit of General Internal Medicine, Hirslanden Clinic, Zurich, Switzerland
| | - Roman Gaudenz
- Internal Medicine and Infectiology, Cantonal Hospital Nidwalden, Stans, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | | | - Laurence Senn
- Service of Preventive Medicine, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Danielle Vuichard-Gysin
- Division of Infectious Diseases and Hospital Hygiene, Thurgau Hospital Group Münsterlingen and Frauenfeld, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland.,Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, University Hospital Geneva, HUG, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
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17
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Vetter P, L'Huillier AG, Montalbano MF, Pigny F, Eckerle I, Torriani G, Rothenberger S, Laubscher F, Cordey S, Kaiser L, Schibler M. Puumala Virus Infection in Family, Switzerland. Emerg Infect Dis 2021; 27:658-660. [PMID: 33496646 PMCID: PMC7853570 DOI: 10.3201/eid2702.203770] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report 3 cases of Puumala virus infection in a family in Switzerland in January 2019. Clinical manifestations of the infection ranged from mild influenza-like illness to fatal disease. This cluster illustrates the wide range of clinical manifestations of Old World hantavirus infections and the challenge of diagnosing travel-related hemorrhagic fevers.
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18
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Leidi A, Koegler F, Dumont R, Dubos R, Zaballa ME, Piumatti G, Coen M, Berner A, Darbellay Farhoumand P, Vetter P, Vuilleumier N, Kaiser L, Courvoisier D, Azman AS, Guessous I, Stringhini S. Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study. Clin Infect Dis 2021; 74:622-629. [PMID: 34043763 PMCID: PMC8241483 DOI: 10.1093/cid/ciab495] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
Background Serological assays detecting anti-SARS-CoV-2 antibodies are being widely
deployed in studies and clinical practice. However, the duration and
effectiveness of the protection conferred by the immune response remains to
be assessed in population-based samples. To estimate the incidence of newly
acquired SARS-CoV-2 infections in seropositive individuals as compared to
seronegative controls we conducted a retrospective longitudinal matched
study. Methods A seroprevalence survey including a representative sample of the population
was conducted in Geneva, Switzerland between April and June 2020,
immediately after the first pandemic wave. Seropositive participants were
matched one-to-two to seronegative controls, using a propensity-score
including age, gender, immunodeficiency, BMI, smoking status and education
level. Each individual was linked to a state-registry of SARS-CoV-2
infections. Our primary outcome was confirmed infections occurring from
serological status assessment to the end of the second pandemic wave
(January 2021). Results Among 8344 serosurvey participants, 498 seropositive individuals were
selected and matched with 996 seronegative controls. After a mean follow-up
of 35.6 (SD 3.2) weeks, 7 out of 498 (1.4%) seropositive subjects had a
positive SARS-CoV-2 test, of whom 5 (1.0%) were classified as reinfections.
In contrast, the infection rate was higher in seronegative individuals
(15.5%, 154/996) during a similar follow-up period (mean 34.7 [SD 3.2]
weeks), corresponding to a 94% (95%CI 86% to 98%, P<0.001) reduction in
the hazard of having a positive SARS-CoV-2 test for seropositives. Conclusions Seroconversion after SARS-CoV-2 infection confers protection against
reinfection lasting at least 8 months. These findings could help global
health authorities establishing priority for vaccine allocation.
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Affiliation(s)
- Antonio Leidi
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Flora Koegler
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Roxane Dumont
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Richard Dubos
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Giovanni Piumatti
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Institute of Public Health, Faculty of BioMedical Sciences, Università della, Svizzera Italiana, Lugano, Switzerland
| | - Matteo Coen
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Amandine Berner
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Pauline Vetter
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Andrew S Azman
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
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19
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Boehm E, Kronig I, Neher RA, Eckerle I, Vetter P, Kaiser L. Novel SARS-CoV-2 variants: the pandemics within the pandemic. Clin Microbiol Infect 2021; 27:1109-1117. [PMID: 34015535 PMCID: PMC8127517 DOI: 10.1016/j.cmi.2021.05.022] [Citation(s) in RCA: 227] [Impact Index Per Article: 75.7] [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: 02/22/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
Background Many new variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been termed variants of concern/interest (VOC/I) because of the greater risk they pose due to possible enhanced transmissibility and/or severity, immune escape, diagnostic and/or treatment failure, and reduced vaccine efficacy. Aims We sought to review the current knowledge of emerging SARS-CoV-2 variants, particularly those deemed VOC/Is: B.1.351, B.1.1.7, and P.1. Sources MEDLINE and BioRxiv databases, as well as the grey literature, were searched for reports of SARS-CoV-2 variants since November 2020. Relevant articles and their references were screened. Content Mutations on the spike protein in particular may affect both affinity for the SARS-CoV-2 cell receptor ACEII and antibody binding. These VOC/Is often share similar mutation sets. The N501Y mutation is shared by the three main VOCs: B.1.1.7, first identified in the United Kingdom, P.1, originating from Brazil, and B.1.351, first described in South Africa. This mutation likely increases transmissibility by increasing affinity for ACEII. The B.1.351 and P.1 variants also display the E484K mutation which decreases binding of neutralizing antibodies, leading to partial immune escape; this favours reinfections, and decreases the in vitro efficacy of some antibody therapies or vaccines. Those mutations may also have phenotypical repercussions of greater severity. Furthermore, the accumulation of mutations poses a diagnostic risk (lowered when using multiplex assays), as seen for some assays targeting the S gene. With ongoing surveillance, many new VOC/Is have been identified. The emergence of the E484K mutation independently in different parts of the globe may reflect the adaptation of SARS-CoV-2 to humans against a background of increasing immunity. Implications These VOC/Is are increasing in frequency globally and pose challenges to any herd immunity approach to managing the pandemic. While vaccination is ongoing, vaccine updates may be prudent. The virus continues to adapt to transmission in humans, and further divergence from the initial Wuhan sequences is expected.
