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Jacobson KB, Pinsky BA, Montez Rath ME, Wang H, Miller JA, Skhiri M, Shepard J, Mathew R, Lee G, Bohman B, Parsonnet J, Holubar M. Post-Vaccination Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infections and Incidence of the Presumptive B.1.427/B.1.429 Variant Among Healthcare Personnel at a Northern California Academic Medical Center. Clin Infect Dis 2022; 74:821-828. [PMID: 34137815 PMCID: PMC8344553 DOI: 10.1093/cid/ciab554] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although mRNA-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines report >90% efficacy, breakthrough infections occur. Little is known about their effectiveness against SARS-CoV-2 variants, including the highly prevalent B.1.427/B.1.429 variant. METHODS In this quality improvement project, we collected demographic and clinical information from post-vaccine SARS-CoV-2 cases (PVSCs), defined as healthcare personnel (HCP) with positive SARS-CoV-2 nucleic acid amplification test after receiving ≥1 vaccine dose. Available specimens were tested for L452R, N501Y, and E484K mutations using reverse-transcription polymerase chain reaction. Mutation prevalence was compared among unvaccinated, early post-vaccinated (≤14 days after dose 1), partially vaccinated (positive test >14 days after dose 1 and <14 days after dose 2), and fully vaccinated (>14 days after dose 2) PVSCs. RESULTS From December 2020 to April 2021, ≥23 090 HCP received ≥1 dose of an mRNA-based SARS-CoV-2 vaccine, and 660 HCP cases of SARS-CoV-2 occurred, of which 189 were PVSCs. Among the PVSCs, 114 (60.3%), 49 (25.9%), and 26 (13.8%) were early post-vaccination, partially vaccinated, and fully vaccinated, respectively. Of 261 available samples from vaccinated and unvaccinated HCP, 103 (39.5%), including 42 PVSCs (36.5%), had the L452R mutation presumptive of B.1.427/B.1.429. When adjusted for community prevalence of B.1.427/B.1.429, PVSCs did not have significantly elevated risk of B.1.427/B.1.429 compared with unvaccinated HCP. CONCLUSIONS Most PVSCs occurred prior to expected onset of full, vaccine-derived immunity. Presumptive B.1.427/B.1.429 was not more prevalent in post-vaccine cases than in unvaccinated SARS-CoV-2 HCP. Continued infection control measures, particularly <14 days post-vaccination, and continued variant surveillance in PVSCs are imperative to control future SARS-CoV-2 surges.
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Affiliation(s)
- Karen B Jacobson
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin A Pinsky
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Maria E Montez Rath
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Hannah Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Jacob A Miller
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Mehdi Skhiri
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - John Shepard
- Department of Quality, Patient Safety and Clinical Effectiveness, Stanford Health Care, Stanford, California, USA
| | - Roshni Mathew
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, USA
| | - Grace Lee
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, USA
| | - Bryan Bohman
- Workforce Health and Wellness, Stanford University School of Medicine, Stanford, California, USA
| | - Julie Parsonnet
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Marisa Holubar
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
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Romano A, Cerchione C, Conticello C, Filetti S, Bulla A, Chiarenza A, Del Fabro V, Leotta S, Markovic U, Motta G, Parisi M, Stagno F, Palumbo GA, Di Raimondo F. Reduced Absolute Count of Monocytes in Patients Carrying Hematological Neoplasms and SARS-CoV2 Infection. Cancers (Basel) 2022; 14:cancers14051173. [PMID: 35267478 PMCID: PMC8909066 DOI: 10.3390/cancers14051173] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary In hematological neoplasms associated with COVID-19, immunological dysfunction, including reduced count of non-classical monocytes, has been suggested as a primary driver of morbidity and mortality. In this work, we investigated the contribution of absolute monocyte count to clinical outcome of COVID-19 in 120 patients affected by hematological neoplasms that tested positive to SARS-CoV-2. We found that there was no statistical difference in 30-day mortality, rate of hospitalization for intensive cure and viral clearance at 14 days between fully vaccinated and unvaccinated patients. Increased 30-day mortality was associated with presence of active/progressing disease and absolute monocyte count lower than 400 cells/uL. Reduced absolute counts of monocytes should be used as an alert of increased risk of severe/critical forms of COVID-19 in patients with hematological malignancies, even when the full vaccination cycle has been completed. Abstract Background: Clinical course of COVID-19 depends on several patient-specific risk factors, including immune function, that is largely compromised in cancer patients. Methods: We prospectively evaluated 120 adult consecutive patients (including 34 cases of COVID-19 breakthrough after two full doses of BNT162b2 vaccine) with underlying hematological malignancies and a SARS-CoV-2 infection, in terms of patient’s clinical outcome. Results: Among fully vaccinated patients the achievement of viral clearance by day 14 was more frequent than in unvaccinated patients. Increased 30-day mortality was associated with presence of active/progressing disease and absolute monocyte count lower than 400 cells/uL. Results of multivariable analysis in unvaccinated patients showed that the pre-infection absolute count of monocytes less or equal to 400 cells/mmc, active or progressive disease of the underlying hematological malignancy, the COVID-19 severity identified by hospitalization requirement and lack of viral clearance at 14 days were independent predictors of 1-year overall survival. Conclusions: Taken together, our results indicate that absolute monocyte count determined one month before any documented SARS-CoV-2 infection could identify patients affected by hematological neoplasms with increased risk of inferior overall survival.
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Affiliation(s)
- Alessandra Romano
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95124 Catania, Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori [M1] (IRST) IRCCS, 47014 Meldola (FC), Italy
- Correspondence:
| | - Concetta Conticello
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Sabina Filetti
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Anna Bulla
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Annalisa Chiarenza
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Vittorio Del Fabro
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Salvatore Leotta
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Uros Markovic
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Oncohematology and BMT Unit, Mediterranean Institute of Oncology, 95125 Viagrande, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giovanna Motta
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Marina Parisi
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Fabio Stagno
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Giuseppe Alberto Palumbo
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Ingrassia Department, University of Catania, 95100 Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95124 Catania, Italy
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