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Alispahic IA, Eklöf J, Sivapalan P, Jordan AR, Harboe ZB, Biering-Sørensen T, Jensen JUS. Risk of Mortality and Cardiovascular Events in Patients with Chronic Obstructive Pulmonary Disease Treated with Azithromycin, Roxithromycin, Clarithromycin, and Amoxicillin. J Clin Med 2024; 13:1987. [PMID: 38610752 PMCID: PMC11013008 DOI: 10.3390/jcm13071987] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Prior research has raised concerns regarding the use of macrolides and their association with an increased risk of cardiovascular events. Methods: We conducted a cohort study, where we explored the cardiovascular risks associated with the treatment of COPD patients using macrolide antibiotics-namely azithromycin, clarithromycin, and roxithromycin-with amoxicillin serving as a reference. The study focused on COPD patients in an outpatient setting and included a thorough 3-year follow-up. Patients were categorized into four groups based on their treatment. The primary analysis utilized an adjusted Cox model, supplemented by sensitivity analysis through inverse probability of treatment weighting. Results: No significant differences were found in major adverse cardiovascular events (MACE-stroke, acute myocardial infarction, cardiovascular death) between the macrolide groups, and the amoxicillin/hazard ratios (HR) were azithromycin HR = 1.01, clarithromycin HR = 0.99, and roxithromycin HR = 1.02. Similarly, sensitivity analysis showed no disparities in all-cause mortality and cardiovascular death among the groups. Conclusions: Overall, the study revealed no evidence of increased risk of MACE, all-cause mortality, or cardiovascular death in COPD patients treated with these macrolides compared to amoxicillin over a 3-year period.
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Affiliation(s)
- Imane Achir Alispahic
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, 2100 Copenhagen, Denmark; (J.E.); (P.S.); (J.-U.S.J.)
| | - Josefin Eklöf
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, 2100 Copenhagen, Denmark; (J.E.); (P.S.); (J.-U.S.J.)
| | - Pradeesh Sivapalan
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, 2100 Copenhagen, Denmark; (J.E.); (P.S.); (J.-U.S.J.)
| | - Alexander Ryder Jordan
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, 2100 Copenhagen, Denmark; (J.E.); (P.S.); (J.-U.S.J.)
| | - Zitta Barrella Harboe
- Department of Respiratory and Infectious Diseases, Copenhagen University Hospital, 3400 North Zealand, Denmark;
| | | | - Jens-Ulrik Stæhr Jensen
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, 2100 Copenhagen, Denmark; (J.E.); (P.S.); (J.-U.S.J.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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2
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Sequeros CB, Tulstrup M, Bliddal S, Sørensen KM, Nissen I, Rezahosseini O, Brooks PT, Feenstra B, Gang AO, Geller F, Hald A, Harboe ZB, Helleberg M, Jespersen JS, Lebech AM, Lindegaard B, Mogensen TH, Møller MEE, Nielsen CH, Niemann CU, Podlekareva D, Sejdic A, Sørensen E, Teglgaard RS, Tommerup N, Weis N, Brunak S, Pedersen OBV, Banasik K, Feldt-Rasmussen U, Nielsen SD, Ostrowski SR, Grønbæk K. Clonal hematopoiesis and COVID-19 hospitalization in Danish adults. Hemasphere 2024; 8:e58. [PMID: 38463443 PMCID: PMC10924741 DOI: 10.1002/hem3.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Affiliation(s)
- Celia Burgos Sequeros
- Translational Disease Systems Biology, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Morten Tulstrup
- Department of Haematology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Biotech Research and Innovation Center (BRIC) University of Copenhagen Copenhagen Denmark
| | - Sofie Bliddal
- Department of Endocrinology and Metabolism Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | | | - Ioanna Nissen
- Department of Clinical Immunology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Omid Rezahosseini
- Department of Respiratory Medicine and Infectious Diseases Copenhagen University Hospital, North Zealand Hillerød Denmark
| | - Patrick Terrence Brooks
- Department of Clinical Immunology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Bjarke Feenstra
- Department of Clinical Immunology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Anne Ortved Gang
- Department of Haematology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
| | - Frank Geller
- Department of Clinical Immunology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Annemette Hald
- Department of Infectious Diseases Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases Copenhagen University Hospital, North Zealand Hillerød Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
| | - Marie Helleberg
- Department of Infectious Diseases Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Center of Excellence for Health, Immunity and Infections Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Jakob S Jespersen
- Biotech Research and Innovation Center (BRIC) University of Copenhagen Copenhagen Denmark
- The Finsen Laboratory Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Anne-Mette Lebech
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
- Department of Infectious Diseases Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Birgitte Lindegaard
- Department of Respiratory Medicine and Infectious Diseases Copenhagen University Hospital, North Zealand Hillerød Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
| | - Trine H Mogensen
- Department of Infectious Diseases Aarhus University Hospital Aarhus Denmark
- Department of Biomedicine Aarhus University Aarhus Denmark
| | | | - Claus Henrik Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Carsten Utoft Niemann
- Department of Haematology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
| | - Daria Podlekareva
- Department of Respiratory Medicine and Infectious Diseases Copenhagen University Hospital, Bispebjerg Copenhagen Denmark
| | - Adin Sejdic
- Department of Respiratory Medicine and Infectious Diseases Copenhagen University Hospital, North Zealand Hillerød Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Rebecca Svanberg Teglgaard
- Department of Haematology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Department of Clinical Immunology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Niels Tommerup
- Department of Cellular and Molecular Medicine University of Copenhagen Denmark
| | - Nina Weis
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
- Department of Infectious Diseases Copenhagen University Hospital, Hvidovre Copenhagen Denmark
| | - Søren Brunak
- Translational Disease Systems Biology, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Ole Birger Vestager Pedersen
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
- Department of Clinical Immunology Zealand University Hospital Køge Denmark
| | - Karina Banasik
- Translational Disease Systems Biology, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Gynecology and Obstetrics Copenhagen University Hospital, Hvidovre Copenhagen Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
- Department of Infectious Diseases Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
| | - Kirsten Grønbæk
- Department of Haematology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Biotech Research and Innovation Center (BRIC) University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences University of Copenhagen Copenhagen Denmark
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3
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Harboe ZB, Holler JG, Eiberg MF, Roed C, Rezahosseini O. Outcomes of Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant, Influenza, and Respiratory Syncytial Virus on the Dissecting Table: Is Further Dissection Required? Clin Infect Dis 2024:ciad739. [PMID: 38173175 DOI: 10.1093/cid/ciad739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Jon Gitz Holler
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
| | - Mads Frederik Eiberg
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
| | - Casper Roed
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Omid Rezahosseini
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
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Harboe ZB, Hald A, Ekenberg C, Ete Wareham N, Fogt Lundbo L, Holler JG, Qvist T, Rask Hamm S, Bjerrum S, Rezahosseini O, Suno Krohn P, Gustafsson F, Perch M, Rasmussen A, Dam Nielsen S. Implementation of a vaccination clinic for adult solid organ transplant candidates: A single-center experience. Vaccine 2023; 41:6637-6644. [PMID: 37775467 DOI: 10.1016/j.vaccine.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
Vaccination is an evidence-based strategy to prevent or reduce the severity of infectious diseases (ID). Here, we aimed to describe the experience of implementing a vaccination clinic specifically targeting liver, heart, lung, and combined dual organ transplantation at a single transplantation center in Denmark. In this cohort of 242 solid organ transplant (SOT) candidates, we investigated seroprotection and the proportion of recommended vaccinations documented before transplantation. Furthermore, we registered completed vaccinations after ID consultations. The median age in our cohort was 53 years (IQR, 42-60), 60% were males (n = 135), and liver transplants (n = 138; 57%) were the most frequently planned organ transplants. Before the consultation to the vaccination clinic, influenza and pneumococcal vaccines had the highest proportion of documented vaccination (58% and 37%, respectively). Serological protection was more frequently observed for measles, mumps, or rubella (MMR, approximately 90% for each), while only 30% (n = 72) of SOT candidates showed seroprotection against pneumococcal disease. All SOT candidates required at least one of the recommended vaccines, and over 90% required three or more. At least 10% of patients in our cohort needed a live attenuated vaccine for either MMR or yellow fever. The most frequently administered vaccine was the tetanus-diphtheria-acelullar pertussis (Tdap) booster (n = 217; 90%), influenza vaccination was either administered (n = 16; 7%) or recommended (n = 226; 93%), PCV13 was administered (n = 155; 64%) or recommended (n = 27; 11%), and PPSV23 was either administered (n = 18; 7.4%) or recommended (n = 140; 58%). All SOT candidates adhered completely to their vaccination schedules. Based on our findings, we recommend prioritizing vaccination before transplantation by providing ID consultations for SOT candidates.
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Affiliation(s)
- Zitta Barrella Harboe
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
| | - Annemette Hald
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christina Ekenberg
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Neval Ete Wareham
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lene Fogt Lundbo
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jon Gitz Holler
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Tavs Qvist
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Rask Hamm
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Stephanie Bjerrum
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Omid Rezahosseini
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Paul Suno Krohn
- Department of Surgical Gastroenterology, Liver Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Heart and Lung Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Heart and Lung Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Liver Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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5
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Hamm SR, Saini SK, Hald A, Vaaben AV, Pedersen NW, Suarez-Zdunek MA, Harboe ZB, Bruunsgaard H, Johansen IS, Larsen CS, Bistrup C, Birn H, Sørensen SS, Hadrup SR, Nielsen SD. Herpes Virus Infections in Kidney Transplant Patients (HINT) - a prospective observational cohort study. BMC Infect Dis 2023; 23:687. [PMID: 37845608 PMCID: PMC10578002 DOI: 10.1186/s12879-023-08663-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Kidney transplant recipients receive maintenance immunosuppressive therapy to avoid allograft rejection resulting in increased risk of infections and infection-related morbidity and mortality. Approximately 98% of adults are infected with varicella zoster virus, which upon reactivation causes herpes zoster. The incidence of herpes zoster is higher in kidney transplant recipients than in immunocompetent individuals, and kidney transplant recipients are at increased risk of severe herpes zoster-associated disease. Vaccination with adjuvanted recombinant glycoprotein E subunit herpes zoster vaccine (RZV) prevents herpes zoster in older adults with excellent efficacy (90%), and vaccination of kidney transplant candidates is recommended in Danish and international guidelines. However, the robustness and duration of immune responses after RZV vaccination, as well as the optimal timing of vaccination in relation to transplantation remain unanswered questions. Thus, the aim of this study is to characterize the immune response to RZV vaccination in kidney transplant candidates and recipients at different timepoints before and after transplantation. METHODS The Herpes Virus Infections in Kidney Transplant Patients (HINT) study is a prospective observational cohort study. The study will include kidney transplant candidates on the waiting list for transplantation (n = 375) and kidney transplant recipients transplanted since January 1, 2019 (n = 500) from all Danish kidney transplant centers who are offered a RZV vaccine as routine care. Participants are followed with repeated blood sampling until 12 months after inclusion. In the case of transplantation or herpes zoster disease, additional blood samples will be collected until 12 months after transplantation. The immune response will be characterized by immunophenotyping and functional characterization of varicella zoster virus-specific T cells, by detection of anti-glycoprotein E antibodies, and by measuring cytokine profiles. DISCUSSION The study will provide new knowledge on the immune response to RZV vaccination in kidney transplant candidates and recipients and the robustness and duration of the response, potentially enhancing preventive strategies against herpes zoster in a population at increased risk. TRIAL REGISTRATION ClinicalTrials.gov (NCT05604911).