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Affiliation(s)
- Erik Boehm
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
| | - Ilona Kronig
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Richard A Neher
- Biozentrum, University of Basel, Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Isabella Eckerle
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
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20
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Vetter P, Cordey S, Schibler M, Vieux L, Despres L, Laubscher F, Andrey DO, Martischang R, Harbarth S, Cuvelier C, Bekliz M, Eckerle I, Siegrist CA, Didierlaurent AM, Eberhardt CS, Meyer B, Kaiser L. Clinical, virologic and immunologic features of a mild case of SARS-CoV-2 reinfection. Clin Microbiol Infect 2021; 27:S1198-743X(21)00085-9. [PMID: 33618012 PMCID: PMC7896115 DOI: 10.1016/j.cmi.2021.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/06/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To report a case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection 6 months after the first infection in a young healthy female physician. Both episodes led to mild coronavirus disease 2019 (COVID-19). METHODS SARS-CoV-2 infections were detected by real-time reverse transcriptase PCR (RT-PCR) on nasopharyngeal specimens. Reinfection was confirmed by whole-genome sequencing. Kinetics of total anti-S receptor binding domain immunoglobulins (Ig anti-S RBD), anti-nucleoprotein (anti-N) and neutralizing antibodies were determined in serial serum samples retrieved during both infection episodes. Memory B-cell responses were assessed at day 12 after reinfection. RESULTS Whole-genome sequencing identified two different SARS-CoV-2 genomes both belonging to clade 20A, with only one nonsynonymous mutation in the spike protein and clustered with viruses circulating in Geneva (Switzerland) at the time of each of the corresponding episodes. Seroconversion was documented with low levels of total Ig anti-S RBD and anti-N antibodies at 1 month after the first infection, whereas neutralizing antibodies quickly declined after the first episode and then were boosted by the reinfection, with high titres detectable 4 days after symptom onset. A strong memory B-cell response was detected at day 12 after onset of symptoms during reinfection, indicating that the first episode elicited cellular memory responses. CONCLUSIONS Rapid decline of neutralizing antibodies may put medical personnel at risk of reinfection, as shown in this case. However, reinfection leads to a significant boosting of previous immune responses. Larger cohorts of reinfected subjects with detailed descriptions of their immune responses are needed to define correlates of protection and their duration after infection.
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Affiliation(s)
- Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva, Switzerland.
| | - Samuel Cordey
- Laboratory of Virology, Division of Laboratory Medicine, Geneva, Switzerland
| | - Manuel Schibler
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva, Switzerland
| | - Laure Vieux
- Division of Occupational Medicine, Geneva, Switzerland
| | - Lena Despres
- Division of Occupational Medicine, Geneva, Switzerland
| | - Florian Laubscher
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva, Switzerland
| | - Diego O Andrey
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva, Switzerland
| | - Romain Martischang
- Infection Control Division, WHO Collaborating Center for Patient Safety, Geneva University Hospitals & Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Division, WHO Collaborating Center for Patient Safety, Geneva University Hospitals & Faculty of Medicine, Geneva, Switzerland
| | - Clémence Cuvelier
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Meriem Bekliz
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Department of Microbiology and Molecular Medicine, Geneva, Switzerland
| | - Isabella Eckerle
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Department of Microbiology and Molecular Medicine, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Centre for Vaccinology, Department of Pathology and Immunology, Geneva, Switzerland
| | - Arnaud M Didierlaurent
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Centre for Vaccinology, Department of Pathology and Immunology, Geneva, Switzerland
| | - Christiane S Eberhardt
- Centre for Vaccinology, Department of Pathology and Immunology, Geneva, Switzerland; Division of General Pediatrics, Department of Woman, Child and Adolescent Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva, Switzerland
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21
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Fougère Y, Rohr M, Vetter P, Wagner N. [Treatment of SARS-CoV-2 in paediatrics : what is the evidence to date?]. Rev Med Suisse 2021; 17:344-348. [PMID: 33599410] [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: 06/12/2023]
Abstract
Although SARS-CoV-2 infects individuals of all ages, children show less severe symptoms. Nevertheless, the very rare COVID-19 severe cases in paediatrics require our full attention. Much research has been conducted and is still ongoing on effective treatments. On the antiviral front, no molecule has been proven effective yet and the results of several studies on the benefit of monoclonal antibodies and convalescent plasma are pending. On the side of immunomodulators, the benefit of steroids has been demonstrated for patients severely ill. Other molecules are being investigated. However, all these studies focused on adults and paediatric data are warranted.
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Affiliation(s)
- Yves Fougère
- Unité d'infectiologie pédiatrique et vaccinologie, Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - Marie Rohr
- Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14
| | - Pauline Vetter
- Service des maladies infectieuses, Département des spécialités, HUG, 1211 Genève 14
| | - Noémie Wagner
- Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14
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22
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Nguyen A, Posfay-Barbe K, Blanchard-Rohner G, Buvelot H, Eberhardt C, Huttner B, Negro F, Pham TT, Schibler M, Vetter P, Wagner N, Zanella MC, Jacquérioz F, Huttner A. [Not Available]. Rev Med Suisse 2021; 17:42-49. [PMID: 33443830] [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: 06/12/2023]
Abstract
What's new in infectious diseases in 2020 ? This year has been marked by the COVID-19 pandemic, prompting a review of the current knowledge on SARS-CoV-2 and its management in this article. The results of the Swiss project « PIRATE » indicate non-inferiority between CRP-guided antibiotic durations or fixed 7-day durations and 14-day durations for Gram-negative bacteremia. A Mongolian study did not show any benefit of vitamin D substitution in protecting children from tuberculosis. Baloxavir, a new antiviral against the flu, has been approved by Swissmedic. Finally, new American recommendations for therapeutic monitoring of vancomycin and universal screening for hepatitis C virus have been published.
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Affiliation(s)
- Aude Nguyen
- Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14
| | - Klara Posfay-Barbe
- Unité d'infectiologie pédiatrique, Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14
| | - Géraldine Blanchard-Rohner
- Unité d'immunologie-vaccinologie pédiatrique, Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14
| | - Hélène Buvelot
- Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14
| | - Christiane Eberhardt
- Centre de vaccinologie et Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14
| | - Benedikt Huttner
- Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14
| | - Francesco Negro
- Service de gastroentérologie et hépatologie, Département de médecine, HUG, 1211 Genève 14
| | - Truong-Thanh Pham
- Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, Département de chirurgie, HUG, 1211 Genève 14
| | - Manuel Schibler
- Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14
- Laboratoire de virologie, HUG, 1211 Genève 14
| | - Pauline Vetter
- Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14
- Centre des maladies virales émergentes, HUG, 1211 Genève 14
| | - Noémie Wagner
- Unité d'infectiologie pédiatrique, Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14
| | | | - Frédérique Jacquérioz
- Service de médecine de premier recours, Département de médecine, HUG, 1211 Genève 14
| | - Angela Huttner
- Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14
- Centre de vaccinologie et Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14
- Centre de recherche clinique, HUG, 1211 Genève 14
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23
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Vernaz N, Agoritsas T, Calmy A, Gayet-Ageron A, Gold G, Perrier A, Picard F, Prendki V, Reny JL, Samer C, Stirnemann J, Vetter P, Zanella MC, Zekry D, Baggio S. Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs. Swiss Med Wkly 2020; 150:w20446. [PMID: 33382449 DOI: 10.4414/smw.2020.20446] [Citation(s) in RCA: 10] [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] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619). CONCLUSIONS Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.
