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Çelik M, Baba C, Irmak Ç, Özakbaş S, Avkan-Oğuz V. Risk of hepatitis B virus reactivation in people with multiple sclerosis treated with ocrelizumab: an observational study from Turkey. J Neurol 2024:10.1007/s00415-024-12333-0. [PMID: 38578494 DOI: 10.1007/s00415-024-12333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The risk of hepatitis B virus (HBV) reactivation remains unclear in people with multiple sclerosis (MS) receiving ocrelizumab. We aimed to assess HBV seroprevalence and reactivation risk in MS patients on ocrelizumab and to evaluate the effectiveness of antiviral prophylaxis against HBV reactivation. METHODS In this single-center, cross-sectional study, 400 people with MS receiving ocrelizumab were screened for HBV at baseline and antiviral prophylaxis was implemented based on serological results. Patients were monitored for HBV reactivation, and outcomes were analyzed. RESULTS Among 56 (14%) patients who had serology compatible with occult or resolved HBV infection, 49 (85.7%) received antiviral prophylaxis regularly and had no HBV reactivation during the follow-up. Reactivation of HBV occurred in 2 out of 7 (28.6%) patients who did not receive antiviral prophylaxis and in one patient who did not adhere to the prophylaxis regimen. All patients with reactivation had anti-HBs levels below 100 mIU/mL and the median titer was significantly lower than the patients with no HBV reactivation (p = 0.034). CONCLUSION This study highlights a 14% anti-HBc positivity, indicating a potential risk for HBV reactivation in people with MS receiving ocrelizumab. This suggests the importance of vigilant monitoring and the implementation of prophylactic measures. Our recommendation emphasizes antiviral prophylaxis, particularly for patients with low anti-HBs, and a pre-emptive strategy for others.
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Affiliation(s)
- Muammer Çelik
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, 35330, Izmir, Turkey.
| | - Cavid Baba
- Dokuz Eylul University, Graduate School of Health Sciences and Urla State Hospital, Izmir, Turkey
| | - Çağlar Irmak
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, 35330, Izmir, Turkey
| | - Serkan Özakbaş
- Faculty of Medicine, Department of Neurology, Izmir University of Economics, Izmir, Turkey
| | - Vildan Avkan-Oğuz
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, 35330, Izmir, Turkey
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Alp Çavuş S, Çelik M, Irmak Ç, Helvacı G, Ömeroğlu Şimşek G, Coşkun F. Vaccination Status and Outcome of Hospitalized Patients with Coronavirus Disease 2019 Before and After the Spread of Omicron Variant: An Observational Study from İzmir, Turkey. Thorac Res Pract 2023; 24:284-291. [PMID: 37721490 PMCID: PMC10724727 DOI: 10.5152/thoracrespract.2023.22234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Despite the efforts in vaccination against coronavirus disease 2019 (COVID-19), breakthrough infections occur and the need for hospitalization continues. We aimed to determine the relationship between severe acute respiratory syndrome coronavirus 2 vaccination and the severity of COVID-19 and mortality among hospitalized patients with COVID-19. MATERIAL AND METHODS This cross-sectional study was conducted between September 2021 and February 2022 in a university hos- pital in Turkey. Hospitalized patients with COVID-19 (both in clinics and in intensive care units), ≥18 years old, and who had no previous COVID-19 were included in the study. The demographic characteristics, clinical data, vaccination status, and outcome of the patients were analyzed retrospectively and the relationship between vaccination status and mortality was determined statistically. RESULTS Of the 674 patients, 180 (26.7%) had no vaccination, 282 (41.8%) had incomplete vaccination, and 212 (31.5%) were fully vaccinated according to the updated vaccination recommendations. While 44.0% of the patients were fully vaccinated before the occur- rence of omicron variant, 15.9% of the patients were fully vaccinated during the wave of the omicron variant. The patients with no vaccination were younger and had fewer comorbidities. The overall mortality was 31.8%. Under 50 years old, all the patients with fully vaccination survived and the patients with no vaccination or incomplete vaccination had higher (10.1%) mortality. During the omicron period, mortality was lower in fully vaccinated pateints. CONCLUSION Immunization with and booster doses of BNT162b2 should be encouraged to protect both healthy and vulnerable populations.