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Affiliation(s)
- Sebastian Rask Hamm
- Viro-Immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sunil Kumar Saini
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Annemette Hald
- Viro-Immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anna V Vaaben
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Natasja Wulff Pedersen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Moises Alberto Suarez-Zdunek
- Viro-Immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle Bruunsgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Claus Bistrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, and Departments of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sine Reker Hadrup
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Susanne Dam Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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6
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Rezahosseini O, Roed C, Gitz Holler J, Frimodt-Møller N, Harboe ZB. Adjunctive antibiotic therapy with clindamycin or linezolid in patients with group A streptococcus (GAS) meningitis. Infect Dis (Lond) 2023; 55:751-753. [PMID: 37415443 DOI: 10.1080/23744235.2023.2231073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Omid Rezahosseini
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
| | - Casper Roed
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
| | - Jon Gitz Holler
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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7
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Heerfordt CK, Rønn C, Harboe ZB, Ingebrigtsen TS, Svorre Jordan A, Wilcke JT, Bonnesen B, Biering-Sørensen T, Sørensen R, Holler JG, Itenov TS, Johansen HK, Sivapalan P, Eklöf J, Jensen JUS. Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease: a nationwide cohort study. BMJ Open Respir Res 2023; 10:e001814. [PMID: 37775111 PMCID: PMC10546164 DOI: 10.1136/bmjresp-2023-001814] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Inhaled corticosteroids (ICSs) are associated with an increased risk of pneumonia among patients with chronic obstructive pulmonary disease (COPD). The introduction of extrafine particle ICS has aimed to improve the distribution of medicine in the airways by altering deposition within the lungs, potentially affecting efficacy and side effects. It remains unclear if extrafine particle ICS administration alters the risk of pneumonia compared with standard particle size ICS. METHODS An observational cohort study including all Danish COPD outpatients receiving ICS from 2010 to 2017. The primary outcome was pneumonia hospitalisation in the different ICS particle dosing regimens. The primary analysis was an adjusted Cox proportional hazards model. For sensitivity analysis, a subgroup analysis of patients receiving spray devices was done. Further, we created a propensity score matched cohort, in which we matched for the same covariates as adjusted for in the main analysis. RESULTS A total of 35 691 patients were included of whom 1471 received extrafine particle ICS. Among these patients, 4657 were hospitalised due to pneumonia. Patients with COPD receiving extrafine particle ICS had a lower risk of hospitalisation due to pneumonia compared with patients receiving standard particle size ICS in our primary analysis (HR 0.75; 95% CI 0.63 to 0.89; p=0.002), subgroup analysis (HR 0.54; 95% CI 0.45 to 0.65; p<0.0001) and the propensity-matched population (HR 0.72; 95% CI 0.60 to 0.87; p=0.0006). INTERPRETATION The use of extrafine particle ICS administration was associated with a lower risk of pneumonia hospitalisation in patients with COPD compared with those who received standard size treatment.
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Affiliation(s)
- Christian Kjer Heerfordt
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Christian Rønn
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Truls Sylvan Ingebrigtsen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Alexander Svorre Jordan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Jon Torgny Wilcke
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Barbara Bonnesen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Faculty of Biomedical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark
| | - Jon Gitz Holler
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | | | - Helle Krogh Johansen
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Department of Clinical Microbiology, Rigshospitalet, København, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, PERSIMUNE & CHIP, Kobenhavn, Denmark
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8
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Rezahosseini O, Harboe ZB. Risk of Acute Myocardial Infarction Following Invasive Pneumococcal Disease: How Much Is Due to Antibiotic Treatments? Clin Infect Dis 2023; 77:330. [PMID: 36975109 DOI: 10.1093/cid/ciad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Omid Rezahosseini
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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9
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Rømer V, Sivapalan P, Eklöf J, Nielsen SD, Harboe ZB, Biering-Sørensen T, Itenov T, Jensen JUS. SARS-CoV-2 and risk of psychiatric hospital admission and use of psychopharmaceuticals: A nationwide registry study of 4,585,083 adult Danish citizens. Eur Psychiatry 2023:1-26. [PMID: 37282564 DOI: 10.1192/j.eurpsy.2023.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- Valdemar Rømer
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Theis Itenov
- Centre for Health and Infectious Diseases Research (CHIP), University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Anaesthesiology and Intensive Care, University Hospital of Copenhagen, Bispebjerg, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, Hellerup, Denmark
- Centre for Health and Infectious Diseases Research (CHIP), University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen
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10
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Bukan K, Pearce-Slade T, Eiberg M, Tinelli M, Yahav D, Tuells J, Epaulard O, Holler JG, Roed C, Søborg C, Jensen JUS, Harboe ZB. Exclusion of older adults and immunocompromised individuals in influenza, pneumococcal and COVID-19 vaccine trials before and after the COVID-19 pandemic. Aging Clin Exp Res 2023; 35:917-923. [PMID: 37027085 PMCID: PMC10080508 DOI: 10.1007/s40520-023-02380-4] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/25/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Older adults and immunocompromised individulas are often excluded from vaccine trials. AIM We hypothesised that during the coronavirus disease 2019 (COVID-19) pandemic, the proportion of trials excluding these patients decreased. METHODS Using the US Food and Drug Administration and and European Medicines Agency search engines, we identified all vaccines approved against pneumococcal disease, influenza (quadrivalent vaccines), and COVID-19 from 2011 to 2021. Study protocols were screened for direct and indirect age exclusion criteria and exclusion of immunocompromised individuals. In addition, we reviewed the studies with no explicit exclusion criteria and investigated the actual inclusion of those individuals. RESULTS We identified 2024 trial records; 1702 were excluded (e.g., use of other vaccine or risk group); and 322 studies were eligible for our review. Among the pneumococcal and influenza vaccine trials (n = 193), 81 (42%) had an explicit direct age exclusion, and 150 (78%) had an indirect age-related exclusion. In total, 163 trials (84%) trials were likely to exclude older adults. Among the COVID-19 vaccine trials (n = 129), 33 (26%) had direct age exclusion and 82 (64%) had indirect age exclusion; in total, 85 (66%) trials were likely to exclude older adults. Therefore was a 18% decrease in the proportion of trials with age-related exclusion between 2011 and 2021 (only influenza and pneumococcal vaccine trials) and 2020-2021 (only COVID-19 vaccine trials) (p = 0.014). In a sub-analysis assessing observational and randomised trials, the decrease was 25% and 9%, respectively. Immunocompromised individuals were included in 87 (45%) of the pneumococcal and influenza vaccine trials compared with 54 (42%) of the COVID-19 vaccine trials (p = 0.058). CONCLUSIONS During the COVID-19 pandemic, we found a decrease in the exclusion of older adults from vaccine trials but no significant change in the inclusion of immunocompromised individulas.
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Affiliation(s)
- Katrine Bukan
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Toby Pearce-Slade
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Mads Eiberg
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marco Tinelli
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in the Elderly (ESGIE), Basel, Switzerland
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Dafna Yahav
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in the Elderly (ESGIE), Basel, Switzerland
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Jose Tuells
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Vaccine Study Group (EVASG), Basel, Switzerland
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Olivier Epaulard
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Vaccine Study Group (EVASG), Basel, Switzerland
- Infectious Disease Unit, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Jon G Holler
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Casper Roed
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Christian Søborg
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerød, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in the Elderly (ESGIE), Basel, Switzerland.
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Vaccine Study Group (EVASG), Basel, Switzerland.
- Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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11
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Leding C, Bodilsen J, Brieghel C, Harboe ZB, Helleberg M, Holm C, Israelsen SB, Jensen J, Jensen TØ, Johansen IS, Johnsen S, Kirk O, Lindegaard B, Meyer CN, Mohey R, Pedersen L, Nielsen H, Nielsen SL, Omland LH, Podlekareva D, Ravn P, Starling J, Storgaard M, Søborg C, Søgaard OS, Tranborg T, Wiese L, Worm SHW, Christensen HR, Benfield T. Treatment effect modifiers in hospitalised patients with COVID-19 receiving remdesivir and dexamethasone. Infect Dis (Lond) 2023; 55:351-360. [PMID: 36905638 DOI: 10.1080/23744235.2023.2187081] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The combined effectiveness of remdesivir and dexamethasone in subgroups of hospitalised patients with COVID-19 is poorly investigated. METHODS In this nationwide retrospective cohort study, we included 3826 patients with COVID-19 hospitalised between February 2020 and April 2021. The primary outcomes were use of invasive mechanical ventilation and 30-day mortality, comparing a cohort treated with remdesivir and dexamethasone with a previous cohort treated without remdesivir and dexamethasone. We used inverse probability of treatment weighting logistic regression to assess associations with progression to invasive mechanical ventilation and 30-day mortality between the two cohorts. The analyses were conducted overall and by subgroups based on patient characteristics. RESULTS Odds ratio for progression to invasive mechanical ventilation and 30-day mortality in individuals treated with remdesivir and dexamethasone compared to treatment with standard of care alone was 0.46 (95% confidence interval, 0.37-0.57) and 0.47 (95% confidence interval, 0.39-0.56), respectively. The reduced risk of mortality was observed in elderly patients, overweight patients and in patients requiring supplemental oxygen at admission, regardless of sex, comorbidities and symptom duration. CONCLUSIONS Patients treated with remdesivir and dexamethasone had significantly improved outcomes compared to patients treated with standard of care alone. These effects were observed in most patient subgroups.
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Affiliation(s)
- Cæcilie Leding
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Brieghel
- Department of Infectious Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Claire Holm
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Simone Bastrup Israelsen
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Janne Jensen
- Department of Medicine, Kolding Hospital, Kolding, Denmark
| | - Tomas Østergaard Jensen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Denmark
| | - Isik Somuncu Johansen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Stine Johnsen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Rajesh Mohey
- Department of Medicine, Herning Hospital, Herning, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Lønberg Nielsen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Daria Podlekareva
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Pernille Ravn
- Department of Infectious Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Jonathan Starling
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Søborg
- Department of Infectious Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | | | - Lothar Wiese
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Signe Heide Westring Worm
- Department of Infectious Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Hanne Rolighed Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thomas Benfield
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Denmark
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12
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Thomsen MM, Munthe-Fog L, Trier Petersen P, Hillig T, Friis-Hansen LJ, Roed C, Harboe ZB, Brandt CT. Pentraxin 3 in the cerebrospinal fluid during central nervous system infections: A retrospective cohort study. PLoS One 2023; 18:e0282004. [PMID: 36862691 PMCID: PMC9980753 DOI: 10.1371/journal.pone.0282004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
The present study describes diagnostic and prognostic abilities of Cerebrospinal fluid (CSF) Pentraxin 3 (PTX3) in central nervous system (CNS) infections. CSF PTX3 was measured retrospectively from 174 patients admitted under suspicion of CNS infection. Medians, ROC curves and Youdens index was calculated. CSF PTX3 was significantly higher among all CNS infections and undetectable in most of the patients in the control group, and significantly higher in bacterial infections compared to viral and Lyme infections. No association was found between CSF PTX3 and Glasgow Outcome Score. PTX3 in the CSF can distinguish bacterial infection from viral and Lyme infections and non-CNS infections. Highest levels were found in bacterial meningitis. No prognostic abilities were found.
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Affiliation(s)
- Martin Munthe Thomsen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
- * E-mail:
| | - Lea Munthe-Fog
- Stemform/StemMedical, Cell Production and RnD, Søborg, Copenhagen Region, Denmark
| | - Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
| | - Lennart Jan Friis-Hansen
- Department of Clinical Biochemistry, University Hospitals Bispebjerg and Frederiksberg, University of Copenhagen, Copenhagen, Denmark
| | - Casper Roed
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Region, Copenhagen, Denmark
| | - Christian Thomas Brandt
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Region, Copenhagen, Denmark
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
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13
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Svanberg R, MacPherson C, Zucco A, Agius R, Faitova T, Andersen MA, da Cunha-Bang C, Gjærde LK, Møller MEE, Brooks PT, Lindegaard B, Sejdic A, Harboe ZB, Gang AO, Hersby DS, Brieghel C, Nielsen SD, Podlekareva D, Hald A, Bay JT, Marquart H, Lundgren J, Lebech AM, Helleberg M, Niemann CU, Ostrowski SR. Erratum: Author Correction: Early stimulated immune responses predict clinical disease severity in hospitalized COVID-19 patients. Commun Med (Lond) 2023; 3:15. [PMID: 38625315 PMCID: PMC9893954 DOI: 10.1038/s43856-023-00248-2] [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] [Indexed: 02/05/2023] Open
Abstract
[This corrects the article DOI: 10.1038/s43856-022-00178-5.].
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Affiliation(s)
- Rebecka Svanberg
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cameron MacPherson
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Adrian Zucco
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rudi Agius
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tereza Faitova
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Asger Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Caspar da Cunha-Bang
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Klingen Gjærde
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Patrick Terrence Brooks
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Adin Sejdic
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
- Department of Virus & Microbiological Special Diagnostics, Division of Infectious Disease Preparedness and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Ortved Gang
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Section of Infectious Diseases, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Section of Infectious Diseases, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Christian Brieghel
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Section of Infectious Diseases, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daria Podlekareva
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Annemette Hald
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Thaning Bay
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Marquart
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Lundgren
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Rezahosseini O, Hamm SR, Heftdal LD, Pérez-Alós L, Møller DL, Perch M, Madsen JR, Hald A, Hansen CB, Armenteros JJA, Pries-Heje MM, Hasselbalch RB, Fogh K, Frikke-Schmidt R, Hilsted LM, Sørensen E, Ostrowski SR, Harboe ZB, Iversen K, Bundgaard H, Sørensen SS, Rasmussen A, Garred P, Nielsen SD. Humoral and T-cell response 12 months after the first BNT162b2 vaccination in solid organ transplant recipients and controls: Kinetics, associated factors, and role of SARS-CoV-2 infection. Front Immunol 2023; 13:1075423. [PMID: 36713395 PMCID: PMC9880190 DOI: 10.3389/fimmu.2022.1075423] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction We investigated humoral and T-cell responses within 12 months after first BNT162b2 vaccine in solid organ transplant (SOT) recipients and controls who had received at least three vaccine doses. Furthermore, we compared the immune response in participants with and without previous SARS-CoV-2 infection. Methods We included adult liver, lung, and kidney transplant recipients, and controls were selected from a parallel cohort of healthcare workers. Results At 12th-month, the IgG geometric mean concentrations (GMCs) (P<0.001), IgA GMCs (P=0.003), and median IFN-γ (P<0.001) were lower in SOT recipients than in controls. However, in SOT recipients and controls with previous infection, the neutralizing index was 99%, and the IgG, and IgA responses were comparable. After adjustment, female-sex (aOR: 3.6, P<0.009), kidney (aOR: 7.0, P= 0.008) or lung transplantation (aOR: 7.5, P= 0.014), and use of mycophenolate (aOR: 5.2, P=0.03) were associated with low IgG non response. Age (OR:1.4, P=0.038), time from transplantation to first vaccine (OR: 0.45, P<0.035), and previous SARS-CoV-2 infection (OR: 0.14, P<0.001), were associated with low IgA non response. Diabetes (OR:2.4, P=0.044) was associated with T-cell non response. Conclusion In conclusion, humoral and T-cell responses were inferior in SOT recipients without previous SARS-CoV-2 infection but comparable to controls in SOT recipients with previous infection.
