Profiling Antibody Response Patterns in COVID-19: Spike S1-Reactive IgA Signature in the Evolution of SARS-CoV-2 Infection

This contribution explores in a new statistical perspective the antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 141 coronavirus disease 2019 (COVID-19) patients exhibiting a broad range of clinical manifestations. This cohort accurately reflects the characteristics of the first wave of the SARS-CoV-2 pandemic in Italy. We determined the IgM, IgA, and IgG levels towards SARS-CoV-2 S1, S2, and NP antigens, evaluating their neutralizing activity and relationship with clinical signatures. Moreover, we longitudinally followed 72 patients up to 9 months postsymptoms onset to study the persistence of the levels of antibodies. Our results showed that the majority of COVID-19 patients developed an early virus-specific antibody response. The magnitude and the neutralizing properties of the response were heterogeneous regardless of the severity of the disease. Antibody levels dropped over time, even though spike reactive IgG and IgA were still detectable up to 9 months. Early baseline antibody levels were key drivers of the subsequent antibody production and the long-lasting protection against SARS-CoV-2. Importantly, we identified anti-S1 IgA as a good surrogate marker to predict the clinical course of COVID-19. Characterizing the antibody response after SARS-CoV-2 infection is relevant for the early clinical management of patients as soon as they are diagnosed and for implementing the current vaccination strategies.

[A proposal for the management of health surveillance and monitoring procedures in relation to the risks posed by SARS-COV-2 to hospital and nursing home workers, based on strategies implemented in the facilities of the Fondazione Opera San Camillo]

This paper describes how the health surveillance protocols adopted in hospitals and nursing homes have changed in response to the spread of SARS-CoV-2 and its risks. These changes concern assessments that must be performed with urgency, to detect potential cases and symptoms that may indicate contagion and to protect vulnerable and hypersensitive workers. Besides, these changes have been implemented in order to regulate how the appointed occupational physician should perform everyday tasks, particularly in regard to preventive visits, periodic visits, office visits, and visits meant to authorize one's return to the workplace. This paper recommends that both preventive visits and periodic visits should include rapid antigen swab tests to screen for SARS-CoV-2 (which, if positive, should be confirmed by molecular tests) and serologic tests to detect IgG SARS-CoV-2 antibodies. Since this phase involves great risks for healthcare facilities, this paper proposes that swab testing should be performed every month and that serologic testing should be performed every three months (depending on whether the first test detects the presence of IgG antibodies). By combining antigen and molecular swab tests, healthcare professionals can diagnose workers with SARS-CoV-2 and identify positive asymptomatic cases. Because of its costs and its long turnaround times for results, molecular swab testing is recommended only when one needs to confirm a positive antigen swab test result. Serologic testing should be used alongside swab testing, to acquire data concerning the immunity of workers.

[Technology upgrades and exposure to chemical agents: results of the PPTP study in the footwear industry]

In the present work the chemical compositions of the products used in shoes manufacturing are reported. The data were collected over the period 2004-2007 in 156 shoe factories in Vigevano area during a study aiming the evaluation of safety conditions and occupational exposure to hazardous chemicals of the employees. The study was part of a regional project for "Occupational cancer prevention in the footwear industry". In the first phase of the study an information form on production cycle, products used and their composition was filled during preliminary audit. In the second phase of the study an in depth qualitative/quantitative evaluation of professional exposure was conducted in 13 selected shoe factories. Data analysis showed the increase in use of water-based adhesives at expense of solvent-based adhesives, the reduction to less than 3.5 weight %, and up to 1 weight %, of n-hexane concentration in solvent mixtures, the increase in use of products containing less hazardous ketones, esters, cyclohexane and heptane. Only in very few cases, products containing from 4 to 12 weight% of toluene were used. These data attest a positive trend in workers risks prevention in shoes industry.

