Routine SARS-CoV-2 vaccination for all children

The Clinical Burden of SARS-CoV-2 Compared to Influenza A in the Same Cohort of Paediatric Outpatients; Increased Influenza Severity and Potential Insights

INTRODUCTION

The variation in the clinical severity of viral infections remains a matter of scientific debate. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Influenza A virus (IAV) are both RNA viruses, exhibiting a range of clinical presentations, ranging from asymptomatic cases to fatalities, influenced by both viral and host factors. A descriptive real-life study was conducted, aiming to compare the clinical manifestations of recent COVID-19 with those of IAV infection in the same group of non-hospitalised, unvaccinated children.

MATERIALS AND METHOD

Between September 2021 and February 2023, we evaluated 115 individuals (male 48.7%, mean age 101.8 ± 50.8 months) who had not received vaccination for both SARS-CoV-2 and the quadrivalent influenza vaccine and were documented to be infected with both viruses within a 12-month time interval. The visual analogue scale (VAS-5) was used to assess parents'/patients' evaluation comparing the two infections.

RESULTS

In cases of IAV infection, a significantly higher prevalence of prolonged high fever, upper and lower respiratory symptoms, and secondary infections was observed. The majority (74.8%) of patients and/or parents assessed IAV as a more severe clinical syndrome compared with SARS-CoV-2.

CONCLUSIONS

The clinical burden of IAV was found to be greater than that of SARS-CoV-2 infection in the same unvaccinated children. This variation in clinical severity may provide a reference for effective vaccination policies; however, underlying mechanisms that could explain this difference require further evaluation.

Intranasal parainfluenza virus-vectored vaccine expressing SARS-CoV-2 spike protein of Delta or Omicron B.1.1.529 induces mucosal and systemic immunity and protects hamsters against homologous and heterologous challenge

The continuous emergence of new SARS-CoV-2 variants requires that COVID vaccines be updated to match circulating strains. We generated B/HPIV3-vectored vaccines expressing 6P-stabilized S protein of the ancestral, B.1.617.2/Delta, or B.1.1.529/Omicron variants as pediatric vaccines for intranasal immunization against HPIV3 and SARS-CoV-2 and characterized these in hamsters. Following intranasal immunization, these B/HPIV3 vectors replicated in the upper and lower respiratory tract and induced mucosal and serum anti-S IgA and IgG. B/HPIV3 expressing ancestral or B.1.617.2/Delta-derived S-6P induced serum antibodies that effectively neutralized SARS-CoV-2 of the ancestral and B.1.617.2/Delta lineages, while the cross-neutralizing potency of B.1.1.529/Omicron S-induced antibodies was lower. Despite the lower cross-neutralizing titers induced by B/HPIV3 expressing S-6P from B.1.1.529/Omicron, a single intranasal dose of all three versions of B/HPIV3 vectors was protective against matched or heterologous WA1/2020, B.1.617.2/Delta or BA.1 (B.1.1.529.1)/Omicron challenge; hamsters were protected from challenge virus replication in the lungs, while low levels of challenge virus were detectable in the upper respiratory tract of a small number of animals. Immunization also protected against lung inflammatory response after challenge, with mild inflammatory cytokine induction associated with the slightly lower level of cross-protection of WA1/2020 and B.1.617.2/Delta variants against the BA.1/Omicron variant. Serum antibodies elicited by all vaccine candidates were broadly reactive against 20 antigenic variants, but the antigenic breadth of antibodies elicited by B/HPIV3-expressed S-6P from the ancestral or B.1.617.2/Delta variant exceeded that of the S-6P B.1.1.529/Omicron expressing vector. These results will guide development of intranasal B/HPIV3 vectors with S antigens matching circulating SARS-CoV-2 variants.

Parental hesitancy for pediatric COVID-19 vaccines in Chile

Background

Since the introduction of the SARS-CoV-2 vaccine, the incidence of complications associated with pediatric infection has markedly declined. However, there is a notable decline in vaccination coverage among younger age groups. The objective of this study was to identify the factors associated with hesitancy to receive the SARS-CoV-2 vaccine in parents of children aged 3-15 years in a Latin American context.

