[Cryptogenic new-onset super-refractory status epilepticus following SARS-CoV-2 vaccination. A case report]

INTRODUCTION

New-onset super-refractory status epilepticus (NOSRSE) is a neurological emergency characterised by the development of status epilepticus in a patient without epilepsy or any known prior neurological disease and with no clear structural, toxic or metabolic cause, which recurs after 24 hours of induced coma. The most common identifiable cause is inflammatory-autoimmune. Consequently, we present a case of NOSRSE related to SARS-CoV-2 vaccination as an opportunity to investigate the dysimmune origin of this pathology.

CASE REPORT

We report the case of a 40-year-old male who presented at the emergency department with fever and headache with no clear source of infection. His personal history included bacterial meningitis in childhood without any sequelae and protein S deficiency without treatment at the time, as well as vaccination with ChAdOx1 nCoV-19 21 days earlier. He was initially diagnosed with a urinary tract infection and treated with cefuroxime. Two days later, he was taken back to the emergency department with confusional symptoms and tonic-clonic seizures. He did not respond to midazolam and finally required sedation and orotracheal intubation for refractory status epilepticus. While in hospital, he required a number of lines of antiepileptic drugs, ketamine, a ketogenic diet, immunotherapy and plasmapheresis in order to successfully limit NOSRSE. The aetiological study offered normal results for serology, antineuronal antibodies in serum and cerebrospinal fluid, transthoracic echocardiography, testicular ultrasound and computed tomographic angiography. Only the control MRI scan showed a diffuse and bilateral alteration of the right hemispheric cortex and thalamic pulvinar as the only finding.

CONCLUSION

It is crucial to report suspected adverse reactions associated with SARS-CoV-2 vaccination, thereby allowing continued monitoring of the risk/benefit ratio of vaccination.

IMPACTO DE LA VACUNACIÓN CONTRA SARS-CoV-2 EN LA INCIDENCIA DE INFECCIÓN EN ÁMBITO ESCOLAR

Antecedentes.

La pandemia por SARS-CoV-2 afectó a la población en edad escolar debido a la propia enfermedad y, al mismo tiempo, por las medidas aplicadas de prevención y control de la infección. El objetivo del estudio fue evaluar el efecto de la vacunación poblacional contra COVID-19 en la incidencia de infección en ámbito escolar.

Materiales y métodos.

Se realizó un estudio descriptivo retrospectivo de casos y brotes escolares por COVID-19 a nivel provincial. Se incluyó alumnado, docentes y personal de diferentes etapas educativas de los centros. La medida principal de resultados fue la incidencia acumulada en función de etapa educativa, perfil del caso y clínica durante el primer trimestre del curso 2020/2021 frente al mismo periodo 2021/2022.

Resultados.

La incidencia total de infección por SARS-CoV-2 en las aulas fue de 2.470 casos por cada 100.000 habitantes en el primer trimestre del curso 2020/2021 y de 2.720 casos por cada 100.000 habitantes en el mismo periodo 2021/2022. El número de brotes escolares notificados fue 7 veces mayor en este segundo periodo; y, al mismo tiempo, el riesgo de infección en las aulas de mayores de 12 años (alumnos y docentes) se redujo un 43,1% (vacunados en elevado porcentaje).

Conclusiones.

Este estudio muestra menor transmisión de infección por SARS-CoV-2 en los alumnos de las etapas educativas superiores (Secundaria y Bachillerato) durante el primer trimestre escolar 2021/2022 (grupo con elevada cobertura vacunal al inicio del período) respecto al curso previo (sin vacunación).

IR-7968. Enfermedad invasiva por neumococo en 2021. Impacto de la pandemia de COVID-19

El objetivo del estudio es analizar los cambios provocados por la pandemia de COVID-19 en la demanda asistencial hospitalaria, solicitud de pruebas diagnósticas para neumococo y casos confirmados de enfermedad neumocócica invasiva (ENI) en la población pediátrica en 2021 respecto al periodo prepandémico (2018-2019).

Métodos

El estudio se realizó en 3 hospitales de nuestra comunidad autónoma que atienden el 32% de la población pediátrica hospitalizada en la misma. En 2021 y en 2018-2019 (promedio) se recogieron: visitas a urgencias, solicitudes de PCR diagnóstica de ENI, casos de ENI, y distribución por serotipos (incluidos en vacuna antineumocócica conjugada-13v [PCV13] y no incluidos [noPCV13]), y por grupos de edad (< 5 y ≥ 5 años). Se compararon las tasas de incidencia (TI) en 2021 respecto 2018-2019 mediante el cálculo de razón TI (RTI), con IC 95%. El cambio porcentual en RTI se expresó según fórmula: (1-RTI) × 100.