[The shoe industry: from productive reality to risk individualization]

This article describes in detail each stage of the shoe manufacturing process: design, cutting and shearing, sewing and trimming, assemblage, sole preparation, finishing, packaging and stocking, shoe manufacturing with synthetic materials. It will then discuss new technologies and their impact on the improvement of the worker's health, safety and convenience. A definition of the shoe parts and of the materials and machinery employed in its production will be provided, as well as a synthesis of the occupational hazards involved in each department. Although dealing with competitors who can take advantage of low-cost production and lack of concern for labour protection and environmental issues, the industry should always take great care of topics such as innovation and automation, but also workplace health and safety, while pushing the limits of that technological advance which companies have to face.

[Effectiveness of preventive measures for workplace health and safety in Lombardia region during the period 2007-2008]

BACKGROUND

The Lombardy Region has managed workplace safety prevention projects via evaluation of efficacy indicators since 1998 but is only now measuring the effectiveness of heir application. For the 3-year period 2008-2010 Regional Law 8/2007 made it mandatory for all injury prevention departments to assess effectiveness. A study carried out by the International Labour Organization concluded that investigations carried out to identify the causes and the responsibilities of work accidents or occupational diseases are extremely effective in improving the sureveillance and prevention system.

METHODS

The ratio between the number of cases in which it was possible to identify an individual who could be charged with penal responsibilities and the number of investigated cases were taken as an efficacy indicator ofHealth Service investigation procedures.

RESULTS AND DISCUSSION

Analysis revealed that in only 29% of the 5008 industrial injuries, investigated and in 16% of the 2370 occupational diseases assessed was it possible to identify penal responsibilities. These percentages appear too low and a revision of the investigation protocol is therefore necessary mainly as regards priority criteria for the selection of cases to be investigated.

[Vigilance in application of law 125/2001 concerning alcohol and alcohol-related risk assessment in workplaces]

BACKGROUND AND OBJECTIVES

The prohibition of using, dispensing or distributing alcoholic drinks at workplaces involving an elevated risk of accidents (Art. 15 - Law 125/2001 "General policy concerning alcohol and alcohol- related problems") is consistent with the duties of employers and employees regulated by Decree 626/94. The purpose of this rule of law is the health protection of workers and of any third party in the workplace. Alcohol-addiction in workers has to be considered as part of the risk assessment and, in the case of the hazardous activities identified in the law, the increase in risk due to alcohol consumption must also be considered

RESULTS AND CONCLUSIONS

Along with the prohibition of dispensing or distributing alcoholic drinks at the workplace, companies can launch training and information campaigns on the adverse health effects resulting from by harmful and hazardous alcohol consumption in workplaces, which will be all the more effective if addressed to all workers and not only to the more exposed employees. In developing this activity, the company occupational health physician has a central role to play by giving assistance to employees, involving the management and cooperating with public institutions. The controlling body will promote, support and supervise this process. In particular, the local authorities for Occupational Health and Safety (PSAL), together with social partners, will encourage companies to start up projects for health protection, will facilitate cooperation with the Pathological Addiction Services (Ser. T), and will encourage the implementation of a network to facilitate occupational health physicians in analyzing accident risks and solving health problems related to alcohol abuse.

[Active search of work related tumours: preliminary findings]

The OCCAM (Occupational Cancer Monitoring) project enabled the active detection of occupational cancer cases in Lombardy Region.

METHODS

OCCAM is based on a record linkage with social security files to obtain occupational histories for all subjects having worked in private firms, since 1974. It provides risks by area, site and job.

RESULTS

271 incident cancer cases obtained by hospital discharge record in the period 2001-2002 where investigate to assess eventually their occupational origin. Approximately 38% where considered to be occupational cancers.

CONCLUSIONS

OCCAM provides name of the firms and their economic activity completed by information coming from OCCAM risks ascertainment and deeper knowledge on productive cycle retained by local occupational health services. Thus this system can lead to detection of many cancer cases of occupational origin suitable for compensation and determine strategies for the improvement of the work environment.