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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sebastian Rask Hamm
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Line Dam Heftdal
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johannes Roth Madsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annemette Hald
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jose Juan Almagro Armenteros
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mia Marie Pries-Heje
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark,Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kamille Fogh
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark,Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Linda Maria Hilsted
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Section 2034, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Immunology, Section 2034, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Pulmonary and Infectious Diseases, Hospital of North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark,Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,*Correspondence: Susanne Dam Nielsen,
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15
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Heerfordt CK, Eklöf J, Sivapalan P, Ingebrigtsen TS, Biering-Sørensen T, Harboe ZB, Koefod Petersen J, Andersen CØ, Boel JB, Bock AK, Mathioudakis AG, Hurst JR, Kolekar S, Johansson SL, Bangsborg JM, Jarløv JO, Dessau RB, Laursen CB, Perch M, Jensen JUS. Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and Risk of Acquiring Streptococcus pneumoniae Infection. A Multiregional Epidemiological Study. Int J Chron Obstruct Pulmon Dis 2023; 18:373-384. [PMID: 36974273 PMCID: PMC10039661 DOI: 10.2147/copd.s386518] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023] Open
Abstract
Background Inhaled corticosteroids (ICS) are associated with an increased risk of clinical pneumonia among patients with chronic obstructive pulmonary disease (COPD). It is unknown whether the risk of microbiologically verified pneumonia such as pneumococcal pneumonia is increased in ICS users. Methods The study population consists of all COPD patients followed in outpatient clinics in eastern Denmark during 2010-2017. ICS use was categorized into four categories based on accumulated use. A Cox proportional hazard regression model was used adjusting for age, body mass index, sex, airflow limitation, use of oral corticosteroids, smoking, and year of cohort entry. A propensity score matched analysis was performed for sensitivity analyses. Findings A total of 21,438 patients were included. Five hundred and eighty-two (2.6%) patients acquired a positive lower airway tract sample with S. pneumoniae during follow-up. In the multivariable analysis ICS-use was associated with a dose-dependent risk of S. pneumoniae as follows: low ICS dose: HR 1.11, 95% CI 0.84 to 1.45, p = 0.5; moderate ICS dose: HR 1.47, 95% CI 1.13 to 1.90, p = 0.004; high ICS dose: HR 1.77, 95% CI 1.38 to 2.29, p < 0.0001, compared to no ICS use. Sensitivity analyses confirmed these results. Interpretation Use of ICS in patients with severe COPD was associated with an increased and dose-dependent risk of acquiring S. pneumoniae, but only for moderate and high dose. Caution should be taken when administering high dose of ICS to patients with COPD. Low dose of ICS seemed not to carry this risk.
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Affiliation(s)
- Christian Kjer Heerfordt
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
- Correspondence: Christian Kjer Heerfordt, Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark, Tel +4523303431, Email
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Truls Sylvan Ingebrigtsen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
- Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
| | - Jesper Koefod Petersen
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Pulmonary Medicine, Zealand University Hospital, Roskilde, Denmark
| | | | - Jonas Bredtoft Boel
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Anne Kathrine Bock
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Alexander G Mathioudakis
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Shailesh Kolekar
- Department of Pulmonary Medicine, Zealand University Hospital, Roskilde, Denmark
| | | | - Jette Marie Bangsborg
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark
| | - Christian Borbjerg Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Perch
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- PERSIMUNE & CHIP: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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16
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Rønn C, Sivapalan P, Eklöf J, Kamstrup P, Biering-Sørensen T, Bonnesen B, Harboe ZB, Browatzki A, Kjærgaard JL, Meyer CN, Jensen TT, Johansson SL, Bendstrup E, Ulrik CS, Stæhr Jensen JU. Hospitalization for chronic obstructive pulmonary disease and pneumonia: association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients. Clin Microbiol Infect 2022; 29:523-529. [PMID: 36503112 DOI: 10.1016/j.cmi.2022.11.029] [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: 07/29/2022] [Revised: 10/18/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES International guidelines only advocate the use of inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) experiencing recurring exacerbations and eosinophilic inflammation. However, ICSs are commonly used in patients with COPD and without exacerbations and signs of eosinophilic inflammation, thus possibly increasing the risk of hospitalization for pneumonia. Thus, we aimed to determine the risk of hospitalization for pneumonia associated with increasing cumulated ICS doses among patients with COPD to establish whether there is dose dependency. METHODS A retrospective cohort study included all patients with COPD treated at a respiratory outpatient clinic in Denmark. The patients were divided into four groups based on their average daily ICS exposure. The dose-response relationship was investigated using a multivariable Cox proportional hazard regression analysis. RESULTS In total, 52 100 patients were included, who were divided into the no-use (n = 15 755), low-dose (n = 12 050), moderate-dose (n = 12 488), and high-dose (n = 11 807) groups. ICS use was strongly associated with hospitalization for pneumonia (hazard ratio [HR], 1.3; CI, 1.2-1.3) (ICS vs. no ICS). The risk of hospitalization for pneumonia increased with every dosing group step: low dose: HR, 1.1 (CI, 1.0-1.2); moderate dose: HR, 1.2 (CI, 1.1-1.3), and high dose: HR, 1.5 (CI, 1.4-1.6); "no use" was the reference. Sensitivity analyses confirmed these findings. CONCLUSIONS In the dose-response relationship analysis, ICS dose were associated with a substantially increased risk of hospitalization for pneumonia of up to 50%. Our data support that ICSs should be administered at the lowest possible dose and only to patients with COPD who have a documented need.
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Affiliation(s)
- Christian Rønn
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark.
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Gentofte, Hellerup, Denmark; Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Barbara Bonnesen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerod, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Jakob Lyngby Kjærgaard
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Christian Niels Meyer
- Department of Pulmonary Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | | | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Hamm SR, Rezahosseini O, Møller DL, Loft JA, Poulsen JR, Knudsen JD, Pedersen MS, Schønning K, Harboe ZB, Rasmussen A, Sørensen SS, Nielsen SD. Incidence and severity of SARS-CoV-2 infections in liver and kidney transplant recipients in the post-vaccination era: Real-life data from Denmark. Am J Transplant 2022; 22:2637-2650. [PMID: 35801693 PMCID: PMC9349423 DOI: 10.1111/ajt.17141] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 07/03/2022] [Indexed: 01/25/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has been associated with a high risk of adverse outcomes in solid organ transplant (SOT) recipients in the pre-vaccination era. In this retrospective cohort study, we examined the incidence and severity of COVID-19 in kidney and liver transplant recipients in Denmark in the post-vaccination era, from December 27, 2020, to December 27, 2021. We included 1428 SOT recipients with 143 cases of first-positive SARS-CoV-2 PCR test. The cumulative incidence of first-positive SARS-CoV-2 PCR test 1 year after initiation of vaccination was 10.4% (95% CI: 8.8-12.0), and the incidence was higher in kidney than in liver transplant recipients (11.6% [95% CI: 9.4-13.8] vs. 7.4% [95% CI: 5.1-9.8], p = .009). After the first-positive SARS-CoV-2 PCR test, the hospitalization rate was 31.5% (95% CI: 23.9-39.1), and 30-day all-cause mortality was 3.7% (95% CI: 0.5-6.8). Hospitalization was lower in vaccinated than in unvaccinated SOT recipients (26.4% [95% CI: 18.1-34.6] vs. 48.5% [95% CI: 31.4-65.5], p = .011), as was mortality (1.8% [95% CI: 0.0-4.3] vs. 9.1% [95% CI: 0.0-18.9], p = .047). In conclusion, SOT recipients remain at high risk of adverse outcomes after SARS-CoV-2 infections, with a lower risk observed in vaccinated than in unvaccinated SOT recipients.
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Affiliation(s)
- Sebastian Rask Hamm
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Josefine Amalie Loft
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Johan Runge Poulsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Martin Schou Pedersen
- Department of Clinical Microbiology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Kristian Schønning
- Department of Clinical Microbiology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Hospital of North Zealand Copenhagen University Hospital Hillerød Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Allan Rasmussen
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark,Department of Nephrology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark,Susanne Dam Nielsen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, København, Denmark.
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18
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Harboe ZB, Modin D, Gustafsson F, Perch M, Gislason G, Sørensen SS, Rasmussen A, Biering‐Sørensen T, Nielsen SD. Effect of influenza vaccination in solid organ transplant recipients: A nationwide population-based cohort study. Am J Transplant 2022; 22:2409-2417. [PMID: 35384275 PMCID: PMC9790571 DOI: 10.1111/ajt.17055] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
Vaccination can prevent influenza in solid organ transplant (SOT) recipients. Using a modified season-specific approach over nine consecutive influenza seasons, we investigated influenza vaccination coverage and effectiveness in a population-based nationwide cohort study that included all SOT recipients aged ≥18 years who were living in Denmark from December 1, 2007 to April 1, 2016. The primary outcome was the season-specific risk of all-cause pneumonia admission. Secondary outcomes were season-specific influenza-related admission, intensive care unit (ICU) admission, and all-cause mortality. Crude and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. In total, 11 381 person-years of follow-up data were collected from 5745 SOT recipients, 48% of whom were vaccinated. Influenza vaccination was associated with a reduced risk of all-cause pneumonia admission (aHR, 0.83; 95% CI, 0.69-0.99; p = .035) and all-cause mortality (aHR, 0.60; 95% CI, 0.47-0.76; p = .001), but not influenza-related admission (aHR, 0.75; 95% CI, 0.46-1.22; p = .24) or ICU admission (aHR, 0.84; 95% CI, 0.67-1.06; p = .14) during the same season. Despite these benefits, uptake of influenza vaccination among SOT recipients was low. Therefore, annual influenza vaccination needs to be prioritized.
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Affiliation(s)
- Zitta Barrella Harboe
- Department of Infectious DiseasesVaccination Clinic for ImmunocompromisedUniversity Hospital of CopenhagenCopenhagenDenmark,Department of Pulmonary and Infectious DiseasesUniversity Hospital of CopenhagenCopenhagenDenmark,Department of Clinical MedicineFaculty of Health and Medical ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Daniel Modin
- Department of CardiologyUniversity of CopenhagenHerlev & Gentofte HospitalCopenhagenDenmark
| | - Finn Gustafsson
- Department of Clinical MedicineFaculty of Health and Medical ScienceUniversity of CopenhagenCopenhagenDenmark,Department of Cardiology, Heart and Lung Transplant UnitUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Michael Perch
- Department of Clinical MedicineFaculty of Health and Medical ScienceUniversity of CopenhagenCopenhagenDenmark,Department of Cardiology, Heart and Lung Transplant UnitUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Gunnar Gislason
- Department of Clinical MedicineFaculty of Health and Medical ScienceUniversity of CopenhagenCopenhagenDenmark,Department of CardiologyUniversity of CopenhagenHerlev & Gentofte HospitalCopenhagenDenmark
| | - Søren Schwartz Sørensen
- Department of Clinical MedicineFaculty of Health and Medical ScienceUniversity of CopenhagenCopenhagenDenmark,Department of NephrologyKidney Transplant UnitUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Allan Rasmussen
- Department of Surgical GastroenterologyLiver Transplant UnitUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Tor Biering‐Sørensen
- Department of CardiologyUniversity of CopenhagenHerlev & Gentofte HospitalCopenhagenDenmark,Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Susanne Dam Nielsen
- Department of Infectious DiseasesVaccination Clinic for ImmunocompromisedUniversity Hospital of CopenhagenCopenhagenDenmark,Department of Clinical MedicineFaculty of Health and Medical ScienceUniversity of CopenhagenCopenhagenDenmark
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19
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Rezahosseini O, Liljendahl MS, Loft N, Møller DL, Harboe ZB, Rasmussen MK, Ajgeiy KK, Egeberg A, Skov L, Nielsen SD. Incidence, risk factors, and consequences of human alphaherpesvirus infections in patients with psoriasis who initiate methotrexate or biologic agents. J Infect Dis 2022; 226:1510-1518. [PMID: 36097341 DOI: 10.1093/infdis/jiac367] [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: 06/15/2022] [Accepted: 09/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Immunosuppressive agents may increase the risk of infections with human alphaherpesviruses. METHODS We included all adult patients with moderate to severe psoriasis who initiated methotrexate (MTX) or biologic agents in a retrospective cohort study. An episode of alphaherpesviruses infection was defined as filling a prescription for systemic acyclovir, valacyclovir, or famciclovir. Using nation-wide registries, we determined the incidence, risk factors, 180-days hospital contacts, and 30-days mortality following infection. RESULTS We included 7,294 patients; 4,978 (68%) received MTX, and 2,316 (32%) biologic agents. The incidence rates [95% CI] of alphaherpesviruses were 23 [20-27], 26 [19-35], 17 [11-27] and 6.7 [1.3-21] per 1000 PYFU in patients on MTX, TNFα-, IL-12/23-, and IL-17 inhibitors, respectively. Males had an unadjusted HR of 0.47 (P < 0.001) for alphaherpesvirus infection. Patients on IL-17 inhibitors had an adjusted HR of 0.24 (P = 0.048) compared to TNFα inhibitors. Within 180-days after infection, 13%, 7.5%, and <0.5% of patients on MTX, TNFα inhibitors, and IL-12/23 or IL-17 inhibitors, respectively, had hospital contacts, and the 30-days mortality for all groups was <0.5%. CONCLUSIONS The incidence and risk of alphaherpesvirus infections was comparable between patients on MTX and TNFα inhibitors, while use of IL-17 inhibitors was associated with a lower risk.