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Affiliation(s)
- Nathalie Vernaz
- Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University, Switzerland
| | - Thomas Agoritsas
- Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland / Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexandra Calmy
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals, Switzerland
| | - Angèle Gayet-Ageron
- CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Switzerland
| | - Gabriel Gold
- Service of Geriatrics, Department of Internal Medicine Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Switzerland
| | - Arnaud Perrier
- Medical Directorate, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland / Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Fabienne Picard
- Division of Neurology, Department of Clinical Neurosciences, University of Geneva and University Hospitals of Geneva, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland
| | - Jean-Luc Reny
- Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland
| | - Jérôme Stirnemann
- Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Switzerland
| | | | - Dina Zekry
- Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland
| | - Stéphanie Baggio
- Division of Prison Health, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland / Office of Corrections, Department of Justice and Home Affairs of the Canton of Zurich, Zurich, Switzerland
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24
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Vetter P, Eberhardt CS, Meyer B, Martinez Murillo PA, Torriani G, Pigny F, Lemeille S, Cordey S, Laubscher F, Vu DL, Calame A, Schibler M, Jacquerioz F, Blanchard-Rohner G, Siegrist CA, Kaiser L, Didierlaurent AM, Eckerle I. Daily Viral Kinetics and Innate and Adaptive Immune Response Assessment in COVID-19: a Case Series. mSphere 2020; 5:e00827-20. [PMID: 33177214 PMCID: PMC7657589 DOI: 10.1128/msphere.00827-20] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023] Open
Abstract
Viral shedding patterns and their correlations with immune responses are still poorly characterized in mild coronavirus (CoV) disease 2019 (COVID-19). We monitored shedding of viral RNA and infectious virus and characterized the immune response kinetics of the first five patients quarantined in Geneva, Switzerland. High viral loads and infectious virus shedding were observed from the respiratory tract despite mild symptoms, with isolation of infectious virus and prolonged positivity by reverse transcriptase PCR (RT-PCR) until days 7 and 19 after symptom onset, respectively. Robust innate responses characterized by increases in activated CD14+ CD16+ monocytes and cytokine responses were observed as early as 2 days after symptom onset. Cellular and humoral severe acute respiratory syndrome (SARS)-CoV-2-specific adaptive responses were detectable in all patients. Infectious virus shedding was limited to the first week after symptom onset. A strong innate response, characterized by mobilization of activated monocytes during the first days of infection and SARS-CoV-2-specific antibodies, was detectable even in patients with mild disease.IMPORTANCE This work is particularly important because it simultaneously assessed the virology, immunology, and clinical presentation of the same subjects, whereas other studies assess these separately. We describe the detailed viral and immune profiles of the first five patients infected by SARS-CoV-2 and quarantined in Geneva, Switzerland. Viral loads peaked at the very beginning of the disease, and infectious virus was shed only during the early acute phase of disease. No infectious virus could be isolated by culture 7 days after onset of symptoms, while viral RNA was still detectable for a prolonged period. Importantly, we saw that all patients, even those with mild symptoms, mount an innate response sufficient for viral control (characterized by early activated cytokines and monocyte responses) and develop specific immunity as well as cellular and humoral SARS-CoV-2-specific adaptive responses, which already begin to decline a few months after the resolution of symptoms.
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Affiliation(s)
- Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christiane S Eberhardt
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Benjamin Meyer
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Paola Andrea Martinez Murillo
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Giulia Torriani
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fiona Pigny
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sylvain Lemeille
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Samuel Cordey
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Florian Laubscher
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Diem-Lan Vu
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Adrien Calame
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Manuel Schibler
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frederique Jacquerioz
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Géraldine Blanchard-Rohner
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud M Didierlaurent
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Isabella Eckerle
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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25
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Yelin D, Wirtheim E, Vetter P, Kalil AC, Bruchfeld J, Runold M, Guaraldi G, Mussini C, Gudiol C, Pujol M, Bandera A, Scudeller L, Paul M, Kaiser L, Leibovici L. Long-term consequences of COVID-19: research needs. The Lancet Infectious Diseases 2020; 20:1115-1117. [PMID: 32888409 PMCID: PMC7462626 DOI: 10.1016/s1473-3099(20)30701-5] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Dana Yelin
- Unit of infectious Diseases, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva 49100, Israel
| | - Eytan Wirtheim
- Management, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva 49100, Israel
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Division of Infectious Diseases, Division of Laboratory Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andre C Kalil
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden; Divison of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Michael Runold
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Alessandra Bandera
- Clinic of Infectious Diseases, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Foundation, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luigia Scudeller
- Scientific Direction, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Foundation, Milan, Italy
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Division of Infectious Diseases, Division of Laboratory Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Leonard Leibovici
- Research Authority, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva 49100, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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26
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Affiliation(s)
- Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Laboratory of Virology, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
| | - Diem Lan Vu
- Division of Infectious Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Laboratory of Virology, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, 1205 Geneva, Switzerland
| | - Arnaud G L'Huillier
- Laboratory of Virology, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
- Pediatric Infectious Diseases Unit, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Manuel Schibler
- Division of Infectious Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Laboratory of Virology, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, 1205 Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Laboratory of Virology, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, 1205 Geneva, Switzerland
| | - Frederique Jacquerioz
- Laboratory of Virology, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
- Primary Care Division, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
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27
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Vetter P, Kaiser L. [Ebola : an uncontrolled outbreak despite vaccines and new treatments]. Rev Med Suisse 2020; 16:739-743. [PMID: 32301308] [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: 06/11/2023]
Abstract
The Ebola virus disease outbreak raging in the North-Kivu and Ituri provinces of Democratic Republic of the Congo already accounts for more than 3400 cases, from which 2200 died. Major progress have been achieved since the 2014-2016 West Africa outbreak. A vaccine is now approved by the European Medicine Agency and has been administered to more than 250 000 volunteers in the field. New specific antiviral treatments are now available. Ebola virus disease shifted from a deadly disease to a preventable, curable one. However, the long-lasting conflict and repeated attacks of civilians and health workers hampers the control of the outbreak.