Resultados

El número de visitas a urgencias en 2018-19 fue de 227.148 y de 178.243 en 2021 (-21%; p < 0,0001). La variación en visitas a urgencias en < 5 años fue de + 4% y de -38% en ≥ 5 años. El número de PCR solicitadas en 2018-19 fue de 641 y de 754 en 2021 (+ 19%; p = 0,001) y el de casos por ENI en 2018-19 de 57 y de 19 en 2021 (-66%; p < 0,0001). El número de serotipos PCV13 en 2018-19 fue de 25 y de 8 en 2021 (-68%; p = 0,003), y el de serotipos no-PCV13 fue de 29 en 2018-19 y de 10 en 2021 (-65%; p = 0,002); siendo esta variación especialmente marcada en < 5 años.

Conclusiones

En 2021 se observó una disminución de carga asistencial en visitas a urgencias respecto al periodo prepandémico, pero un incremento en las pruebas diagnósticas solicitadas. La disminución de casos de ENI ha sido del 66% en 2021. Las medidas no farmacológicas de prevención podrían explicar estos resultados.

Características de los profesionales vacunados frente al COVID-19 en un hospital de tercer nivel

La vacunación frente a la COVID-19 constituye una estrategia esencial para superar la actual pandemia. Los profesionales sanitarios han sido prioritarios en la estrategia de vacunación, para poder disminuir el impacto de la pandemia sobre el sistema asistencial.

Objetivos

Describir las características de los profesionales sanitarios vacunados frente al COVID-19 en nuestro centro.

Métodos

Desde enero a febrero de 2021, se desarrolló una campaña de vacunación de los profesionales sanitarios de un hospital de tercer nivel frente al COVID-19. Todos dieron su consentimiento para ser vacunados. La vacuna fue administrada por el enfermero de medicina preventiva y la enfermería de apoyo. Se calcularon los porcentajes y las frecuencias de las siguientes variables estudiadas: categoría profesional, características sociodemográficas y mes de administración de la vacuna. En procesamiento de los datos se realizó con Stata 15.

Resultados

Un total de 1.204 fueron vacunados de su primera dosis frente al COVID-19 con la vacuna de Comenarty® (bioNtech/Pfizer), siendo el mes de mayor afluencia el de enero. Del total de vacunados, el 23% fueron médicos, el 25,2% enfermeros/TCAE, el 30,7% otros profesionales sanitarios, y el 21,13% representaban el resto de trabajos de hospitalarios no asistenciales. La media de edad fue de 36,9 años, y el 26,32% fueron hombres.

Conclusiones

La campaña de vacunación frente al COVID-19 en nuestro centro ha sido satisfactoria.

Implementation of immuno-chemoinformatics approaches to construct multi-epitope for vaccine development against Omicron and Delta SARS-CoV-2 variants

Background

The new coronavirus is still a life-threatening menace, because of its changing nature and capacity to produce many mutations to bypass the immune system. The vaccination is the first effective weapon against COVID-19.

Aim

The study's goal was to design a multi-epitope peptide vaccine (MEPV) for a mix of Omicron and Delta Coronavirus strains using immuno-chemoinformatics tools.

Methods

To create the vaccine epitopes, seven proteins from the Omicron and Delta coronavirus strains were selected (ORF1a, ORF3a, surface protein, membrane protein, ORF7a, ORF8, and nucleocapsid protein). Antigenicity, toxicity, and allergenicity of the epitopes were evaluated.

Results

The designed vaccine is made up of 534 amino acids that are homogeneous, antigenic, and non-toxic. Sticky restriction enzymes (XhoI and XbaI) were used to incorporate the MEPV into the pmirGLO luciferase vector. SnapGene server was used to create primers for PCR testing. Developing the MEPV is a terrific cost-effective strategy. The created MEPV's physiochemical properties have been determined to be basic, hydrophobic, and stableImmunogenicity and immune response profiles of the developed vaccine candidate were better assessed using in silico immunological simulations.

Conclusions

We advocate moving the built vaccine to the biological validation step, where it may test our findings using appropriate model organisms.

[From a pathogen's genome to an effective vaccine: the four-component meningococcal serogroup B vaccine]

Invasive meningococcal disease (IMD), caused by the bacterium Neisseria meningitidis, entails significant mortality and morbidity. Disease incidence is highest in infants <1 year and young children globally. In Europe, N. meningitidis serogroup B is responsible for over 50% of overall IMD cases, whereas the majority of IMD cases in Latin America is caused either by serogroup B or C. The development of an effective vaccine against serogroup B has challenged the researchers for over half a century. Serogroup B capsular polysaccharide was an inappropriate vaccine antigen, and the success of outer membrane vesicle (OMV) vaccines was restricted to homologous bacterial strains. Reverse vaccinology led to the development of a 4-component meningococcal vaccine including three novel antigens, and OMVs (4CMenB). Each vaccine component has a different target. 4CMenB has been authorised based on its immunogenicity and safety data because the low disease incidence precluded formal clinical efficacy studies. Human serum bactericidal antibody (hSBA) assay tests functional antibodies in the serum of vaccinated individuals (i.e. the vaccine immunogenicity), and is the accepted correlate of protection. Vaccine strain coverage has been assessed both through hSBA assays and a more conservative method named Meningococcal Antigen Typing System (MATS). Effectiveness data of 4CMenB have been collected in the field since 2013. The vaccine proved effective in outbreak control in North America, and recent data from the introduction of the vaccine in the United Kingdom infant national immunisation programme reveal a vaccine effectiveness of 82.9% for the first two doses, with an acceptable safety profile.