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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mie Sylow Liljendahl
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, .,Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nikolai Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen,
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen,
| | - Zitta Barrella Harboe
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, .,Department of Pulmonary and Infectious Diseases, Hospital of Nordsjælland, Nordsjællands University Hospital, Denmark
| | | | - Kawa Khaled Ajgeiy
- DERMBIO, .,Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, .,DERMBIO, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,DERMBIO, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Svanberg R, MacPherson C, Zucco A, Agius R, Faitova T, Andersen MA, da Cunha-Bang C, Gjærde LK, Møller MEE, Brooks PT, Lindegaard B, Sejdic A, Harboe ZB, Gang AO, Hersby DS, Brieghel C, Nielsen SD, Podlekareva D, Hald A, Bay JT, Marquart H, Lundgren J, Lebech AM, Helleberg M, Niemann CU, Ostrowski SR. Early stimulated immune responses predict clinical disease severity in hospitalized COVID-19 patients. Commun Med (Lond) 2022; 2:114. [PMID: 36101705 PMCID: PMC9466310 DOI: 10.1038/s43856-022-00178-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/26/2022] [Indexed: 02/06/2023] Open
Abstract
Background The immune pathogenesis underlying the diverse clinical course of COVID-19 is poorly understood. Currently, there is an unmet need in daily clinical practice for early biomarkers and improved risk stratification tools to help identify and monitor COVID-19 patients at risk of severe disease. Methods We performed longitudinal assessment of stimulated immune responses in 30 patients hospitalized with COVID-19. We used the TruCulture whole-blood ligand-stimulation assay applying standardized stimuli to activate distinct immune pathways, allowing quantification of cytokine responses. We further characterized immune cell subsets by flow cytometry and used this deep immunophenotyping data to map the course of clinical disease within and between patients. Results Here we demonstrate impairments in innate immune response pathways at time of COVID-19 hospitalization that are associated with the development of severe disease. We show that these impairments are transient in those discharged from hospital, as illustrated by functional and cellular immune reconstitution. Specifically, we identify lower levels of LPS-stimulated IL-1β, and R848-stimulated IL-12 and IL-17A, at hospital admission to be significantly associated with increasing COVID-19 disease severity during hospitalization. Furthermore, we propose a stimulated immune response signature for predicting risk of developing severe or critical COVID-19 disease at time of hospitalization, to validate in larger cohorts. Conclusions We identify early impairments in innate immune responses that are associated with subsequent COVID-19 disease severity. Our findings provide basis for early identification of patients at risk of severe disease which may have significant implications for the early management of patients hospitalized with COVID-19.
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Affiliation(s)
- Rebecka Svanberg
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cameron MacPherson
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Adrian Zucco
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rudi Agius
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tereza Faitova
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Asger Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Caspar da Cunha-Bang
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Klingen Gjærde
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Patrick Terrence Brooks
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Adin Sejdic
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
- Department of Virus & Microbiological Special Diagnostics, Division of Infectious Disease Preparedness and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Ortved Gang
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Section of Infectious Diseases, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Section of Infectious Diseases, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Christian Brieghel
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Section of Infectious Diseases, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daria Podlekareva
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Annemette Hald
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Thaning Bay
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Marquart
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Lundgren
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- PERSIMUNE Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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21
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Barkauskas C, Mylonakis E, Poulakou G, Young BE, Vock DM, Siegel L, Engen N, Grandits G, Mosaly NR, Vekstein AM, Rogers R, Shehadeh F, Kaczynski M, Mylona EK, Syrigos KN, Rapti V, Lye DC, Hui DS, Leither L, Knowlton KU, Jain MK, Marines-Price R, Osuji A, Overcash JS, Kalomenidis I, Barmparessou Z, Waters M, Zepeda K, Chen P, Torbati S, Kiweewa F, Sebudde N, Almasri E, Hughes A, Bhagani SR, Rodger A, Sandkovsky U, Gottlieb RL, Nnakelu E, Trautner B, Menon V, Lutaakome J, Matthay M, Robinson P, Protopapas K, Koulouris N, Kimuli I, Baduashvili A, Braun DL, Günthard HF, Ramachandruni S, Kidega R, Kim K, Hatlen TJ, Phillips AN, Murray DD, Jensen TO, Padilla ML, Accardi EX, Shaw-Saliba K, Dewar RL, Teitelbaum M, Natarajan V, Laverdure S, Highbarger HC, Rehman MT, Vogel S, Vallée D, Crew P, Atri N, Schechner AJ, Pett S, Hudson F, Badrock J, Touloumi G, Brown SM, Self WH, North CM, Ginde AA, Chang CC, Kelleher A, Nagy-Agren S, Vasudeva S, Looney D, Nguyen HH, Sánchez A, Weintrob AC, Grund B, Sharma S, Reilly CS, Paredes R, Bednarska A, Gerry NP, Babiker AG, Davey VJ, Gelijns AC, Higgs ES, Kan V, Matthews G, Argyraki K, Lourida P, Bakakos P, Vlachakos V, Balis E, Zakynthinos S, Sigala I, Gianniou N, Dima E, Magkouta S, Thompson BT, Synolaki E, Konstanta S, Vlachou M, Stathopoulou P, Panagopoulos P, Petrakis V, Papazoglou D, Tompaidou E, Isaakidou E, Leontis K, Legenne P, Nitsotolis T, Athanasiou K, Myrodia M, Kyriakoulis K, Trontzas I, Arfara-Melanini M, Kolonia V, Kityo C, Mugerwa H, Lukaakome J, Chandra R, Nsereko C, Lubega G, Kibirige M, Nakahima W, Wangi D, Aguti E, Generous L, Massa R, Nalaki M, Magala F, Lane HC, Nabaggala PK, Kityo C, Mugerwa H, Faith OD, Florence A, Emmanuel O, Beacham MP, Geoffrey A, Nakiboneka D, Apiyo P, Neaton JD, Kiweewa F, Kirenga B, Kimuli I, Atukunda A, Muttamba W, Remmy K, Segawa I, Pheona N, Kigere D, Mbabazi QL, Lundgren JD, Boersalino L, Nyakoolo G, Kiweewa F, Fred A, Alupo A, Ebong D, Monday E, Nalubwama RN, Kainja M, Ambrose M, Barkauskas C, Kwehayo V, Nalubega MG, Ongoli A, Obbo S, Alaba J, Magombe G, Tino H, Obonya E, Lutaakome J, Kitonsa J, Mylonakis E, Onyango M, Naboth T, Naluyinda H, Nanyunja R, Irene M, Jane B, Wimfred K, Leonar S, Deus T, Babra N, Poulakou G, Taire P, Lutaakone J, Nabankema E, Ogavu J, Mugerwa O, Okoth I, Mwebaze R, Mugabi T, Makhoba A, Arikiriza P, Young BE, Theresa N, Nakayima H, Frank K, Ramgi P, Pereira K, Osinusi A, Cao H, Stumpp M, Goncalves S, Ramanathan K, Vock DM, Baseler B, Holley HP, Jankelevich S, Adams A, Becker N, Dolney S, Hissey D, Simpson S, Kim MH, Beeler J, Siegel L, Harmon L, Asomah M, Jato Y, Stottlemyer A, Tang O, Vanderpuye S, Yeon L, Buehn M, Eccard-Koons V, Frary S, Engen N, MacDonald L, Cash J, Hoopengardner L, Linton J, Schaffhauser M, Nelson M, Spinelli-Nadzam M, Proffitt C, Lee C, Engel T, Grandits G, Fontaine L, Osborne C, Hohn M, Galcik M, Thompson D, Chang W, Sherman BT, Rupert AW, Baseler M, Lallemand P, Mosaly NR, Imamichi T, Paudel S, Cook K, Haupt K, Highbarger J, Hazen A, Badralmaa Y, Smith K, Patel B, Kubernac R, Vekstein AM, Hoover ML, Brown C, DuChateau N, Ellis S, Flosi A, Fox L, Johnson L, Nelson R, Stojanovic J, Treagus A, Rogers R, Wenner C, Williams R, Shehadeh F, Kaczynski M, Mylona EK, Syrigos KN, Rapti V, Lye DC, Hui DS, Leither L, Knowlton KU, Jain MK, Marines-Price R, Osuji A, Overcash JS, Kalomenidis I, Barmparessou Z, Waters M, Zepeda K, Chen P, Torbati S, Kiweewa F, Sebudde N, Almasri E, Hughes A, Bhagani SR, Rodger A, Sandkovsky U, Gottlieb RL, Nnakelu E, Trautner B, Menon V, Lutaakome J, Matthay M, Robinson P, Protopapas K, Koulouris N, Kimuli I, Baduashvili A, Braun DL, Günthard HF, Ramachandruni S, Kidega R, Kim K, Hatlen TJ, Phillips AN, Murray DD, Jensen TO, Padilla ML, Accardi EX, Shaw-Saliba K, Dewar RL, Teitelbaum M, Natarajan V, Laverdure S, Highbarger HC, Rehman MT, Vogel S, Vallée D, Crew P, Atri N, Schechner AJ, Pett S, Hudson F, Badrock J, Touloumi G, Brown SM, Self WH, North CM, Ginde AA, Chang CC, Kelleher A, Nagy-Agren S, Vasudeva S, Looney D, Nguyen HH, Sánchez A, Weintrob AC, Grund B, Sharma S, Reilly CS, Paredes R, Bednarska A, Gerry NP, Babiker AG, Davey VJ, Gelijns AC, Higgs ES, Kan V, Matthews G, Thompson BT, Legenne P, Chandra R, Lane HC, Neaton JD, Lundgren JD, Sahner D, Tierney J, Herpin BR, Smolskis MC, McKay LA, Cahill K, Sardana R, Raim SS, Hensely L, Lorenzo J, Mock R, Zuckerman J, Miller M, Chung L, Kang N, Adam SJ, Read S, Draghia-Akli R, Carlsen A, Carter A, Denning E, DuChene A, Eckroth K, Frase A, Gandits G, Harrison M, Kaiser P, Koopmeiners J, Meger S, Murray T, Quan K, Quan SF, Thompson G, Walski J, Wentworth D, Moskowitz AJ, Bagiella E, Moquete E, O’Sullivan K, Marks ME, Kinzel E, Burris S, Bedoya G, Gupta L, Overbey JR, Padillia ML, Santos M, Gillinov MA, Miller MA, Taddei-Peters WC, Fenton K, Mack M, Berhe M, Haley C, Dishner E, Bettacchi C, Golden K, Duhaime E, Ryan M, Burris S, Tallmadge C, Estrada L, Jones F, Villa S, Wang S, Robert R, Coleman T, 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Sullins B, Olbrich N, Gong MN, Richardson LD, Gong MN, Nair R, Lopez B, Amosu O, Tzehaie H, Nkemdirim W, Boujid S, Mosier JM, Hypes C, Campbell ES, Bixby B, Gilson B, Lopez A, Hite RD, Terndrup TE, Wiedemann HP, Hudock K, Tanzeem H, More H, Martinkovic J, Sellers S, Houston J, Burns M, Hough CL, Robinson BH, Hough CL, Khan A, Krol OF, Mills E, Kinjal M, Briceno G, Reddy R, Hubel K, Parimon T, Caudill A, Mattison B, Jackman SE, Chen PE, Bayoumi E, Ojukwu C, Fine D, Weissberg G, Isip K, Choi-Kuaea Y, Mehdikhani S, Dar TB, Augustin NBF, Tran D, Dukov JE, O’Mahony DS, Wilson DM, Wallick JA, Duven AM, Fletcher DD, Files DC, Miller C, Gibbs KW, Flores LS, LaRose ME, Landreth LD, Palacios DR, Parks L, Hicks M, Goodwin AJ, Kilb EF, Lematty CT, Patti K, Bledsoe J, Brown S, Lanspa M, Pelton I, Armbruster BP, Montgomery Q, Kumar N, Fergus M, Imel K, Palmer G, Webb B, Klippel C, Jensen H, Duckworth S, Gray A, Burke T, Knox D, Lumpkin J, Aston VT, Rice TW, Self WH, Rice TW, Casey JD, Johnson J, 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Vjecha MJ, Osuji A, Agbor BTA, Petersen T, Kamel D, Hansen L, Garcia A, Cha C, Mozaffari A, Hernandez R, Jain MK, Agbor BTA, Petersen T, Kamel D, Hansen L, Garcia A, Kim M, DellaValle N, Gonzales S, Somboonwit C, Oxner A, Guerra L, Tran T, Pinto A, Anderson B, Zepeda-Gutierrez A, Martin D, Temblador C, Cuenca A, Guerrero M, Daar E, Correa R, Hartnell G, Wortmann G, Doshi S, Moriarty T, Gonzales M, Garman K, Baker JV, Frosch A, Goldsmith R, Jibrell H, Lo M, Klaphake J, Mackedanz S, Ngo L, Garcia-Myers K, Kunisaki KM, Hassler M, Walquist M, Augenbraun M, Dehovitz J, Abassi M, Leuck AM, Rao V, Biswas K, Harrington C, Garcia A, Bremer T, Burke T, Koker B, Davis-Karim A, Pittman D, Vasudeva SS, Pandit L, Hines-Munson C, Van J, Dillon L, Wang Y, Ochalek T, Caldwell E, Humerickhouse E, Boone D, McGraw W, Mehta SR, Johns ST, John MS, Raceles J, Sear E, Funk S, Cesarini R, Fang M, Nicalo K, Drake W, Jones B, Holtman T, Maniar A, Johnson EA, Nguyen L, Tran MT, Barrett TW, Johnston T, Huggins JT, Beiko TY, Hughes HY, McManigle WC, Tanner NT, Washburn RG, Ardelt M, Tuohy PA, Mixson JL, Hinton CG, Thornley N, Allen H, Elam S, Boatman B, Baber BJ, Ryant R, Roller B, Nguyen C, Mikail AM, Hansen M, Lichtenberger P, Baracco G, Ramos C, Bjork L, Sueiro M, Tien P, Freasier H, Buck T, Nekach H, Holodniy M, Chary A, Lu K, Peters T, Lopez J, Tan SY, Lee RH, Asghar A, Isip TKK, Le K, Nguyen T, Wong S, Raben D, Aagaard B, Nielsen CB, Krapp K, Nykjær BR, Olsson C, Kanne KL, Grevsen AL, Joensen ZM, Bruun T, Bojesen A, Woldbye F, Normand NE, Benfield T, Clausen CL, Hovmand N, Israelsen SB, Iversen K, Leding C, Pedersen KB, Thorlacius-Ussing L, Tinggaard M, Tingsgard S, Jensen JUS, Overgaard R, Rastoder E, Heerfordt C, Hedsund C, Ronn CP, Kamstrup PT, Hogsberg DS, Bergsoe C, Ostergaard L, Staerke NB, Yehdego Y, Sondergaard A, Johansen IS, Holden IK, Lindvig SO, Helleberg M, Gerstoft J, Kirk O, Bruun T, Jensen TO, Madsen BL, Pedersen TI, Harboe ZB, Roge BT, Hansen TM, Glesner MK, Lofberg SV, Nielsen AD, Nielsen H, Thisted RK, Petersen KT, Juhl MR, Podlekareva D, Johnsen S, Wiese L, Knudsen LS, Expósito M, Badillo J, Martínez A, Abad E, Chamorro A, Mateu L, España S, Lucero MC, Santos JR, Lladós G, Lopez C, Carabias L, Fernández-Cruz E, Di Natale M, Padure S, Gomez J, Ausin C, Cervilla E, Balastegui H, Sainz CR, Lopez P, Escobar M, Balerdi L, Legarda A, Roldan M, Letona L, Muñoz J, Arribas JR, Sánchez RM, Díaz-Pollán B, Stewart SM, Garcia I, Borobia A, Estrada V, Cabello N, Nuñez-Orantos M, Sagastagoitia I, Homen J, Orviz E, Montalvá AS, Espinosa-Pereiro J, Bosch-Nicolau P, Salvador F, Morales-Rull JL, Pena AMM, Acosta C, Solé-Felip C, West E, M’Rabeth-Bensalah K, Eichinger ML, Grüttner-Durmaz M, Grube C, Zink V, Goes J, Tsertsvadze T, Abutidze A, Chkhartishvili N, Metchurtchlishvili R, Endeladze M, Paciorek M, Bursa D, Krogulec D, Pulik P, Ignatowska A, Fishchuk R, Kobrynska O, Levandovska K, Kirieieva I, Kuziuk M, Polizzotto M, Carey C, Dharan NJ, Hough S, Virachit S, Davidson S, Bice DJ, Ognenovska K, Cabrera G, Flynn R, Chia PY, Lee TH, Lin RJ, Ong SW, Puah SH, Yeo TW, Ongko J, Yeo HP, Kwaghe V, Zaiyad H, Idoko G, Uche B, Selvamuthu P, Kumarasamy N, Beulah FE, Govindarajan N, Mariyappan K, Losso MH, Abela C, Moretto R, Belloc CG, Ludueña J, Amar J, Losso MH, Toibaro J, Macias LM, Fernandez L, Frare PS, Chaio SR, Pachioli V, Timpano SM, Sanchez MDL, Sierra MDP, Stanek V, Belloso W, Cilenti FL, Valentini RN, Stryjewski ME, Locatelli N, Riera MCS, Salgado C, Baeck IM, Di Castelnuovo V, Zarza SM, Parmar MK, Goodman AL, Gregory A, Goodall K, Harris N, Wyncoll J, Luntiel A, Patterson C, Morales J, Witele E, Preston A, Nandani A, Price D, Nell J, Patel B, Hays C, Jones G, Davidson J, Pantazis N, Gioukari V, Souliou T, Antoniadou A, Kavatha D, Grigoropoulou S, Tziolos R, Oikonomopoulo C, Moschopoulos C, Tzimopoulos K, Koromilias A. Efficacy and Safety of Ensovibep for Adults Hospitalized With COVID-19 : A Randomized Controlled Trial. Ann Intern Med 2022; 175:1266-1274. [PMID: 35939810 PMCID: PMC9384272 DOI: 10.7326/m22-1503] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection. OBJECTIVE To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone. DESIGN Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978). SETTING Multinational, multicenter trial. PARTICIPANTS Adults hospitalized with COVID-19. INTERVENTION Intravenous ensovibep, 600 mg, or placebo. MEASUREMENTS Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90. RESULTS An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR < 1 would favor ensovibep). LIMITATION The trial was prematurely stopped because of futility, limiting power for the primary outcome. CONCLUSION Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