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Affiliation(s)
- Pauline Vetter
- Centre des maladies virales émergentes et laboratoire de virologie, HUG, 2015 Genève
- Service des maladies infectieuses, Département des spécialités médicales, HUG, 2015 Genève
| | - Laurent Kaiser
- Centre des maladies virales émergentes et laboratoire de virologie, HUG, 2015 Genève
- Service des maladies infectieuses, Département des spécialités médicales, HUG, 2015 Genève
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28
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Peters A, Vetter P, Guitart C, Lotfinejad N, Pittet D. Understanding the emerging coronavirus: what it means for health security and infection prevention. J Hosp Infect 2020; 104:440-448. [PMID: 32145323 PMCID: PMC7124368 DOI: 10.1016/j.jhin.2020.02.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Affiliation(s)
- A Peters
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Vetter
- Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C Guitart
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - N Lotfinejad
- Department of Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - D Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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29
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Affiliation(s)
- Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Isabella Eckerle
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- University of Geneva, Faculty of Medicine, 1205 Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, 1205 Geneva, Switzerland
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30
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Kuhn JH, Adachi T, Adhikari NKJ, Arribas JR, Bah IE, Bausch DG, Bhadelia N, Borchert M, Brantsæter AB, Brett-Major DM, Burgess TH, Chertow DS, Chute CG, Cieslak TJ, Colebunders R, Crozier I, Davey RT, de Clerck H, Delgado R, Evans L, Fallah M, Fischer WA, Fletcher TE, Fowler RA, Grünewald T, Hall A, Hewlett A, Hoepelman AIM, Houlihan CF, Ippolito G, Jacob ST, Jacobs M, Jakob R, Jacquerioz FA, Kaiser L, Kalil AC, Kamara RF, Kapetshi J, Klenk HD, Kobinger G, Kortepeter MG, Kraft CS, Kratz T, Bosa HSK, Lado M, Lamontagne F, Lane HC, Lobel L, Lutwama J, Lyon GM, Massaquoi MBF, Massaquoi TA, Mehta AK, Makuma VM, Murthy S, Musoke TS, Muyembe-Tamfum JJ, Nakyeyune P, Nanclares C, Nanyunja M, Nsio-Mbeta J, O'Dempsey T, Pawęska JT, Peters CJ, Piot P, Rapp C, Renaud B, Ribner B, Sabeti PC, Schieffelin JS, Slenczka W, Soka MJ, Sprecher A, Strong J, Swanepoel R, Uyeki TM, van Herp M, Vetter P, Wohl DA, Wolf T, Wolz A, Wurie AH, Yoti Z. New filovirus disease classification and nomenclature. Nat Rev Microbiol 2020; 17:261-263. [PMID: 30926957 DOI: 10.1038/s41579-019-0187-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA.
| | - Takuya Adachi
- Department of Infectious Diseases, Toshima Hospital, Tokyo, Japan
| | - Neill K J Adhikari
- Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Jose R Arribas
- Internal Medicine Department, Infectious Diseases Unit Madrid, Hospital La Paz-Carlos III IdiPAZ, Madrid, Spain
| | | | | | | | - Matthias Borchert
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Arne Broch Brantsæter
- Division of Medicine, Department of Infectious Diseases and Norwegian National Unit for CBRNE Medicine, University of Oslo, Oslo, Norway
| | - David M Brett-Major
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Timothy H Burgess
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Daniel S Chertow
- Critical Care Medicine Department, Emerging Pathogens Section, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Theodore J Cieslak
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | | | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - Richard T Davey
- Clinical Research Section, Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Rafael Delgado
- Molecular Microbiology, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Laura Evans
- Division of Pulmonary and Critical Care Medicine, NYU Langone Medical Center, New York, NY, USA
| | | | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Tom E Fletcher
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool Institute of Translational Medicine and National Institute for Health Research, Liverpool, United Kingdom
| | - Robert A Fowler
- Departments of Medicine and Critical Care Medicine, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Center, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Andy Hall
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | | | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Giuseppe Ippolito
- Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" (National Institute for Infectious diseases "Lazzaro Spallanzani" - IRCCS), Rome, Italy
| | - Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | | | - Frederique A Jacquerioz
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Center for Emerging Viral Diseases, Geneva, Switzerland
| | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jimmy Kapetshi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Hans-Dieter Klenk
- Institute of Virology, Philipps University of Marburg, Marburg an der Lahn, Hesse, Germany
| | - Gary Kobinger
- Department of Microbiology, Immunology and Infectious Diseases, Université Laval, Québec City, Québec, Canada
| | - Mark G Kortepeter
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | | | - Thomas Kratz
- Federal Information Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Henry S Kyobe Bosa
- College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Marta Lado
- Partners in Health (PIH), Freetown, Sierra Leone
| | | | - H Cliff Lane
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Leslie Lobel
- Shraga Segal Department of Microbiology, Immunology and Genetics, School of Pharmacy, Center for Emerging Diseases, Tropical Diseases and AIDS, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Julius Lutwama
- Uganda Virus Research Institute, Arbovirology Emerging and Re-emerging Diseases, Entebbe, Uganda
| | | | - Moses B F Massaquoi
- Sub-Regional Consortium on Ebola Vaccine and Therapeutic Trials, Clinton Health Access Initiative - Liberia, Boston, MA, USA
| | | | | | | | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Jean-Jacques Muyembe-Tamfum
- Department of Microbiology, University of Kinshasa Medical School, Kinshasa, Democratic Republic of the Congo
| | - Phiona Nakyeyune
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Miriam Nanyunja
- Department of Communicable Diseases, World Health Organization, Kampala, Kampala District, Uganda
| | - Justus Nsio-Mbeta
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Tim O'Dempsey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Janusz T Pawęska
- Center for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, 2131, Sandringham-Johannesburg, Gauteng, South Africa
| | | | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christophe Rapp
- Department of Infectious and Tropical Diseases, Bégin Military Teaching Hospital, Saint-Mande, France
| | - Bertrand Renaud
- Faculté de Médecine, Université de Paris Descartes, Paris, France
| | - Bruce Ribner
- Emory University School of Medicine, Atlanta, GA, USA
| | - Pardis C Sabeti
- Broad Institute of the Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | | | - Werner Slenczka
- Institute of Virology, Philipps University of Marburg, Marburg an der Lahn, Hesse, Germany
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | | | - James Strong
- Public Health Agency of Canada, Special Pathogens Program, Ottawa, Ontario, Canada
| | - Robert Swanepoel
- Vectors and Vector-Borne Diseases Research Programme, Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Pauline Vetter
- Geneva Center for Emerging Viral Diseases, Geneva, Switzerland
| | - David A Wohl
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Timo Wolf
- University Hospital, Frankfurt am Main, Germany
| | - Anja Wolz
- Médecins Sans Frontières, Brussels, Belgium