[Efficacy of the activities of the Prevention and Safety Services at the Occupational Setting of the Lombardy Region]

The authors describe the programme of the Regione Lombardia about efficacy of the Public Occupational Health Services. The Regional law 12/03 abrogated the visits for under-age workers not exposed to risks. It is established methods to value efficacy considering the number of workers protected by the risk through prevention activity.

[Role of the Services for Prevention Safety at the Working Setting (SPSAL) in the application of the Ministerial Decree of July 15, 2003, No. 388 (regulation on the organization of first aid in the construction sector]

Article 15 of the D.Lgs. 626/94 and D.M. 388/2003, performance regulations, have codified of the new modalities of management and organization of the Service of Ready business Aid. I previewed in the new approach, entrusted main tasks to the employer, they are of organizational and formative type.

[Research and formal demonstration of evidence of efficiency in occupational medicine]

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.

[De Quervain's tenosynovitis and work with hand tools: a case study]

Work-related musculoskeletal disorders of the upper limbs are a frequent complaint and their pathogenetic mechanism is often related to mechanical overload of the body region involved without traumatic events. The occupational origin of such disorders is much debated, since the clinical pictures are often not specific and may be found in subjects who do not perform hazardous work tasks. A better understanding of the relationship between clinical symptoms, diagnosis, and functional capacity would provide a deeper knowledge in decision making for return to work and rehabilitation strategies. In this paper we present a case study of a worker using scissors who developed De Quervain's syndrome in the dominant hand. A methodology for the biomechanical investigation of the work task and the possible occupational aetiology of the clinical picture are discussed according to the findings of the specific literature.

Urinary determination of N-acetyl- S-( N-methylcarbamoyl)cysteine and N-methylformamide in workers exposed to N, N-dimethylformamide

OBJECTIVES

We conducted this biomonitoring study with the aim of evaluating the correlation between the excretion of N-methylformamide (NMF) (mainly from N-hydroxy- N-methylformamide) and N-acetyl- S-( N-methylcarbamoyl)cysteine (AMCC), and levels of exposure to N, N-dimethylformamide (DMF) among occupationally exposed subjects.

METHODS

Exposure levels were determined by personal sampling: breathing zone air samples were collected by means of passive samplers. DMF collected by the charcoal in personal samplers was analysed after extraction with methanol by a gas chromatograph. For the purpose of biological monitoring the levels of NMF and AMCC were measured in pre-shift and post-shift samples. Determinations were carried out by, respectively, gas chromatography and high performance liquid chromatography (HPLC).

RESULTS AND CONCLUSIONS

The mean time-weighted average (TWA) exposure was approximately half (13.5 mg/m(3)) of the current threshold limit value, the range of the values was from 0.4 to 75.2 mg/m(3). Environmental DMF concentrations exhibited a significant correlation with the specific mercapturic acid (AMCC) collected at the end of the working week (AMCC Friday morning mg/l=1.384xDMF (mg/m(3))+8.708; r(2)=0.47; P<0.008]; hence urinary AMCC represents an index of the average exposure during several preceding working days, making it possible to calculate the approximate relationship between DMF uptake and excretion of this metabolite. A significant correlation was found also between the daily excretion of NMF and the corresponding levels of DMF in air. The equation of the regression line was: NMF (mg/g creatinine)=0.936xDMF (mg/m(3))+7.306; r(2)=0.522 ( P<0.0001).

[Analysis of occupational allergies reported to the Occupational Medicine and Hygiene Service of the Pavia ASL and to the Hospital Operative Unit of Occupational Medicine in 1993-98]

In this article the cases of occupational allergic diseases notified to 2 Occupational Health Units in Pavia in the period 1993-1998 are reported. A retrospective study was performed to obtain a descriptive analysis of the diseases. In the studied period 58 cases of occupational allergic diseases were notified. This datum probably underestimates the real occurrence of occupational diseases, because of the low accuracy of the notification system. Allergic skin diseases were more frequent (70.7%) than respiratory diseases.