| | - Christina Barkauskas
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke Health, Durham, North Carolina
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | | | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lianne Siegel
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Nicole Engen
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Greg Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Ralph Rogers
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fadi Shehadeh
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew Kaczynski
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Evangelia K Mylona
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Konstantinos N Syrigos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Vasiliki Rapti
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - David C Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Singapore
| | - Diong Shiau Hui
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Lindsay Leither
- Division of Pulmonary and Critical Care, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah
| | - Kirk U Knowlton
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, Utah
| | - Mamta K Jain
- UT Southwestern Medical Center and Parkland Health and Hospital Systems, Dallas, Texas
| | - Rubria Marines-Price
- UT Southwestern Medical Center and Parkland Health and Hospital Systems, Dallas, Texas
| | - Alice Osuji
- UT Southwestern Medical Center and Parkland Health and Hospital Systems, Dallas, Texas
| | | | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evaggelismos General Hospital, Athens, Greece
| | - Zafeiria Barmparessou
- 1st Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evaggelismos General Hospital, Athens, Greece
| | | | | | - Peter Chen
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Sam Torbati
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Eyad Almasri
- University of California, San Francisco-Fresno, Fresno, California
| | - Alyssa Hughes
- University of California, San Francisco-Fresno, Fresno, California
| | | | | | | | | | | | - Barbara Trautner
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Vidya Menon
- NYC Health + Hospitals/Lincoln, Bronx, New York
| | - Joseph Lutaakome
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Michael Matthay
- University of California, San Francisco, Medical Center, Fresno, California
| | - Philip Robinson
- Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Nikolaos Koulouris
- 1st Respiratory Medicine Department, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Ivan Kimuli
- Makerere University Lung Institute, Kampala, Uganda
| | - Amiran Baduashvili
- Division of Hospital Medicine, University of Colorado Hospital - Anschutz Medical Campus, Aurora, Colorado
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | | | - Kami Kim
- Division of Infectious Diseases, University of South Florida and Global Emerging Diseases Institute, Tampa General Hospital, Tampa, Florida
| | - Timothy J Hatlen
- Lundquist Institute for Biomedical Innovation, Torrance, California
| | | | - Daniel D Murray
- CHIP Center of Excellence for Health, Immunity, and Infections and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Tomas O Jensen
- CHIP Center of Excellence for Health, Immunity, and Infections and Department of Infectious Diseases, Rigshospitalet, Copenhagen, and Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Hillerod, Denmark
| | | | - Evan X Accardi
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Katy Shaw-Saliba
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Robin L Dewar
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | | | - Ven Natarajan
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Sylvain Laverdure
- Laboratory of Human Retrovirology and Immunoinformatics, National Institutes of Health, Frederick, Maryland
| | | | - M Tauseef Rehman
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Susan Vogel
- Office of Clinical Research Policy and Regulatory Operations, National Institutes of Health, Bethesda, Maryland
| | - David Vallée
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Page Crew
- Collaborative Clinical Research Branch, National Institutes of Health, Bethesda, Maryland
| | - Negin Atri
- Office of Clinical Research Policy and Regulatory Operations, National Institutes of Health, Bethesda, Maryland
| | | | - Sarah Pett
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Fleur Hudson
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Jonathan Badrock
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, and Department of Internal Medicine, University of Utah, Murray, Utah
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Crystal M North
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado
| | - Christina C Chang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Kelleher
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - David Looney
- The Veterans Medical Research Foundation, San Diego, California
| | - Hien H Nguyen
- Veterans Affairs Northern California Health Care System, Sacramento, California
| | | | - Amy C Weintrob
- Infectious Diseases Section, Washington Veterans Affairs Medical Center, Washington, DC
| | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Cavan S Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Roger Paredes
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Agnieszka Bednarska
- Wojewódzki Szpital Zakaźny w Warszawie, Medical University of Warsaw, Warsaw, Poland
| | - Norman P Gerry
- Advanced Biomedical Laboratories, Cinnaminson, New Jersey
| | - Abdel G Babiker
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | | | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth S Higgs
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Virginia Kan
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - K. Argyraki
- Sotiria General, Medical School, National & Kapodistrian University of Athens
| | - P. Lourida
- Sotiria General Hospital, Medical School, National & Kapodistrian University of Athens
| | - P. Bakakos
- Sotiria General Hospital, Medical School, National & Kapodistrian University of Athens
| | - V. Vlachakos
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - E. Balis
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - S. Zakynthinos
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - I. Sigala
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - N. Gianniou
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - E. Dima
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - S. Magkouta
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - B Taylor Thompson
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - E. Synolaki
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - S. Konstanta
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - M. Vlachou
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - P. Stathopoulou
- Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens
| | - P. Panagopoulos
- Alexandroupolis General Hospital, Medical School, Democritus University of Thrace
| | - V. Petrakis
- Alexandroupolis General Hospital, Medical School, Democritus University of Thrace
| | - D. Papazoglou
- Alexandroupolis General Hospital, Medical School, Democritus University of Thrace
| | - E. Tompaidou
- Alexandroupolis General Hospital, Medical School, Democritus University of Thrace
| | - E. Isaakidou
- Alexandroupolis General Hospital, Medical School, Democritus University of Thrace
| | - K. Leontis
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | | | - T. Nitsotolis
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - K. Athanasiou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - M.D. Myrodia
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - K. Kyriakoulis
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - I. Trontzas
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - M. Arfara-Melanini
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - V. Kolonia
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Cissy Kityo
- Uganda SCC, JCRC/MRC/UVRI Uganda Research Unit
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - H Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | | | | | | | | | | | | | - Jens D Lundgren
- CHIP Center of Excellence for Health, Immunity, and Infections and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | - Christina Barkauskas
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke Health, Durham, North Carolina
| | | | | | | | | | | | | | | | | | | | | | - Eleftherios Mylonakis
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | | | | | | | | | | | | | | | | | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Patrícia Ramgi
- CISPOC: Centro de Investigaçäo e Treino em Saúde da Polana Caniço, Maputo, Mozambique
| | - Kássia Pereira
- CISPOC: Centro de Investigaçäo e Treino em Saúde da Polana Caniço, Maputo, Mozambique
| | | | - Huyen Cao
- Gilead Sciences, Foster City, California
| | | | | | | | - David M. Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Amy Adams
- Leidos Biomedical Research, Frederick, Maryland
| | | | | | | | | | - Mi Ha Kim
- Leidos Biomedical Research, Frederick, Maryland
| | - Joy Beeler
- Leidos Biomedical Research, Frederick, Maryland
| | - Lianne Siegel
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Liam Harmon
- Leidos Biomedical Research, Frederick, Maryland
| | | | - Yvonne Jato
- Leidos Biomedical Research, Frederick, Maryland
| | | | - Olivia Tang
- Leidos Biomedical Research, Frederick, Maryland
| | | | | | - Molly Buehn
- Leidos Biomedical Research, Frederick, Maryland
| | | | - Sadie Frary
- Leidos Biomedical Research, Frederick, Maryland
| | - Nicole Engen
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | | | | | | | | | | | | | - Greg Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Matt Hohn
- Leidos Biomedical Research, Frederick, Maryland
| | | | | | - Weizhong Chang
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Brad T. Sherman
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Adam W. Rupert
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Michael Baseler
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Perrine Lallemand
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | | | - Tom Imamichi
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Sharada Paudel
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Kyndal Cook
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Kendra Haupt
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Jeroen Highbarger
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Allison Hazen
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Yunden Badralmaa
- Frederick National Laboratory for Cancer Research/Leidos Biomedical Research, Frederick, Maryland
| | - Kenneth Smith
- Advanced Biomedical Laboratories, Cinnaminson, New Jersey
| | - Bhakti Patel
- Advanced Biomedical Laboratories, Cinnaminson, New Jersey
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ralph Rogers
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Fadi Shehadeh
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew Kaczynski
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Evangelia K. Mylona
- Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Konstantinos N. Syrigos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Vasiliki Rapti
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - David C. Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Singapore
| | - Diong Shiau Hui
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Lindsay Leither
- Division of Pulmonary and Critical Care, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah
| | - Kirk U. Knowlton
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, Utah
| | - Mamta K. Jain
- UT Southwestern Medical Center and Parkland Health and Hospital Systems, Dallas, Texas
| | - Rubria Marines-Price
- UT Southwestern Medical Center and Parkland Health and Hospital Systems, Dallas, Texas
| | - Alice Osuji
- UT Southwestern Medical Center and Parkland Health and Hospital Systems, Dallas, Texas
| | | | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evaggelismos General Hospital, Athens, Greece
| | - Zafeiria Barmparessou
- 1st Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evaggelismos General Hospital, Athens, Greece
| | | | | | - Peter Chen
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Sam Torbati
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Eyad Almasri
- University of California, San Francisco–Fresno, Fresno, California
| | - Alyssa Hughes
- University of California, San Francisco–Fresno, Fresno, California
| | | | | | | | | | | | - Barbara Trautner
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Vidya Menon
- NYC Health + Hospitals/Lincoln, Bronx, New York
| | - Joseph Lutaakome
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Michael Matthay
- University of California, San Francisco, Medical Center, Fresno, California
| | - Philip Robinson
- Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Nikolaos Koulouris
- 1st Respiratory Medicine Department, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Ivan Kimuli
- Makerere University Lung Institute, Kampala, Uganda
| | - Amiran Baduashvili
- Division of Hospital Medicine, University of Colorado Hospital - Anschutz Medical Campus, Aurora, Colorado
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych F. Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | | | - Kami Kim
- Division of Infectious Diseases, University of South Florida and Global Emerging Diseases Institute, Tampa General Hospital, Tampa, Florida
| | | | | | - Daniel D. Murray
- CHIP Center of Excellence for Health, Immunity, and Infections and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Tomas O. Jensen
- CHIP Center of Excellence for Health, Immunity, and Infections and Department of Infectious Diseases, Rigshospitalet, Copenhagen, and Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Hillerod, Denmark
| | | | | | - Katy Shaw-Saliba
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Robin L. Dewar
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | | | - Ven Natarajan
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Sylvain Laverdure