| | - Alie H Wurie
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Zabulon Yoti
- World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
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Vetter P, Schibler M, Herrmann JL, Boutolleau D. Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach. Clin Microbiol Infect 2019; 26:706-712. [PMID: 31899336 DOI: 10.1016/j.cmi.2019.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 10/02/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) testing is a key component for the diagnosis of central nervous system (CNS) infections. Current meningitis and encephalitis management guidelines agree on the need for CSF molecular testing in combination with other direct and indirect biological testing, both in CSF and blood. Multiplex molecular tests have been developed to reduce turnaround times and facilitate the diagnostic approach. OBJECTIVES We aim to discuss the role of multiplex molecular panels in the management of CNS infections. SOURCES The MEDLINE database and the grey literature have been searched for relevant articles. CONTENT New molecular multiplex panels are being developed to simultaneously detect a large array of neuropathogens in CSF. Although one of these assays has been US Food and Drug Administration-approved, extensive analytical and clinical validation is still missing, and suboptimal performance related issues have been raised. Its use has been associated with decreased costs, reduced length of hospital stay and reduced antiviral therapy administration in retrospective, industry-sponsored studies. The pros and cons of this multiplex syndromic approach are discussed in this narrative review. IMPLICATIONS Molecular multiplex CNS infection diagnosis panels have been developed and present several attractive features, including ease of use and low turnaround time. However, suboptimal analytical performances render these tests difficult to use without additional confirmatory tests. Such panels are not comprehensive nor adapted to all situations, depending on the epidemiological or clinical context. Overall, available data in the literature currently do not support the use of a multiplex PCR panel in clinical routine as a 'stand-alone' molecular assay. Except in restricted laboratory capacity settings where such easy-to-use multiplex panels offer the diagnostic means that would otherwise not be available, the stepwise testing approach remains a more rational option. Serological testing both in blood and CSF should not be neglected, but it represents essential complementary tools regarding some neuropathogens.
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Affiliation(s)
- P Vetter
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland.
| | - M Schibler
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland
| | - J L Herrmann
- 2I, UVSQ, INSERM, Université Paris Saclay, Versailles France; AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France
| | - D Boutolleau
- Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie et de Santé Publique (iPLESP), Paris, France; AP-HP, GHU AP-HP. Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Virology Department, National Reference Center for Herpesviruses (associate Laboratory), Paris, France
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Abstract
BACKGROUND The magnitude of the 2013-2016 Ebola virus disease outbreak in West Africa was unprecedented, with >28 500 reported cases and >11 000 deaths. Understanding the key elements of Ebola virus transmission is necessary to implement adequate infection prevention and control measures to protect healthcare workers and halt transmission in the community. METHODS We performed an extensive PubMed literature review encompassing the period from discovery of Ebola virus, in 1976, until 1 June 2016 to evaluate the evidence on modes of Ebola virus shedding and transmission. FINDINGS Ebola virus has been isolated by cell culture from blood, saliva, urine, aqueous humor, semen, and breast milk from infected or convalescent patients. Ebola virus RNA has been noted in the following body fluids days or months after onset of illness: saliva (22 days), conjunctiva/tears (28 days), stool (29 days), vaginal fluid (33 days), sweat (44 days), urine (64 days), amniotic fluid (38 days), aqueous humor (101 days), cerebrospinal fluid (9 months), breast milk (16 months [preliminary data]), and semen (18 months). Nevertheless, the only documented cases of secondary transmission from recovered patients have been through sexual transmission. We did not find strong evidence supporting respiratory or fomite-associated transmission.
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Affiliation(s)
- Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals
- Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases
| | - William A. Fischer
- Division of Pulmonary and Critical Care Medicine, University of North Carolina–Chapel Hill School of Medicine
| | - Manuel Schibler
- Division of Infectious Diseases, Geneva University Hospitals
- Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases
- University of Geneva Medical School, Switzerland
| | - Michael Jacobs
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, United Kingdom
| | - Daniel G. Bausch
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals
- Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases
- University of Geneva Medical School, Switzerland
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Vetter P, Dayer JA, Schibler M, Allegranzi B, Brown D, Calmy A, Christie D, Eremin S, Hagon O, Henderson D, Iten A, Kelley E, Marais F, Ndoye B, Pugin J, Robert-Nicoud H, Sterk E, Tapper M, Siegrist CA, Kaiser L, Pittet D. The 2014–2015 Ebola outbreak in West Africa: Hands On. Antimicrob Resist Infect Control 2016. [PMCID: PMC4858848 DOI: 10.1186/s13756-016-0112-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The International Consortium for Prevention and Infection Control (ICPIC) organises a biannual conference (ICPIC) on various subjects related to infection prevention, treatment and control. During ICPIC 2015, held in Geneva in June 2015, a full one-day session focused on the 2014–2015 Ebola virus disease (EVD) outbreak in West Africa. This article is a non-exhaustive compilation of these discussions. It concentrates on lessons learned and imagining a way forward for the communities most affected by the epidemic. The reader can access video recordings of all lectures delivered during this one-day session, as referenced. Topics include the timeline of the international response, linkages between the dynamics of the epidemic and infection prevention and control, the importance of community engagement, and updates on virology, diagnosis, treatment and vaccination issues. The paper also includes discussions from public health, infectious diseases, critical care and infection control experts who cared for patients with EVD in Africa, in Europe, and in the United Sates and were involved in Ebola preparedness in both high- and low-resource settings and countries. This review concludes that too little is known about the pathogenesis and treatment of EVD, therefore basic and applied research in this area are urgently required. Furthermore, it is clear that epidemic preparedness needs to improve globally, in particular through the strengthening of health systems at local and national levels. There is a strong need for culturally sensitive approaches to public health which could be designed and delivered by social scientists and medical professionals working together. As of December 2015, this epidemic killed more than 11,000 people and infected more than 28,000; it has also generated more than 17,000 survivors and orphans, many of whom face somatic and psychological complications. The continued treatment and rehabilitation of these people is a public health priority, which also requires an integration of specific medical and social science approaches, not always available in West Africa.