Methods

A cross-sectional, analytical study was conducted between February and May 2023. Parents of children between the ages of 3 and 15, residing in the metropolitan region of Chile, were surveyed via an online or in-person questionnaire. Univariate analysis and a multivariate logistic regression model were performed.

Results

Five hundred thirty-nine surveys were completed; 61.6% of parents were aged between 21 and 40 years, 42.3% had completed higher education, 79.4% had paid employment, and 98.1% were fully vaccinated. Age distribution of children was 36.9% for 3-5 years, 42.4% for 6-11 years, and 20.8% for 12-15 years. 87.4% was vaccinated. In the univariate analysis, vaccine hesitancy was observed in 9%, associated mainly with children 3-5 years, fewer doses in parents' vaccination schedule, lacking risk perception and concerns about safety, and not knowing where to access pediatric vaccine formulations against COVID-19. In the multivariate analysis, the younger age, lacking risk perception, and concerns about the vaccine's effectiveness were associated with vaccine hesitancy.

Conclusion

Addressing hesitancy toward COVID-19 vaccines is of utmost importance. Educational interventions should be implemented to inform parents about the importance and effectiveness of COVID-19 vaccination in children, with special emphasis on parents of younger children, to increase vaccination coverage.

The cost-effectiveness of COVID-19 vaccination program among age-groups children, adults, and elderly in Europe: A systematic review

Objectives

To prepare for future epidemics, the experiences from the vaccination programs in the COVID-19 pandemic need to be collated. This systematic review synthesizes health economic evidence of COVID-19 vaccination programs in European countries comparing the target groups children, adults, and elderly, to study whether the Swedish vaccination strategy was justified on cost-effectiveness grounds.

Method

A literature search using the PICOS (Population, Intervention, Control, Outcomes, Study design) convention was conducted in the databases Medline, Embase, PsycInfo, CINAHL, and Tuft CEA Registry, Cochrane and INAHTA in February 2023. The inclusion criteria were economic evaluations (S) comparing COVID-19 vaccination (I) in age-groups children, adult, and elderly European residents (P) with non-vaccinated European residents (C) in terms of cost per QALY, cost differences, and net monetary benefit (O). Hand-search was done on selected websites and in reference lists of included reports. Title/abstract screening, full-text screening, and quality assessment with the Swedish HTA agency checklist were performed by two researchers. The reporting follows the PRISMA 2020 recommendations.

Results

The database search resulted in 5,720 reports, title/abstract screening yielded 162 reports and after full-text screening, four reports remained. Two studies comparing vaccination of adults and elderly with high and moderate study quality were included. No study was found on the children population. The economic evidence indicated that COVID-19 vaccination of the elderly is cost-effective when compared with vaccination of the adult group, but the transferability to Swedish circumstances was inconclusive due to differences in outcome and cost data between Sweden and the included studies' settings.

Conclusion

The common European COVID-19 vaccination policy that prioritized the elderly population was the cost-effective option in the reviewed studies. The lack of transferability to Sweden precludes a clear conclusion on the Swedish vaccination policy.

Evolution of SARS-CoV-2 epidemics in pediatric population in Liguria (North-west Italy) from March 2020 to December 2022: what could we have learned?

Introduction

This retrospective analysis aims to follow the course of SARS-CoV-2 infections in pediatric population residing in Liguria, North-west Italy, from March 2020 to December 2022 and to relate it to the regional and national containment measures adopted, to assess the representativeness of the infection rate observed at the national level and to analyze the vaccination rates in different pediatric groups.

Methods

First episodes of SARS-CoV-2 infections registered in the national surveillance system were extracted and further anonymously analyzed for subjects aging ≤ 19 years. The absolute number of cases diagnosed daily during each year was compared to the number of residents in the region and graphical representations were used to visualize the trends in infection rates both annually and weekly in each year. Through narrative analysis, the relationship between changes in IR and key social events was analyzed.Applying the direct standardization method, the epidemiology of SARS-CoV-2 infection in pediatric population was compared with that observed in the same age group in Italy.All analyses were performed using Stata and Microsoft Excel.