- Laboratory of Human Retrovirology and Immunoinformatics, National Institutes of Health, Frederick, Maryland
| | | | - M. Tauseef Rehman
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Susan Vogel
- Office of Clinical Research Policy and Regulatory Operations, National Institutes of Health, Bethesda, Maryland
| | - David Vallée
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Page Crew
- Collaborative Clinical Research Branch, National Institutes of Health, Bethesda, Maryland
| | - Negin Atri
- Office of Clinical Research Policy and Regulatory Operations, National Institutes of Health, Bethesda, Maryland
| | | | - Sarah Pett
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Fleur Hudson
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Jonathan Badrock
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel M. Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, and Department of Internal Medicine, University of Utah, Murray, Utah
| | - Wesley H. Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Crystal M. North
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adit A. Ginde
- University of Colorado School of Medicine, Aurora, Colorado
| | - Christina C. Chang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Kelleher
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - David Looney
- The Veterans Medical Research Foundation, San Diego, California
| | - Hien H. Nguyen
- Veterans Affairs Northern California Health Care System, Sacramento, California
| | | | - Amy C. Weintrob
- Infectious Diseases Section, Washington Veterans Affairs Medical Center, Washington, DC
| | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Cavan S. Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Roger Paredes
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Agnieszka Bednarska
- Wojewódzki Szpital Zakaźny w Warszawie, Medical University of Warsaw, Warsaw, Poland
| | | | - Abdel G. Babiker
- The Medical Research Council Clinical Trials Unit at University College London, London, England
| | | | - Annetine C. Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth S. Higgs
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Virginia Kan
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - B. Taylor Thompson
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - H. Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - James D. Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jens D. Lundgren
- CHIP Center of Excellence for Health, Immunity, and Infections and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - David Sahner
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - John Tierney
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Betsey R. Herpin
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Mary C. Smolskis
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Laura A. McKay
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Kelly Cahill
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Ratna Sardana
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Sharon Segal Raim
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Lisa Hensely
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Joshua Lorenzo
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Rebecca Mock
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Judith Zuckerman
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Mark Miller
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Lucy Chung
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Nayon Kang
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases
| | - Stacey J. Adam
- Foundation for the National Institutes of Health, The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) and Operation Warp Speed
| | - Sarah Read
- Foundation for the National Institutes of Health, The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) and Operation Warp Speed
| | - Ruxandra Draghia-Akli
- Foundation for the National Institutes of Health, The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) and Operation Warp Speed
| | - Amy Carlsen
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Anita Carter
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Eileen Denning
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Alain DuChene
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Kate Eckroth
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Alex Frase
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Greg Gandits
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Merrie Harrison
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Payton Kaiser
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Joseph Koopmeiners
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Sue Meger
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Thomas Murray
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Kien Quan
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Siu Fun Quan
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Greg Thompson
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Jamie Walski
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Deborah Wentworth
- INSIGHT SDMC, Division of Biostatistics, School of Public Health and School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Alan J. Moskowitz
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Emilia Bagiella
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Ellen Moquete
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Karen O’Sullivan
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Mary E. Marks
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Emily Kinzel
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Sarah Burris
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Gabriela Bedoya
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Lola Gupta
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Jessica R. Overbey
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Maria L. Padillia
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | - Milerva Santos
- Cardiothoracic Surgical Trials Network (CTSN) International Coordinating Center (ICC), Icahn School of Medicine at Mount Sinai, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Amy Adams
- University of Virginia Health Systems
| | | | | | | | | | | | | | | | | | | | - Cathryn Oldmixon
- Prevention and Early Treatment of Acute Lung Injury (PETAL) ICC, Massachusetts General Hospital, Boston, Massachusetts
| | - Nancy Ringwood
- Prevention and Early Treatment of Acute Lung Injury (PETAL) ICC, Massachusetts General Hospital, Boston, Massachusetts
| | - Ariela Muzikansky
- Prevention and Early Treatment of Acute Lung Injury (PETAL) ICC, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Morse
- Prevention and Early Treatment of Acute Lung Injury (PETAL) ICC, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy G. Brower
- PETAL Steering Committee Chair, Johns Hopkins University
| | | | | | | | - Jay H. Steingrub
- ALIGNE Site Coordinating Center (SCC) Lead Investigators, Baystate Medical Center
| | - Peter K. Hou
- ALIGNE Site Coordinating Center (SCC) Lead Investigators, Brigham and Women's Hospital
| | | | | | | | | | | | | | - Daniel Talmor
- Boston SCC Lead Investigators, Beth Israel Deaconess Medical Center
| | - Nathan Shapiro
- Boston SCC Lead Investigators, Beth Israel Deaconess Medical Center
| | | | | | | | | | | | | | | | | | | | | | - Lisa Kurt
- Beth Israel Deaconess Medical Center
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gregory Hendey
- California SCC Lead Investigators, David Geffen School of Medicine at UCLA
| | - Michael A. Matthay
- University of California San Francisco, University of San Francisco Mount Zion
| | - Kirsten Kangelaris
- University of California San Francisco, University of San Francisco Mount Zion
| | - Kimia Ashktorab
- University of California San Francisco, University of San Francisco Mount Zion
| | - Rachel Gropper
- University of California San Francisco, University of San Francisco Mount Zion
| | - Anika Agrawal
- University of California San Francisco, University of San Francisco Mount Zion
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc A. Moss
- Colorado SCC Lead Investigators, University of Colorado Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle N. Gong
- Montefiore-Sinai SCC Lead Investigators: Montefiore Medical Center
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Catherine L. Hough
- Pacific Northwest SCC Lead Investigators, Oregon Health & Science University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Todd W. Rice
- Vanderbilt SCC Lead Investigators, Vanderbilt University Medical Center
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jim Wong
- Carilion Roanoke Memorial Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Laura Popielski
- INSIGHT Washington ICC, Veterans Affairs (VA) Medical Center, Washington, DC
| | - Amy Kambo
- INSIGHT Washington ICC, Veterans Affairs (VA) Medical Center, Washington, DC
| | - Kimberley Viens
- INSIGHT Washington ICC, Veterans Affairs (VA) Medical Center, Washington, DC
| | - Melissa Turner
- INSIGHT Washington ICC, Veterans Affairs (VA) Medical Center, Washington, DC
| | - Michael J. Vjecha
- INSIGHT Washington ICC, Veterans Affairs (VA) Medical Center, Washington, DC
| | | | | | | | | | | | | | | | | | | | - Mamta K. Jain
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Tianna Petersen
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dena Kamel
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura Hansen
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Angie Garcia
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mina Kim
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Sonia Gonzales
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Asa Oxner
- University of South Florida, Tampa General Hospital
| | - Lucy Guerra
- University of South Florida, Tampa General Hospital
| | - Thanh Tran
- University of South Florida, Tampa General Hospital
| | | | | | | | | | | | - Avon Cuenca
- Lundquist Institute for Biomedical Innovation
| | | | - Eric Daar
- Lundquist Institute for Biomedical Innovation
| | | | | | | | | | | | | | | | - Jason V. Baker
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Anne Frosch
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | | | - Hodan Jibrell
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Melanie Lo
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | | | - Shari Mackedanz
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Linh Ngo
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tammy Bremer
- INSIGHT US Department of Veterans Affairs (VA) ICC
| | - Tara Burke
- INSIGHT US Department of Veterans Affairs (VA) ICC
| | | | | | | | | | | | | | - John Van
- Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Laura Dillon
- Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Yiqun Wang
- Michael E. DeBakey VA Medical Center, Houston, Texas
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- Veterans Affairs Palo Alto Health Care System
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- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bitten Aagaard
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte B. Nielsen
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katharina Krapp
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bente Rosdahl Nykjær
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Olsson
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katja Lisa Kanne
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Louise Grevsen
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Zillah Maria Joensen
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tina Bruun
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ane Bojesen
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Woldbye
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nick E. Normand
- INSIGHT Copenhagen ICC, CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Clara Lundetoft Clausen
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Nichlas Hovmand
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Simone Bastrup Israelsen
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Katrine Iversen
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Caecilie Leding
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Karen Brorup Pedersen
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Louise Thorlacius-Ussing
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Michaela Tinggaard
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | - Sandra Tingsgard
- Denmark Copenhagen University Hospital - Amager and Hvidovre, Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases
| | | | - Rikke Overgaard
- Herlev-Gentofte Hospital, Respiratory Medicine Section, Department of Internal Medicine
| | - Ema Rastoder
- Herlev-Gentofte Hospital, Respiratory Medicine Section, Department of Internal Medicine
| | - Christian Heerfordt
- Herlev-Gentofte Hospital, Respiratory Medicine Section, Department of Internal Medicine
| | - Caroline Hedsund
- Herlev-Gentofte Hospital, Respiratory Medicine Section, Department of Internal Medicine
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- Herlev-Gentofte Hospital, Respiratory Medicine Section, Department of Internal Medicine
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- Odense University Hospital, Department of Infectious Diseases
| | | | - Marie Helleberg
- Dept. of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital
| | - Jan Gerstoft
- Dept. of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital
| | - Ole Kirk
- Dept. of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital
| | - Tina Bruun
- Dept. of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital
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- Aalborg University Hospital, Department of Infectious Diseases
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- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Stine Johnsen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital Roskilde and Department of Internal Medicine, Zealand University Hospital Koge
| | - Lene Surland Knudsen
- Department of Infectious Diseases, Zealand University Hospital Roskilde and Department of Internal Medicine, Zealand University Hospital Koge
| | - Maria Expósito
- Spain INSIGHT SCC Spain, Hospital Universitari Germans Trias i Pujol, Badalona
| | - José Badillo
- Spain INSIGHT SCC Spain, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Ana Martínez
- Spain INSIGHT SCC Spain, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Elena Abad
- Spain INSIGHT SCC Spain, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Ana Chamorro
- Spain INSIGHT SCC Spain, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Lourdes Mateu
- Hospital Universitari Germans Trias i Pujol, Badalona
| | - Sergio España
- Hospital Universitari Germans Trias i Pujol, Badalona
| | | | | | - Gemma Lladós
- Hospital Universitari Germans Trias i Pujol, Badalona