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Vetter P, Kaiser L, Schibler M, Ciglenecki I, Bausch DG. Sequelae of Ebola virus disease: the emergency within the emergency. Lancet Infect Dis 2016; 16:e82-e91. [PMID: 27020309 DOI: 10.1016/s1473-3099(16)00077-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 12/22/2022]
Abstract
As the massive outbreak of Ebola virus disease (EVD) in west Africa wanes, it has become increasingly clear that thousands of survivors have many sequelae, some of which might be very severe, such as arthritis and vision-threatening uveitis. The mental health effects of EVD on survivors and other family and community members is similarly profound. Furthermore, it is increasingly being recognised that Ebola virus might persist for weeks or months in selected body compartments of survivors, most notably in the semen of men, bringing risk of renewed transmission where it has previously been eliminated. These challenges to EVD survivors constitute a new emergency in terms of addressing individual patient need and to control the disease spread. In this Review, we assess what is known regarding the sequelae of EVD, including possible delayed virus clearance. We discuss some of the key challenges regarding the provision of care to survivors and implementation of necessary future research.
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Affiliation(s)
- Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Médecins Sans Frontières/Doctors Without Borders, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Manuel Schibler
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Iza Ciglenecki
- Médecins Sans Frontières/Doctors Without Borders, Geneva, Switzerland
| | - Daniel G Bausch
- Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
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Tiffany A, Vetter P, Mattia J, Dayer JA, Bartsch M, Kasztura M, Sterk E, Tijerino AM, Kaiser L, Ciglenecki I. Ebola Virus Disease Complications as Experienced by Survivors in Sierra Leone. Clin Infect Dis 2016; 62:1360-1366. [PMID: 27001797 PMCID: PMC4872294 DOI: 10.1093/cid/ciw158] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/11/2016] [Indexed: 11/28/2022] Open
Abstract
The main complications experienced by Ebola virus disease (EVD) survivors in our clinic were arthralgia and uveitis as described earlier. Treatment of EVD complications should be systematic and initiated as soon as possible to prevent severe disabilities such as blindness. Background. Thousands of people have survived Ebola virus disease (EVD) during the ongoing outbreak. However, data about the frequency and risk factors of long-term post-EVD complications remain scarce. We describe the clinical characteristics of EVD survivors followed in a survivor clinic in Freetown, Sierra Leone. Methods. A survivor clinic opened within an Ebola treatment center compound in Freetown, Sierra Leone. At each visit, clinical and psychological assessments were conducted and free treatment was offered. Survivors were referred to a partner's hospitals if their condition could not be managed in the clinic. We used routinely collected data from the clinic to describe long-term complications of EVD and their risk factors. Results. A total of 1001 medical consultations for 166 patients were performed between 3 February and 21 June 2015. The most frequent complaints and diagnoses were arthralgia (n = 129 [77.7%]), fatigue (n = 116 [69.8%]), abdominal pain (n = 90 [54.2%]), headache (n = 87 [52.4%]), anemia (n = 83 [50%]), skin disorders (n = 81 [48.8%]), back pain (n = 54 [32.5%]), and alopecia (n = 53 [31.9%]). Ocular complications were diagnosed in 94 survivors (56.7%); uveitis was the most common (n = 57 [34%]). Survivors were 10 times more likely to develop uveitis post-EVD if they presented with red/injected eyes during the acute phase of their illness. Conclusions. Post-EVD complications among our patients were similar to those described previously and were detected early following the acute phase of disease. Follow-up of survivors should begin immediately after discharge to address sequelae as they arise and reduce the potential for development of long-term disabilities such as blindness.
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Affiliation(s)
| | - Pauline Vetter
- Médecins Sans Frontières
- Division of Infectious Diseases
- Laboratory of Virology, Geneva University Hospitals, Switzerland
| | - John Mattia
- Lowell and Ruth Gess UMC Eye Hospital, Freetown, Sierra Leone
| | - Julie-Anne Dayer
- Médecins Sans Frontières
- Division of Infectious Diseases
- Laboratory of Virology, Geneva University Hospitals, Switzerland
| | | | | | | | | | - Laurent Kaiser
- Division of Infectious Diseases
- Laboratory of Virology, Geneva University Hospitals, Switzerland
- Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals
- University of Geneva Medical School, Switzerland
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Uyeki TM, Mehta AK, Davey RT, Liddell AM, Wolf T, Vetter P, Schmiedel S, Grünewald T, Jacobs M, Arribas JR, Evans L, Hewlett AL, Brantsaeter AB, Ippolito G, Rapp C, Hoepelman AIM, Gutman J. Clinical Management of Ebola Virus Disease in the United States and Europe. N Engl J Med 2016; 374:636-46. [PMID: 26886522 PMCID: PMC4972324 DOI: 10.1056/nejmoa1504874] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. RESULTS A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. CONCLUSIONS Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.
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Affiliation(s)
- Timothy M Uyeki
- From the Centers for Disease Control and Prevention (T.M.U., J.G.) and the Division of Infectious Diseases, Emory University School of Medicine (A.K.M.) - both in Atlanta; the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (R.T.D.); Texas Health Presbyterian Hospital Dallas, Dallas (A.M.L.); the Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main (T.W.), the First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg (S.S.), and Leipzig Treatment Center for Highly Contagious Diseases, Klinikum St. Georg, Leipzig (T.G.) - all in Germany; the Division of Infectious Diseases and Laboratory of Virology, Geneva University Hospitals, Geneva (P.V.); the Department of Infection, Royal Free London NHS Foundation Trust, London (M.J.); the Internal Medicine Department, Infectious Diseases Unit Madrid, Hospital La Paz-Carlos III IdiPAZ, Madrid (J.R.A.); New York University School of Medicine-Bellevue Hospital Center, New York (L.E.); University of Nebraska Medical Center, Omaha (A.L.H.); the Departments of Infectious Diseases and Acute Medicine, Oslo University Hospital, Oslo (A.B.B.); Lazzaro Spallanzani National Institute for Infectious Diseases, Rome (G.I.); the Infectious and Tropical Diseases Department, Bégin Military Hospital, Saint-Mandé, France (C.R.); and the Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands (A.I.M.H.)