Results

In the study period, 106,537 (17.4%) cases of SARS-CoV-2 infection were registered in subjects ≤ 19 years, out of a total of 610,404 cases reported in Liguria during that period. In the summer of 2020 the IR was close to zero, while later we observed increases and decreases in the IR in relation to activities and social restrictions adopted. Direct standardization showed an almost perfect coincidence between the expected cases in Italy, based on the Liguria incidence, and the observed cases.

Conclusions

Our results show that, in absence of effective therapies and vaccines, strict non-medical interventions (e.g. use of masks, improving indoor ventilation, physical social distancing, general lockdown) can be the only actions to counter the spread of a respiratory infection.

Intranasal parainfluenza virus-vectored vaccine expressing SARS-CoV-2 spike protein of Delta or Omicron B.1.1.529 induces mucosal and systemic immunity and protects hamsters against homologous and heterologous challenge

The continuous emergence of new SARS-CoV-2 variants requires that COVID vaccines be updated to match circulating strains. We generated B/HPIV3-vectored vaccines expressing 6P-stabilized S protein of the ancestral, B.1.617.2/Delta, or B.1.1.529/Omicron variants as pediatric vaccines for intranasal immunization against HPIV3 and SARS-CoV-2 and characterized these in hamsters. Following intranasal immunization, these B/HPIV3 vectors replicated in the upper and lower respiratory tract and induced mucosal and serum anti-S IgA and IgG. B/HPIV3 expressing ancestral or B.1.617.2/Delta-derived S-6P induced serum antibodies that effectively neutralized SARS-CoV-2 of the ancestral and B.1.617.2/Delta lineages, while the cross-neutralizing potency of B.1.1.529/Omicron S-induced antibodies was lower. Despite the lower cross-neutralizing titers induced by B/HPIV3 expressing S-6P from B.1.1.529/Omicron, a single intranasal dose of all three versions of B/HPIV3 vectors was protective against matched or heterologous WA1/2020, B.1.617.2/Delta or BA.1 (B.1.1.529.1)/Omicron challenge; hamsters were protected from challenge virus replication in the lungs, while low levels of challenge virus were detectable in the upper respiratory tract of a small number of animals. Immunization also protected against lung inflammatory response after challenge, with mild inflammatory cytokine induction associated with the slightly lower level of cross-protection of WA1/2020 and B.1.617.2/Delta variants against the BA.1/Omicron variant. Serum antibodies elicited by all vaccine candidates were broadly reactive against 20 antigenic variants, but the antigenic breadth of antibodies elicited by B/HPIV3-expressed S-6P from the ancestral or B.1.617.2/Delta variant exceeded that of the S-6P B.1.1.529/Omicron expressing vector. These results will guide development of intranasal B/HPIV3 vectors with S antigens matching circulating SARS-CoV-2 variants.

Monoclonal Antibody Therapy of Breastfeeding Patient Infected with SARS-CoV-2: A Case Report

Introduction: Although safety data demonstrated the efficacy and effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination for all individuals over 6 months of age, including pregnant and breastfeeding individuals, optimal treatment courses for symptomatic pregnant and lactating individuals infected with SARS-CoV-2 remain to be defined. Case Description: A coronavirus disease 2019 (COVID-19)-vaccinated breastfeeding woman received anti-SARS-CoV-2 monoclonal antibody treatment casirivimab-imdevimab 5 days after diagnosis of a symptomatic breakthrough SARS-CoV-2 infection. Results and Conclusions: The patient did not present with obvious defects in innate or adaptive cellular subsets, but compared with controls had minimal maternal antibody response to recommended pregnancy vaccinations including SARS-CoV-2 and tetanus, diphtheria, pertussis (TDaP). The outcome of the monoclonal antibody infusion treatment was favorable as it transiently increased SARS-CoV-2 antibody titers in plasma and human milk compartments.