| | | | | | | | | | - Sergiu Padure
- Hospital General Universitario Gregorio Marañón, Madrid
| | - Jimena Gomez
- Hospital General Universitario Gregorio Marañón, Madrid
| | | | - Eva Cervilla
- Hospital General Universitario Gregorio Marañón, Madrid
| | | | | | - Paco Lopez
- Hospital General Universitario Gregorio Marañón, Madrid
| | | | - Leire Balerdi
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona
| | - Almudena Legarda
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona
| | - Montserrat Roldan
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona
| | - Laura Letona
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona
| | - José Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona
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- Hospital Clínico San Carlos, Madrid
| | | | | | | | | | | | | | - Cristina Acosta
- Internal Medicine Department, University Hospital Arnau de Vilanova, Lleida
| | | | - Emily West
- Switzerland Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Khadija M’Rabeth-Bensalah
- Switzerland Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Mareile L. Eichinger
- Switzerland Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Manuela Grüttner-Durmaz
- Switzerland Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Christina Grube
- Switzerland Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Veronika Zink
- Switzerland Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Josefine Goes
- Switzerland Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Tengiz Tsertsvadze
- Georgia SCC, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Akaki Abutidze
- Georgia SCC, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Nikoloz Chkhartishvili
- Georgia SCC, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Revaz Metchurtchlishvili
- Georgia SCC, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Marina Endeladze
- Georgia SCC, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | | | - Piotr Pulik
- Poland SCC, Wojewodzki Szpital Zakazny Warsaw
| | | | - Roman Fishchuk
- Ukraine Central City Clinical Hospital of Ivano-Frankivsk City, Ukraine
| | - Olena Kobrynska
- Ukraine Central City Clinical Hospital of Ivano-Frankivsk City, Ukraine
| | | | - Ivanna Kirieieva
- Ukraine Central City Clinical Hospital of Ivano-Frankivsk City, Ukraine
| | - Mykhailo Kuziuk
- Ukraine Central City Clinical Hospital of Ivano-Frankivsk City, Ukraine
| | - Mark Polizzotto
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Catherine Carey
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Nila J. Dharan
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sally Hough
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sophie Virachit
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sarah Davidson
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Daniel J. Bice
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Katherine Ognenovska
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Gesalit Cabrera
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Ruth Flynn
- INSIGHT Sydney ICC, The Kirby Institute, University of New South Wales, Sydney, Australia
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- INSIGHT SCC Argentina, Coordinación en Investigación Clínica Académica en Latinoamérica
| | - Cecilia Abela
- INSIGHT SCC Argentina, Coordinación en Investigación Clínica Académica en Latinoamérica
| | - Renzo Moretto
- INSIGHT SCC Argentina, Coordinación en Investigación Clínica Académica en Latinoamérica
| | - Carlos G. Belloc
- INSIGHT SCC Argentina, Coordinación en Investigación Clínica Académica en Latinoamérica
| | - Jael Ludueña
- INSIGHT SCC Argentina, Coordinación en Investigación Clínica Académica en Latinoamérica
| | - Josefina Amar
- INSIGHT SCC Argentina, Coordinación en Investigación Clínica Académica en Latinoamérica
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Clara Salgado
- Centro de Educacion Medica e Investigaciones Clinicas, Buenos Aires
| | - Ines M. Baeck
- Centro de Educacion Medica e Investigaciones Clinicas, Buenos Aires
| | | | - Stella M. Zarza
- Centro de Educacion Medica e Investigaciones Clinicas, Buenos Aires
| | - Mahesh K.B. Parmar
- INSIGHT London ICC, MRC Clinical Trials Unit at UC, London, United Kingdom
| | - Anna L. Goodman
- INSIGHT London ICC, MRC Clinical Trials Unit at UC, London, United Kingdom
| | - Adam Gregory
- INSIGHT London ICC, MRC Clinical Trials Unit at UC, London, United Kingdom
| | - Katharine Goodall
- INSIGHT London ICC, MRC Clinical Trials Unit at UC, London, United Kingdom
| | - Nicola Harris
- INSIGHT London ICC, MRC Clinical Trials Unit at UC, London, United Kingdom
| | - James Wyncoll
- INSIGHT London ICC, MRC Clinical Trials Unit at UC, London, United Kingdom
| | | | | | | | - E. Witele
- United Kingdom SCC: Royal Free Hospital
| | | | | | | | | | | | | | | | | | - Nikos Pantazis
- Greece SCC, Medical School, National & Kapodistrian University of Athens
| | - Vicky Gioukari
- Greece SCC, Medical School, National & Kapodistrian University of Athens
| | - Tania Souliou
- Greece SCC, Medical School, National & Kapodistrian University of Athens
| | - A. Antoniadou
- Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens
| | - D. Kavatha
- Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens
| | - S. Grigoropoulou
- Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens
| | - R.N. Tziolos
- Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens
| | - C. Oikonomopoulo
- Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens
| | - C. Moschopoulos
- Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens
| | - K. Tzimopoulos
- Sotiria General Hospital, Medical School, National & Kapodistrian University of Athens
| | - A. Koromilias
- Sotiria General Hospital, Medical School, National & Kapodistrian University of Athens
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Harboe ZB, Hamm SR, Pérez-Alós L, Sivapalan P, Priemé H, Wilcke T, Kjeldgaard P, Shaker S, Svorre Jordan A, Møller DL, Heftdal LD, Madsen JR, Bayarri-Olmos R, Hansen CB, Pries-Heje MM, Hasselbalch RB, Fogh K, Armenteros JJA, Hilsted L, Sørensen E, Lindegaard B, Browatzki A, Biering-Sørensen T, Frikke-Schmidt R, Ostrowski SR, Iversen KK, Bundgaard H, Nielsen SD, Garred P, Jensen JUS. Antibody responses and risk factors associated with impaired immunological outcomes following two doses of BNT162b2 COVID-19 vaccination in patients with chronic pulmonary diseases. BMJ Open Respir Res 2022; 9:9/1/e001268. [PMID: 35793836 PMCID: PMC9260234 DOI: 10.1136/bmjresp-2022-001268] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/11/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Responses to COVID-19 vaccination in patients with chronic pulmonary diseases are poorly characterised. We aimed to describe humoral responses following two doses of BNT162b2 mRNA COVID-19 vaccine and identify risk factors for impaired responses. Methods Prospective cohort study including adults with chronic pulmonary diseases and healthcare personnel as controls (1:1). Blood was sampled at inclusion, 3 weeks, 2 and 6 months after first vaccination. We reported antibody concentrations as geometric means with 95% CI of receptor binding domain (RBD)-IgG and neutralising antibody index of inhibition of ACE-2/RBD interaction (%). A low responder was defined as neutralising index in the lowest quartile (primary outcome) or RBD-IgG <225 AU/mL plus neutralising index <25% (secondary outcome), measured at 2 months. We tested associations using Poisson regression. Results We included 593 patients and 593 controls, 75% of all had neutralising index ≥97% at 2 months. For the primary outcome, 34.7% of patients (n=157/453) and 12.9% of controls (n=46/359) were low responders (p<0.0001). For the secondary outcome, 8.6% of patients (n=39/453) and 1.4% of controls (n=5/359) were low responders (p<0.001). Risk factors associated with low responder included increasing age (per decade, adjusted risk ratio (aRR) 1.17, 95% CI 1.03 to 1.32), Charlson Comorbidity Index (per point) (aRR 1.15, 95% CI 1.05 to 1.26), use of prednisolone (aRR 2.08, 95% CI 1.55 to 2.77) and other immunosuppressives (aRR 2.21, 95% CI 1.65 to 2.97). Discussion Patients with chronic pulmonary diseases established functional humoral responses to vaccination, however lower than controls. Age, comorbidities and immunosuppression were associated with poor immunological responses.
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Affiliation(s)
- Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Rask Hamm
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Helene Priemé
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Torgny Wilcke
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Peter Kjeldgaard
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Saher Shaker
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Alexander Svorre Jordan
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Dam Heftdal
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johannes Roth Madsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rafael Bayarri-Olmos
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mia Marie Pries-Heje
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Jose Juan Almagro Armenteros
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Linda Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Section 2034, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Section 2034, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Garred
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- PERSIMUNE & CHIP: Department of Infectious Diseases, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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23
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Benfield T, Bodilsen J, Brieghel C, Harboe ZB, Helleberg M, Holm C, Israelsen SB, Jensen J, Jensen TØ, Johansen IS, Johnsen S, Madsen BL, Lundgren J, Meyer CN, Mohey R, Pedersen L, Nielsen H, Nielsen SL, Obel N, Omland LH, Podlekareva D, Poulsen BK, Ravn P, Sandholdt H, Starling J, Storgaard M, Søborg C, Søgaard OS, Tranborg T, Wiese L, Christensen HR. Correction to: Improved Survival Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Treated With Remdesivir and Dexamethasone. A Nationwide Population-Based Cohort Study. Clin Infect Dis 2022; 74:1889. [PMID: 35460228 PMCID: PMC9327112 DOI: 10.1093/cid/ciac243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas Benfield
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Brieghel
- Department of Infectious Diseases, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Zitta Barrella Harboe
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claire Holm
- Department of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Simone Bastrup Israelsen
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Janne Jensen
- Department of Medicine, Kolding Hospital, Kolding, Denmark
| | - Tomas Østergaard Jensen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Isik Somuncu Johansen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Stine Johnsen
- Department of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Birgitte Lindegaard Madsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Lundgren
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,CHIP, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Rajesh Mohey
- Department of Medicine, Herning Hospital, Herning, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Lønberg Nielsen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Niels Obel
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daria Podlekareva
- Department of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Pernille Ravn
- Department of Infectious Diseases, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Haakon Sandholdt
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Jonathan Starling
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Søborg
- Department of Infectious Diseases, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | | | - Torben Tranborg
- Department of Medicine, Esbjerg Hospital, Esbjerg, Denmarkand
| | - Lothar Wiese
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Hanne Rolighed Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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24
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Hamm SR, Møller DL, Pérez-Alós L, Hansen CB, Pries-Heje MM, Heftdal LD, Hasselbalch RB, Fogh K, Madsen JR, Almagro Armenteros JJ, Knudsen AD, Poulsen JR, Frikke-Schmidt R, Hilsted LM, Sørensen E, Ostrowski SR, Harboe ZB, Perch M, Sørensen SS, Rasmussen A, Bundgaard H, Garred P, Iversen K, Nielsen SD. Decline in Antibody Concentration 6 Months After Two Doses of SARS-CoV-2 BNT162b2 Vaccine in Solid Organ Transplant Recipients and Healthy Controls. Front Immunol 2022; 13:832501. [PMID: 35281023 PMCID: PMC8905653 DOI: 10.3389/fimmu.2022.832501] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/31/2022] [Indexed: 12/19/2022] Open
Abstract
Background Previous studies have indicated inferior responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination in solid organ transplant (SOT) recipients. We examined the development of anti-receptor-binding domain (RBD) immunoglobulin G (IgG) after two doses of BNT162b2b in SOT recipients 6 months after vaccination and compared to that of immunocompetent controls. Methods We measured anti-RBD IgG after two doses of BNT162b2 in 200 SOT recipients and 200 matched healthy controls up to 6 months after first vaccination. Anti-RBD IgG concentration and neutralizing capacity of antibodies were measured at first and second doses of BNT162b2 and 2 and 6 months after the first dose. T-cell responses were measured 6 months after the first dose. Results In SOT recipients, geometric mean concentration (GMC) of anti-RBD IgG increased from first to second dose (1.14 AU/ml, 95% CI 1.08–1.24 to 11.97 AU/ml, 95% CI 7.73–18.77) and from second dose to 2 months (249.29 AU/ml, 95% CI 153.70–385.19). Six months after the first vaccine, anti-RBD IgG declined (55.85 AU/ml, 95% CI 36.95–83.33). At all time points, anti-RBD IgG was lower in SOT recipients than that in controls. Fewer SOT recipients than controls had a cellular response (13.1% vs. 59.4%, p < 0.001). Risk factors associated with humoral non-response included age [relative risk (RR) 1.23 per 10-year increase, 95% CI 1.11–1.35, p < 0.001], being within 1 year from transplantation (RR 1.55, 95% CI 1.30–1.85, p < 0.001), treatment with mycophenolate (RR 1.54, 95% CI 1.09–2.18, p = 0.015), treatment with corticosteroids (RR 1.45, 95% CI 1.10–1.90, p = 0.009), kidney transplantation (RR 1.70, 95% CI 1.25–2.30, p = 0.001), lung transplantation (RR 1.63, 95% CI 1.16–2.29, p = 0.005), and de novo non-skin cancer comorbidity (RR 1.52, 95% CI, 1.26–1.82, p < 0.001). Conclusion Immune responses to BNT162b2 are inferior in SOT recipients compared to healthy controls, and studies aiming to determine the clinical impact of inferior vaccine responses are warranted.