[Application of article 35 of the DPR 303/56: experience of the operators of the Public Occupational Services and competent physicians. Sample survey]

In the last three years 450 requests of derogation to the article 35 of legislative decree 303/56 reached one third of the Public Occupational Services, with a clear progressive increase of their number. The working risks derogation is most frequently requested for are: solvents, welding fumes and metallic dusts. The operators of the Public occupational Services employed these criteria to grant the derogation: the effectiveness of the prevention, the low concentrations of the harmful agents, the occasionality of the unhealthy working, the risk lack or scarcity. In the 80% of the cases the operators of the Public Occupational Services made an inspection in only two cases they notified breaches of the law. 350 (70%) of the requested derogation were granted, 10 (20%) are now under evaluation, 90% (20%) were not allowed. In conclusion we point out that the use of the article 35 in industries with an adequate safety organization, by means of the dilution of the periodical clinical examinations, allows to better fit the health surveillance programs to the real working risks.

[Health surveillance: from risk presumption to risk assessment]

A working group of the Occupational Medicine and Industrial Hygiene Association of Lombardy, the National Association of Occupational Health Physicians the National Society of Prevention Operators made a paper in order to rationalize the sanitary surveillance, observing the laws in force and following the European Directives. The authors, thinking that everyday experience not very useful health examinations are carried out and that the sanitary surveillance should be planned according to the real working risks, give methodological directives about the way to make the mandatory clinical examinations less frequent, to the firms, to the occupational health physician and to the public occupational health operators of the local health units that must supervise the sanitary surveillance.

[Measurement of N-methylformamide in occupational exposure to N,N-dimethylformamide]

N,N-dimethylformamide (DMF) is a solvent that is widely used in industry. The major occupational sources of exposure results from production of synthetic leather. The main metabolite formed in both man and animals is N-hydroxymethyl-N-methylformamide. Demethylation leads to N-methylformamide (NMF) and formamide and also to a small extent to hydroxy-methylformamide. All the metabolites are excreted in urine, as are very small amounts of the unchanged substance. N-acetyl-S-(N-methyl-carbamoyl)-cysteine can be determined in urine as a further metabolite. We conducted this biomonitoring study with the aim of evaluating the correlation between the excretion of N-methylformamide (mainly from N-hydroxymethylformamide) and levels of exposure to N,N-dimethylformamide among occupationally exposed people. The mean time-weighted average (TWA) exposure was about half (13.5 mg/m3) of the current threshold limit value, the range of the values varying from 0.4 to 75.2 mg/m3. A linear equation existed between urinary NMF concentration and DMF concentration in the environment. The findings show that the urinary NMF concentration can be used as an appropriate biological exposure index. The authors suggest for occupationally exposed subjects, a urinary NMF concentration corresponding to the time-weighted average of the threshold limit value of 39.9 mg/l (37.2 mg/g creatinine) and a 95% lower confidence limit (biological threshold) of 23.4 mg/l (22.2 mg/g creatinine).

[Ergonomic evaluation of the physical tasks in "precision fusion" operations]

In the present paper we performed an "on-site" ergonomic analysis of the work tasks in in-plant industrial workers. Specific work cycles have been identified and analysed. We measured spatial and temporal parameters of the different actions performed by the workers, and we then defined the related risk levels according to the internationally accepted guide-lines. The results obtained indicate the need of an ergonomic intervention with the aim of providing structural changes in the work station.

Exposure to organic solvents and its effects on the central nervous system in workers of the Camaçari petrochemical complex in Brazil

While numerous studies have been carried out in industrialized countries, only very few epidemiologic investigations performed in developing countries are reported in the international literature. This study is one of the few examples of investigations carried out in a region where industrialization is at its beginning. A sample of 188 workers employed at the Camaçari Petrochemical Complex in Bahia, Brazil, and exposed for over five years to organic solvents was submitted to neurobehavioral testing (QQS questionnaire, MANS battery) together with a 1/1 control group paired for age, school attendance and alcohol consumption. The exposed subjects showed differences significantly worse at emotional status, manual dexterity, recognition memory and subjective symptoms. Exposed subjects are therefore characterized by decreased psychophysical well-being.