[Bronchospasm and flushing after vaccination with 23 serotype pneumococcal polysaccharide in chronic patients]

OBJECTIVE

To describe the clinical-epidemiological characteristics of a series of suspected systemic adverse reactions registered with the 23 serotype pneumococcal polysaccharide vaccine (PNEUMOVAX23®). Calculate the cumulative incidence of the reaction and know if similar and/or compatible cases have been described in the scientific literature or in pharmacovigilance.

METHODS

Observational and retrospective study realized between 01/12/2015 and 30/09/2017 in the Vaccines Unit of an autonomic reference hospital. We calculated the cumulative incidence of the adverse reaction for that vaccine. The common pharmacovigilance database (FEDRA) was consulted.

RESULTS

Nine systemic adverse reactions were recorded (flushing + bronchospasm + SatO2<95%). The cumulative incidence was 1.036%. The outcome was recovered/resolved for everyone. No similar and/or compatible cases were found.

CONCLUSIONS

The reactions described do not appear in the PNEUMOVAX23® data sheet. Epidemiologically, no causal relationship can be established between the symptoms and the variables studied. This study could be the basis for more detailed research that could modify the vaccine data sheet.

Seroprevalence of measles, mumps, rubella, and varicella zoster virus antibodies among healthcare students: analysis of vaccine efficacy and cost-effectiveness

OBJECTIVE

The aims of this study are to determine the seroprevalence for measles, mumps, rubella, and varicella zoster virus (VZV) in a cohort of nursing students, to evaluate vaccination response rates of nonimmune students, and to calculate the cost of vaccinating students based on seroprevalence screening.

METHODS

A cross-sectional study was conducted August 2015-November 2016 among 326 healthy nursing students aged 14.1-18.1 years. Serum IgG antibodies were measured by ELISA. Results were analyzed by the Chi-square test; a p-value of < 0.05 was considered statistically significant.

RESULTS

The number of seropositive participants (%) was 308 (94.5%) for rubella, 295 (90.5%) for VZV, 244 (74.9%) for measles, and 219 (67.2%) for mumps. A significant correlation was found between measles IgG and age. A relationship was also observed between VZV IgG and kindergarten attendance. Response rates to measles, rubella, VZV, and mumps vaccination were 96%, 92.3%, 87.5%, 78.8%, respectively. The total cost of vaccination after IgG screening was less than vaccination without screening.

CONCLUSIONS

In this study, participants' immunity to measles and VZV was low. Prevaccination serological screening was cost-effectiveness method for preventing measles, mumps, rubella, and varicella infections. We believe that administering booster measles, mumps, and rubella (MMR) vaccine doses or developing a special MMR vaccination strategy for at-risk groups may prevent MMR outbreaks.

[Use of hepatitis B AS04C adjuvanted vaccine in HIV patients]

OBJECTIVE

Co-infection with hepatitis B virus (HBV) in patients with human immunodeficiency virus (HIV) increases associated morbidity and mortality. Vaccination against HBV has been shown to be the most effective method to prevent this situation. Standard vaccination schemes used in this population do not appear to be effective enough. The objective is to identify the response rate following the use of AS04C-adjuvanted hepatitis B vaccine in HIV patients as well as the possible associated adverse reactions.

METHODS

An observational, analytical study with a retrospective cohort of HIV positive patients discharged in 2016 from the Vaccines Unit of a Preventive Medicine and Public Health Service. Patients with antiHBs (-), antiHBcActot (-) and HBsAg (-) at baseline were included, none of them had received prior HBV vaccination. HBV adjuvanted vaccine was used in a 4-dose regimen (0-1-2-6 months). When antiHBs was <10 IU/mL after primovaccination, two additional doses of the same vaccine were applied with an interval of 30 days.

RESULTS

A total of 39 patients were included. Of them, 74.4% were men. The mean age was 47.26 years. The response rate after primary vaccination was higher than 92% and up to 100% with the two subsequent doses. No adverse reactions were reported.

CONCLUSIONS

The administration of AS04C-adjuvanted hepatitis B vaccine in HIV patients showed a 100% response rate, showing an excellent safety profile.