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Affiliation(s)
- Sema Alp Çavuş
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Muammer Çelik
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Çağlar Irmak
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Gamze Helvacı
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Gökçen Ömeroğlu Şimşek
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Figen Coşkun
- Department of Emergency Medicine, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Alp Çavuş S, Çelik M, Süner AF, Güzel I, Irmak Ç, Çağlayan D, Öztürk HG, Şiyve N, Appak Ö, Işık E, Ergör G, Ergör OA, Demiral Y, Sayıner AA, Kılıç B. Pre-infection antibody levels of vaccinated healthcare workers with SARS-CoV-2 breakthrough infection: A nested case-control study. Immunol Lett 2023; 262:1-6. [PMID: 37597753 DOI: 10.1016/j.imlet.2023.08.002] [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] [Received: 04/18/2023] [Revised: 07/24/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
AIM To evaluate anti-RBD IgG antibody levels and neutralizing antibody titers between the health care workers (HCWs) with breakthrough SARS-CoV-2 infection and controls. METHODS In this nested case-case control study, we followed 548 vaccinated HCWs with homologous (only with inactivated vaccine) or heterologous (both with inactivated and BNT162b2 vaccine) vaccination for 11 months, prospectively. We obtained blood samples from the participants for quantitative anti-RBD IgG and surrogate neutralization test. The participants with SARS-CoV-2 PCR positivity (at least 14 days after the last vaccination) were considered breakthrough infection. We chose 1:2 matched controls from the cohort, according to age, sex and vaccination status. We used R version 4.0.2 for the statistical analysis. RESULTS Sixty-five cases and 130 controls were included in the study. The number of the breakthrough infections in HCWs were correlated with the pandemic waves in Türkiye and peaked during Omicron outbreak. The median age of the cases was 39 and 78.5% were female. The cases had more comorbidities than controls, significantly (p = 0.021). All cases experienced no or mild symptoms and recovered completely. Both pre-infection anti-RBD antibody and neutralizing antibody titers did not differ between cases and matched controls (p = 0.767, p = 0.628). CONCLUSION In this study, we showed that there was no comparable difference in humoral response after homologous or heterologous vaccination between the cases of breakthrough infection and matched controls. Compliance with infection control measures should be ensured, in combination with vaccination.
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Affiliation(s)
- Sema Alp Çavuş
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye.
| | - Muammer Çelik
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Ahmet Furkan Süner
- Department of Public Health, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Irmak Güzel
- Department of Medical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Çağlar Irmak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Derya Çağlayan
- Department of Public Health, Division of Epidemiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Huriye Gamze Öztürk
- Department of Medical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Neslişah Şiyve
- Department of Public Health, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Özgür Appak
- Department of Medical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Elif Işık
- Department of Public Health, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Gül Ergör
- Department of Public Health, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Osman Alparslan Ergör
- Department of Public Health, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Yücel Demiral
- Department of Public Health, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Ayça Arzu Sayıner
- Department of Medical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Bülent Kılıç
- Department of Public Health, School of Medicine, Dokuz Eylul University, Izmir, Türkiye
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Avkan-Oğuz V, Çelİk M, Eren-Kutsoylu OÖ, Nazli A, Uğur YL, Taylan A, Ergan B, Irmak Ç, Duğral E, Özkütük AA. Fungal colonization and infections in patients with COVID-19 in intensive care units: A real-life experience at a tertiary-care hospital. Respir Med Res 2022; 82:100937. [PMID: 35792466 PMCID: PMC9249560 DOI: 10.1016/j.resmer.2022.100937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the management of patients with COVID-19 in the intensive care units (ICUs) with fungal infection/colonization and to highlight diagnostic problems in these patients. METHODS We included all patients with a COVID-19 diagnosis who were aged ≥18 years and followed in the ICU for the first 8 months. Patient data were obtained from medical records. We compared the risk factors, laboratory data, and outcomes of patients with fungal infection/colonization. RESULTS A total of 118 patients (81 men and 37 women) were included. The mean age was 70.3 ± 14.8 (35-94) years. Of the patients, 79 (66.9%) patients were ≥65 years old. Fungal infection/colonization was detected in 39 (33.1%) patients. Fungi were isolated from 34 (28.8%) patients. Ten fungal species were isolated from 51 samples (the most common being Candida albicans). Three patients (2.5%) had proven candidemia. We observed two (1.7%) possible cases of COVID-19-associated pulmonary aspergillosis (CAPA). Eighteen patients (15.3%) underwent antifungal therapy. The risk of fungal infection/colonization increased as the duration of invasive mechanical ventilation increased. The fatality rate was 61.9% and increased with age and the use of mechanical ventilation. The fatality rate was 4.2-times-higher and the use of mechanical ventilation was 35.9-times-higher in the patients aged ≥65 years than in the patients aged <65 years. No relationship was found between fungal colonization/infection, antifungal treatment, and the fatality rate. CONCLUSION During the pandemic, approximately one-third of the patients in ICUs exhibited fungal infection/colonization. Candida albicans was the most common species of fungal infection as in the pre-pandemic area. Because of the cross-contamination risk, we performed diagnostic bronchoscopy and control thorax computed tomography during the ICU stay, and our patients mainly received empirical antifungal therapy.