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Cherpillod P, Schibler M, Vieille G, Cordey S, Mamin A, Vetter P, Kaiser L. Ebola virus disease diagnosis by real-time RT-PCR: A comparative study of 11 different procedures. J Clin Virol 2016; 77:9-14. [PMID: 26874083 DOI: 10.1016/j.jcv.2016.01.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 10/13/2015] [Revised: 12/04/2015] [Accepted: 01/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of Ebola virus disease relies on the detection of viral RNA in blood by real-time reverse-transcription PCR. While several of these assays were developed during the unprecedented 2013-2015 Ebola virus disease outbreak in West Africa, few were applied in the field. OBJECTIVES To compare technical performances and practical aspects of 11 Ebola virus real-time reverse-transcription PCR procedures. STUDY DESIGN We selected the most promising assays using serial dilutions of culture-derived Ebola virus RNA and determined their analytical sensitivity and potential range of quantification using quantified in vitro transcribed RNA; viral load values in the serum of an Ebola virus disease patient obtained with these assays were reported. Finally, ease of use and turnaround times of these kits were evaluated. RESULTS Commercial assays were at least as sensitive as in-house tests. Five of the former (Altona, Roche, Fast-track Diagnostics, and Life Technologies) were selected for further evaluation. Despite differences in analytical sensitivity and limits of quantification, all of them were suitable for Ebola virus diagnosis and viral load estimation. The Lifetech Lyophilized Ebola Virus (Zaire 2014) assay (Life Technologies) appeared particularly promising, displaying the highest analytical sensitivity and shortest turnaround time, in addition to requiring no reagent freezing. CONCLUSIONS Commercial kits were at least as sensitive as in-house tests and potentially easier to use in the field than the latter. This qualitative comparison of real-time reverse transcription PCR assays may serve as a basis for the design of future Ebola virus disease diagnostics.
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Affiliation(s)
- Pascal Cherpillod
- Swiss National Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Manuel Schibler
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland.
| | - Gaël Vieille
- Swiss National Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Samuel Cordey
- Swiss National Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Aline Mamin
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Pauline Vetter
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Laurent Kaiser
- Swiss National Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
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Schibler M, Vetter P, Cherpillod P, Petty TJ, Cordey S, Vieille G, Yerly S, Siegrist CA, Samii K, Dayer JA, Docquier M, Zdobnov EM, Simpson AJH, Rees PSC, Sarria FB, Gasche Y, Chappuis F, Iten A, Pittet D, Pugin J, Kaiser L. Clinical features and viral kinetics in a rapidly cured patient with Ebola virus disease: a case report. Lancet Infect Dis 2015. [PMID: 26201298 DOI: 10.1016/s1473-3099(15)00229-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A detailed description of viral kinetics, duration of virus shedding, and intraviral evolution in different body sites is warranted to understand Ebola virus pathogenesis. Patients with Ebola virus infections admitted to university hospitals provide a unique opportunity to do such in-depth virological investigations. We describe the clinical, biological, and virological follow-up of a case of Ebola virus disease. METHODS A 43-year-old medical doctor who contracted an Ebola virus infection in Sierra Leone on Nov 16, 2014 (day 1), was airlifted to Geneva University Hospitals, Geneva, Switzerland, on day 5 after disease onset. The patient received an experimental antiviral treatment of monoclonal antibodies (ZMAb) and favipiravir. We monitored daily viral load kinetics, estimated viral clearance, calculated the half-life of the virus in plasma, and analysed the viral genome via high-throughput sequencing, in addition to clinical and biological signs. FINDINGS The patient recovered rapidly, despite an initial high viral load (about 1 × 10(7) RNA copies per mL 24 h after onset of fever). We noted a two-phase viral decay. The virus half-life decreased from about 26 h to 9·5 h after the experimental antiviral treatment. Compared with a consensus sequence of June 18, 2014, the isolate that infected this patient displayed only five synonymous nucleotide substitutions on the full genome (4901A→C, 7837C→T, 8712A→G, 9947T→C, 16201T→C) despite 5 months of human-to-human transmission. INTERPRETATION This study emphasises the importance of virological investigations to fully understand the course of Ebola virus disease and adaptation of the virus. Whether the viral decay was caused by the effects of the immune response alone, an additional benefit from the antiviral treatment, or a combination of both is unclear. In-depth virological analysis and randomised controlled trials are needed before any conclusion on the potential effect of antiviral treatment can be drawn. FUNDING Geneva University Hospitals, Swiss Office of Public Health, Swiss Agency for Development and Cooperation, and Swiss National Science Foundation.
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Affiliation(s)
- Manuel Schibler
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - Pascal Cherpillod
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Tom J Petty
- Swiss Institute of Bioinformatics, Geneva, Switzerland; Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - Samuel Cordey
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Gaël Vieille
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Sabine Yerly
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Departments of Pathology and Immunology, and Paediatrics, WHO Collaborating Centre for Vaccine Immunology, Geneva University Hospitals and University of Geneva Medical School, Geneva, Switzerland
| | - Kaveh Samii
- Department of Haematology, Geneva University Hospitals, Geneva, Switzerland
| | - Julie-Anne Dayer
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Mylène Docquier
- University of Geneva Medical School, and Genomics Platform, Geneva, Switzerland
| | - Evgeny M Zdobnov
- Swiss Institute of Bioinformatics, Geneva, Switzerland; Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - Andrew J H Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, Wiltshire, UK
| | - Paul S C Rees
- Academic Department of Military Medicine, Barts Health NHS Trust and Defence Medical Services, London, UK
| | - Felix Baez Sarria
- Hospital Universitario Dr Carlos J Finlay, Marianao, La Habana, Cuba
| | - Yvan Gasche
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Iten
- Infection Control Programme, and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and University of Geneva Medical School, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and University of Geneva Medical School, Geneva, Switzerland
| | - Jérôme Pugin
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
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Vetter P, Schibler M, Dayer JA, Kaiser L. [Ebola: the unexpected emerging disease]. Rev Med Suisse 2015; 11:877-883. [PMID: 26050306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In one year, Ebola virus disease has already been responsible of around 10000 deaths. 24 patients have been medically evacuated in different University Hospitals in Europe or in the United States. One medical doctor, infected during a humanitarian mission in the field has been treated in Geneva at the end of 2014. This review aims to summarize the epidemiology of the current outbreak, to describe the main virological and clinical characteristics of Ebola virus disease, and to address the most important experimental treatments available. Although the number of cases has fallen the last two months, the outbreak is not over. A safe and proctective vaccine is still needed in the race to fight this emerging viral disease.