Indirect Dispersion of SARS-CoV-2 Live-Attenuated Vaccine and Its Contribution to Herd Immunity

It has been 34 months since the beginning of the SARS-CoV-2 coronavirus pandemic, which causes the COVID-19 disease. In several countries, immunization has reached a proportion near what is required to reach herd immunity. Nevertheless, infections and re-infections have been observed even in vaccinated persons. That is because protection conferred by vaccines is not entirely effective against new virus variants. It is unknown how often booster vaccines will be necessary to maintain a good level of protective immunity. Furthermore, many individuals refuse vaccination, and in developing countries, a large proportion of the population has not yet been vaccinated. Some live-attenuated vaccines against SARS-CoV-2 are being developed. Here, we analyze the indirect dispersion of a live-attenuated virus from vaccinated individuals to their contacts and the contribution that this phenomenon could have to reaching Herd Immunity.

COVID-19 vaccination in children: a public health priority

OBJECTIVE

Covid-19 had a direct impact on children's health. The aim of this review was to analyze epidemiological and clinical data, the consequences of the pandemic, and vaccination aspects in this group.

SOURCES OF DATA

The searches were carried out from January 2020 to November 2022, in the MEDLINE databases (PubMed) and publications of the Brazilian Ministry of Health and the Brazilian Society of Pediatrics.

SUMMARY OF FINDINGS

Covid-19 has a mild presentation in most children; however, the infection can progress to the severe form and, in some cases, to MIS-C. The prevalence of the so-called long Covid in children was 25.24%. Moreover, several indirect impacts occurred on the health of children and adolescents. Vaccination played a crucial role in enabling the reduction of severe disease and mortality rates. Children and adolescents, as a special population, were excluded from the initial clinical trials and, therefore, vaccination was introduced later in this group. Despite its importance, there have been difficulties in the efficient implementation of vaccination in the pediatric population. The CoronaVac vaccines are authorized in Brazil for children over three years of age and the pediatric presentations of the Pfizer vaccine have shown significant effectiveness and safety.

CONCLUSIONS

Covid-19 in the pediatric age group was responsible for the illness and deaths of a significant number of children. For successful immunization, major barriers have to be overcome. Real-world data on the safety and efficacy of several pediatric vaccines is emphasized, and the authors need a uniform message about the importance of immunization for all children.

Green and efficient one-pot three-component synthesis of novel drug-like furo[2,3–d]pyrimidines as potential active site inhibitors and putative allosteric hotspots modulators of both SARS-CoV-2 MPro and PLPro

In this paper, an environmentally benign, convenient, and efficient one-pot three-component reaction has been developed for the regioselective synthesis of novel 5-aroyl(or heteroaroyl)-6-(alkylamino)-1,3-dimethylfuro[2,3-d]pyrimidine-2,4(1H,3H)-diones (4a‒n) through the sequential condensation of aryl(or heteroaryl)glyoxal monohydrates (1a‒g), 1,3-dimethylbarbituric acid (2), and alkyl(viz. cyclohexyl or tert-butyl)isocyanides (3a or 3b) catalyzed by ultra-low loading ZrOCl₂•8H₂O (just 2 mol%) in water at 50 ˚C. After synthesis and characterization of the mentioned furo[2,3-d]pyrimidines (4a‒n), their multi-targeting inhibitory properties were investigated against the active site and putative allosteric hotspots of both SARS-CoV-2 main protease (M^Pro) and papain-like protease (PL^Pro) based on molecular docking studies and compare the attained results with various medicinal compounds which approximately in three past years were used, introduced, and or repurposed to fight against COVID-19. Furthermore, drug-likeness properties of the mentioned small heterocyclic frameworks (4a‒n) have been explored using in silico ADMET analyses. Interestingly, the molecular docking studies and ADMET-related data revealed that the novel series of furo[2,3-d]pyrimidines (4a‒n), especially 5-(3,4-methylendioxybenzoyl)-6-(cyclohexylamino)-1,3-dimethylfuro[2,3-d]pyrimidine-2,4(1H,3H)-dione (4g) as hit one is potential COVID-19 drug candidate, can subject to further in vitro and in vivo studies. It is worthwhile to note that the protein-ligand-type molecular docking studies on the human body temperature-dependent M^Pro protein that surprisingly contains zinc^II (Zn^II) ion between His41/Cys145 catalytic dyad in the active site, which undoubtedly can make new plans for designing novel SARS-CoV-2 M^Pro inhibitors, is performed for the first time in this paper, to the best of our knowledge.