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Affiliation(s)
- Vildan Avkan-Oğuz
- Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
| | - Muammer Çelİk
- Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
| | - Oya Özlem Eren-Kutsoylu
- Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
| | - Arzu Nazli
- Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
| | - Yasin Levent Uğur
- Dokuz Eylul University Faculty of Medicine, Department of Anesthesiology and Reanimation, Turkey
| | - Abdullah Taylan
- Dokuz Eylul University Faculty of Medicine, Department of Radiology, Turkey
| | - Begüm Ergan
- Dokuz Eylul University Faculty of Medicine, Department of Pulmonary Diseases, Turkey
| | - Çağlar Irmak
- Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
| | - Esra Duğral
- Dokuz Eylul University Faculty of Medicine, Health Sciences Institute / Deputy Chief Physician, Turkey
| | - A Aydan Özkütük
- Dokuz Eylul University Faculty of Medicine, Department of Medical Microbiology, Turkey
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Çağlayan D, Süner AF, Şiyve N, Güzel I, Irmak Ç, Işik E, Appak Ö, Çelik M, Öztürk G, Alp Çavuş S, Ergör G, Sayiner A, Ergör A, Demiral Y, Kiliç B. An analysis of antibody response following the second dose of CoronaVac and humoral response after booster dose with BNT162b2 or CoronaVac among healthcare workers in Turkey. J Med Virol 2022; 94:2212-2221. [PMID: 35075655 PMCID: PMC9015267 DOI: 10.1002/jmv.27620] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 12/10/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
Limited data are available on the short- to midterm levels of antibodies to the CoronaVac vaccine and quantitative change in humoral response after homologous or heterologous booster doses. In this prospective cohort study, we evaluated the anti-receptor-binding domain (RBD) immunoglobulin G (IgG) levels after two doses of CoronaVac and heterologous/homologous booster administration among healthcare workers in a university hospital in Turkey. Quantitative anti-RBD IgG antibody levels were measured at first and fourth months in 560 healthcare workers who had completed two doses of CoronaVac vaccine, and within 2 months after the third dose of CoronaVac or BNT162b2. Participants were asked to complete a questionnaire during the first blood draw. The seropositivity rate was 98.9% and 89.1%, and the median antibody level was 469.2 AU/ml and 166.5 AU/ml at first and fourth month, respectively. In the fourth month, a mean reduction of 61.4% ± 20% in antibody levels was observed in 79.8% of the participants. The presence of chronic disease (odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.15-2.69) and being in the 36-50 age group (OR: 2.11, 95% CI: 1.39-3.19) were identified as independent predictors for low antibody response. The antibody level increased 104.8-fold (median: 17 609.4 vs. 168 AU/ml) and 8.7-fold (median: 1237.9 vs. 141.4 AU/ml) in the participants who received BNT162b2 and CoronaVac, respectively. During the follow-up, 25 healthcare workers (4.5%) were infected with severe acute respiratory syndrome coronavirus 2. Considering the waning immunity and circulating variants, a single booster dose of messenger RNA vaccine seems reasonable after the inactivated vaccine especially in risk groups.
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Affiliation(s)
- Derya Çağlayan
- Department of Public Health, Division of Epidemiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Ahmet F. Süner
- Department of Public Health, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Neslişah Şiyve
- Department of Public Health, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Irmak Güzel
- Department of Medical Microbiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Çağlar Irmak
- Department of Infectious Diseases and Clinical Microbiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Elif Işik
- Department of Public Health, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Özgür Appak
- Department of Medical Microbiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Muammer Çelik
- Department of Infectious Diseases and Clinical Microbiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Gamze Öztürk
- Department of Medical Microbiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Sema Alp Çavuş
- Department of Medical Microbiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Gül Ergör
- Department of Public Health, Division of Epidemiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Arzu Sayiner
- Department of Medical Microbiology, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Alp Ergör
- Department of Public Health, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Yücel Demiral
- Department of Public Health, School of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Bülent Kiliç
- Department of Public Health, School of MedicineDokuz Eylül UniversityIzmirTurkey
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