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Kaiser L, Emonet S, Huttner A, Vetter P, Toutous Trellu L, Uriel Valladares Bickel P, Lecompte T. [Infections disease update: 2014 is viral]. Rev Med Suisse 2015; 11:72-77. [PMID: 25799655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chikungunya's phenomenal dissemination imposes now infection suspicion when returning from endemic areas. Colorectal cancer screening may be dependent of the microbiome. Even a small amount of E. coli in catheter sampled urine is predictive for a urinary infection. Prevention of pharyngitis suppurated late complications doesn't justify systematic antimicrobial therapy. A bitherapy is probably better for severe community acquired pneumonias. Due to epidemiology and resistances, management of gonorrhoea has changed. Enterovirus 68 is particular because of its almost exclusive lung tropism in children. The question is no longer how to treat hepatitis C but which patients to treat and when. Pritelivir clearly improves herpes genitalis symptoms. The first confirmed case of Ebola has reach our contry.
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Pernalete N, Tang F, Chang SM, Cheng FY, Vetter P, Stegemann M, Grantner J. Development of an evaluation function for eye-hand coordination robotic therapy. IEEE Int Conf Rehabil Robot 2012; 2011:5975423. [PMID: 22275624 DOI: 10.1109/icorr.2011.5975423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper is the continuation of a work presented at ICORR 07, in which we discussed the possibility of improving eye-hand coordination in children diagnosed with this problem, using a robotic mapping from a haptic user interface to a virtual environment. Our goal is to develop, implement and refine a system that will assess and improve the eye-hand coordination and grip strength in children diagnosed with poor graphomotor skills. A detailed analysis of patters (e.g., labyrinths, letters and angles) was conducted in order to select three very distinguishable levels of difficulty that could be included in the system, and which would yield the greatest benefit in terms of assessment of coordination and strength issues as well as in training. Support algorithms (position, force, velocity, inertia and viscosity) were also developed and incorporated into the tasks in order to introduce general computer assistance to the mapping of the user's movements to the computer screen without overriding the user's commands to the robotic device. In order to evaluate performance (given by %accuracy and time) of the executed tasks, a sophisticated evaluation function was designed based on image analysis and edge detection algorithms. This paper presents the development of the haptic tasks, the various assistance algorithms, the description of the evaluation function and the results of a study implemented at the Motor Development Clinic at Cal Poly Pomona. The results (Accuracy and Time) of this function are currently being used as inputs to an Intelligent Decision Support System (described in), which in turn, suggests the next task to be executed by the subject based on his/her performance.
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Affiliation(s)
- N Pernalete
- California State Polytechnic University, Pomona, USA.
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Vetter P, Smith F, Petro L, Muckli L. Classification of Natural Sounds from Visual Cortex Activity. J Vis 2010. [DOI: 10.1167/10.7.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vetter P, Bahrami B, Butterworth B. Visual enumeration under load: also subitizing needs attention. J Vis 2010. [DOI: 10.1167/7.9.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vetter P, Butterworth B, Bahrami B. Set-size specific modulation of right TPJ during visual enumeration under attentional load. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Angst J, Frei M, Beck M, Jaenicke U, Müller W, Padrutt A, Scharfetter C, Vetter P, Zulauf S. Vergleich von Perphenazin (Trilafon-Tabletten) und Perphenazin-Oenanthat (Trilafon-Depot-Injektionen) im Doppelblindversuch. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0028-1094344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weber O, Burger C, Fremerey R, Vetter P, Richter A, Wippermann BW. Akute intestinale Kolonpseudoobstruktion 2 Tage nach Versorgung einer pertrochantären Femurfraktur. Unfallchirurg 2006; 109:417-21. [PMID: 16555041 DOI: 10.1007/s00113-006-1057-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute colonic pseudoobstruction, following traumatic injuries, is a rare diagnosis. Nevertheless it is life threatening, if it is not recognized and treated promptly. We report one case of this so-called Ogilvie's syndrome, which followed fixation of a trochanteric fracture by intramedullary nailing within 2 days. Due to massive acute colonic distension, the patient suffered from respiratory failure. We excluded other intestinal diseases by CT scanning. After conservative colonic decompression, he recovered after 2 days in the intensive care unit. We describe a variable treatment depending on the severity of the colonic atony. Knowledge of Ogilvie's syndrome, or acute colonic pseudoobstruction, is a must for trauma surgeons, since it can occur within a few hours and can lead to dramatic situations.
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Affiliation(s)
- O Weber
- Klinik für Unfallchirurgie, Universitätsklinikum Bonn, Siegmund-Freud-Str. 25, 53127 Bonn.
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Vetter P. Prä- und perinatale Einflussfaktoren auf die vorgeburtliche seelische Entwicklung. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Moises HW, Frieboes RM, Spelzhaus P, Yang L, Köhnke M, Herden-Kirchhoff O, Vetter P, Neppert J, Gottesman II. No association between dopamine D2 receptor gene (DRD2) and human intelligence. J Neural Transm (Vienna) 2001; 108:115-21. [PMID: 11261743 DOI: 10.1007/s007020170102] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Significantly diminished intellectual functioning, as indicated by appropriately administered IQ tests with scores below 70, is a frequent mental handicap leading to severe social disadvantages and serves as a paradigm for molecular genetic research of complex disorders and traits due to its multitude of known and unknown, genetic as well as environmental causes. Since the number of confounding variables is expected to be considerably reduced in the normal population at the opposite ends of the IQ distribution, we employed a contrast of extremes approach by comparing adults of high (N = 71) and average IQ (N = 78) in association studies to search for genes involved in the multigenic forms of familial mental retardation. The dopamine D2 receptor gene (DRD2) was chosen as a candidate gene for general cognitive ability (g) since it has been found to be associated with visuospatial ability which in turn is highly correlated with g. Confirming two similar studies in children, however, no significant differences were obtained. Given three negative studies, the DRD2 gene is unlikely to pay a major role in g.
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Affiliation(s)
- H W Moises
- Department of Psychiatry, Kiel University Hospital, Federal Republic of Germany.
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