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Affiliation(s)
- Sebastian Rask Hamm
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mia Marie Pries-Heje
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Line Dam Heftdal
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kamille Fogh
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes Roth Madsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jose Juan Almagro Armenteros
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johan Runge Poulsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Linda Maria Hilsted
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Sørensen
- The Blood Bank, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Blood Bank, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Pulmonary and Infectious Diseases, Hospital of North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Michael Perch
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Lenzing E, Rezahosseini O, Burgdorf SK, Nielsen SD, Harboe ZB. Efficacy, immunogenicity, and evidence for best-timing of pneumococcal vaccination in splenectomized adults: a systematic review. Expert Rev Vaccines 2022; 21:723-733. [PMID: 35236233 DOI: 10.1080/14760584.2022.2049250] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Streptococcus pneumoniae is the most frequent cause of overwhelming post-splenectomy infections. Pneumococcal vaccination is generally recommended for splenectomized individuals. However, most of our knowledge comes from a few observational studies or small randomized clinical trials. We conducted this systematic review to assess the evidence of efficacy, antibody response, and the best timing for pneumococcal vaccination in splenectomized individuals. AREAS COVERED : The systematic review was conducted according to the PRISMA guidelines. We screened 489 articles, included 21 articles, and assessed the risk of bias using Cochrane RoB 2 and ROBINS-I. We summarized the findings narratively due to the heterogeneity of the studies. EXPERT OPINION Splenectomized individuals seem to have adequate antibody responses to pneumococcal vaccines. No differences in antibody responses were observed compared to healthy controls, except in one study. The studies were heterogeneous, and the majority had moderate to high degree of bias. There is a lack of clinical evidence for efficacy and best timing of pneumococcal vaccination in splenectomized individuals. Randomized clinical trials addressing these issues are needed.
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Affiliation(s)
- Emil Lenzing
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Kobbelgaard Burgdorf
- Department of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Denmark
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26
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Lauridsen KH, Olsen KB, Lund EL, Jensen TO, Pedersen TI, Harboe ZB, Antsupova V, Rasmussen LD, Röser D, Banner J, Franck KT, Vorobieva Solholm Jensen V. Neurological Complications in COVID-19 Patients: Can Analysis of Specific Antibodies and Viral RNA in Paired Cerebrospinal Fluid and Serum be Used for Accurate Diagnosis of SARS-CoV-2 Neuroinflammatory Disease? A Case Series. Clin Med Insights Pathol 2022; 15:2632010X221139096. [DOI: 10.1177/2632010x221139096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Neurological complications during and after SARS-CoV-2 infection have been frequently described. The detection of either SARS-CoV-2 RNA or specific antibodies against SARS-CoV-2 in cerebrospinal fluid in the context of concomitant neurological manifestations indicates neuroinfection. Methods and Results: This is a retrospective descriptive analysis of cerebrospinal fluids and serum samples from 2 hospitalized patients and autopsy findings from 2 patients who died at home. Samples were analysed by 3 independent enzyme-linked immunosorbent assays. Specific antibodies against SARS-CoV-2 were detected in cerebrospinal fluids and paired serum in all 4 cases. Levels of antibodies in cerebrospinal fluids were highest in samples from a deceased man with critical progression of COVID-19 and detectable SARS-CoV-2 viral RNA in cerebrospinal fluid, serum, 4 brain biopsies and 15 additional tissue samples, though immunohistochemical staining for SARS-CoV-2 in brain tissue did not detect the virus. Conclusion: Detection of SARS-CoV-2 antibodies in paired serum and cerebrospinal fluid may support the presence of SARS-CoV-2 neuroinflammatory disease in patients with COVID-19 and neurological manifestations.
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Affiliation(s)
- Karin Holst Lauridsen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
| | - Kristine Boisen Olsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eva Løbner Lund
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Tomas O Jensen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
- CHIP Center of Excellence for Health, Immunity, and Infections and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Ingemann Pedersen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - Valeria Antsupova
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Lasse Dam Rasmussen
- Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
| | - Dennis Röser
- Department of Paediatrics, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristina Træholt Franck
- Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
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Lundbo LF, Harboe ZB, Sandholdt H, Smith-Hansen L, Valentiner-Branth P, Hoffmann S, Benfield T. Comorbidity increases the risk of invasive meningococcal disease in adults. Clin Infect Dis 2021; 75:125-130. [PMID: 34569601 DOI: 10.1093/cid/ciab856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Risk of invasive meningococcal disease (IMD) is increased in patients with complement deficiency and HIV infection. Risk associated with comorbidity is not well described. METHODS Nationwide adult case-control study. Cases for the period 1977-2018 were identified by the national meningococcus reference laboratory. Matched controls were identified by registry linkage. Comorbidity diagnosed prior to IMD were based on the International Classification of Disease, eight or tenth revision. Odds ratios (OR) with 95% confidence intervals were estimated by logistic regression after adjustment for sex, age and other comorbidities. RESULTS We identified 1221 cases (45% male), median age 45 years (interquartile range: 22-64 years). The dominant meningococcal serogroups were B (n=738) and C (n=337). Increased risk of IMD was associated with solid organ transplantation (SOT) (OR 40.29 [95% confidence interval (CI), 4.84-335.75]), hemolytic anemia (OR 7.56 [95% CI, 2.63-21.79]), renal disease (OR 2.95 [95% confidence interval (CI), 1.77- 4.91]), liver disease (OR 2.53 [95% CI, 1.57-4.08]), cancer (OR 2.31 [95% CI, 1.85-2.89 ]), diabetes (OR 1.74 [95% CI, 1.26-2.39]), neurological disease (OR 1.72 [95% CI, 1.20-2.46]) and autoimmune disease (OR 1.70 [95% CI, 1.33-2.19]). Having 1, 2 and >2 comorbidities was associated with increased risk of IMD with ORs 1.6 to 3.5. Increased risk was not associated with specific serogroups. CONCLUSIONS This study of adults with IMD over four decades showed increased risk of IMD associated with renal disease, immunological disorders, liver disease, cancer, and SOT ranging from a 2- to a 40-fold increased risk. Vaccination may be warranted in these populations.
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Affiliation(s)
- Lene Fogt Lundbo
- Centre of Research and Disruption of Infectious Disease, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand.,Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen
| | - Håkon Sandholdt
- Centre of Research and Disruption of Infectious Disease, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre
| | - Lars Smith-Hansen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen
| | - Steen Hoffmann
- Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen; all Denmark
| | - Thomas Benfield
- Centre of Research and Disruption of Infectious Disease, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen
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28
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Kamstrup P, Sivapalan P, Eklöf J, Hoyer N, Ulrik CS, Pedersen L, Lapperre TS, Harboe ZB, Bodtger U, Bojesen RD, Håkansson KEJ, Tidemandsen C, Armbruster K, Browatzki A, Meteran H, Meyer CN, Skaarup KG, Lassen MCH, Lundgren JD, Biering-Sørensen T, Jensen JUS, Sivapalan P. Hydroxychloroquine as a primary prophylactic agent against SARS-CoV-2 infection. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.pa923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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29
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Kamstrup P, Sivapalan P, Eklöf J, Hoyer N, Ulrik CS, Pedersen L, Lapperre TS, Harboe ZB, Bodtger U, Bojesen RD, Håkansson KEJ, Tidemandsen C, Armbruster K, Browatzki A, Meteran H, Meyer CN, Skaarup KG, Lassen MCH, Lundgren JD, Biering-Sørensen T, Jensen JU. Hydroxychloroquine as a primary prophylactic agent against SARS-CoV-2 infection: A cohort study. Int J Infect Dis 2021; 108:370-376. [PMID: 34087484 PMCID: PMC8168303 DOI: 10.1016/j.ijid.2021.05.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/16/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Hydroxychloroquine has been proposed as a primary prophylactic agent against coronavirus disease 2019 (COVID-19). This study aimed to investigate if patients treated with hydroxychloroquine for a non-COVID-19 indication had a lower risk of verified infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) compared with matched controls. METHODS A cohort comprising all persons in Denmark collecting hydroxychloroquine prescriptions in 2020 and 2019 (i.e., both during and before SARS-CoV-2 was confirmed in Denmark), matched by age and sex with controls, was studied. Data were collected using the Danish national registries, which contain complete information on patient health data, prescriptions and microbiological test results. The main outcome was microbiologically verified SARS-CoV-2 infection. RESULTS In total, 5488 hydroxychloroquine users were matched with 54,486 non-users. At baseline, the groups differed in terms of diagnoses of pulmonary disease, cardiovascular disease, renal disease, gastrointestinal/metabolic disease and dementia, as well as treatment with antirheumatic drugs. The final model was adjusted for these potential confounders. Use of hydroxychloroquine for non-COVID-19 indications was not associated with any change in confirmed SARS-CoV-2 (hazard ratio 0.90, 95% confidence interval 0.76-1.07). This result was robust in the propensity-score-matched sensitivity analysis. CONCLUSION This study, which is the largest to date to investigate the primary prophylactic effect of hydroxychloroquine against SARS-CoV-2, does not support any prophylactic benefit of hydroxychloroquine in the prevention of infection with SARS-CoV-2.
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Affiliation(s)
- Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark.
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Nils Hoyer
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Therese S Lapperre
- Department of Respiratory Medicine, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital North Zealand, Hillerød, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit, Department of Respiratory Medicine, Næstved, Slagelse and Ringsted Hospitals, Næstved, Denmark
| | | | - Kjell E J Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Casper Tidemandsen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Karin Armbruster
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Andrea Browatzki
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - Howraman Meteran
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark
| | | | | | | | - Jens D Lundgren
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; PERSIMUNE & CHIP: Department of Infectious Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; PERSIMUNE & CHIP: Department of Infectious Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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30
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Rezahosseini O, Møller DL, Sørensen SS, Perch M, Gustafsson F, Gelpi M, Knudsen J, Helleberg M, Rasmussen A, Nielsen SD, Harboe ZB. An Observational Prospective Cohort Study of Incidence and Outcome of Streptococcus pneumoniae and Hemophilus influenzae Infections in Adult Solid Organ Transplant Recipients. Microorganisms 2021; 9:1371. [PMID: 34202542 PMCID: PMC8304095 DOI: 10.3390/microorganisms9071371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae (S. pneumoniae) and Hemophilus influenzae (H. influenzae) are among the main vaccine-preventable bacterial infections in immunocompromised individuals including solid organ transplant (SOT) recipients. There is a lack of information about incidence and outcomes of these infections in SOT recipients. METHODS We determined the incidence of S. pneumoniae and H. influenzae, the related hospitalization, and 30- and 180-days mortality in a large cohort of 1182 adult SOT recipients. We calculated 95% confidence intervals (CI) of incidence rate (IR) using Byar's approximation to the Poisson distribution. RESULTS The overall IR of S. pneumoniae and H. influenzae were 1086 (95% CI, 796-1448) and 1293 (95% CI, 974-1687) per 100,000 person-years of follow-up (PYFU), respectively. The IR of invasive infections were 76 (95% CI, 21-202) and 25 (95% CI, 2.3-118) per 100,000 PYFU, respectively. Hospital admission was required in >50%, 30-days mortality was 0, and 180-days mortality was 8.8% and 4.5% after S. pneumoniae and H. influenzae infections, respectively. CONCLUSIONS The IR of invasive S. pneumoniae and H. influenzae infections in SOT recipients were much higher than reports from the general population in Denmark. Furthermore, a large proportion of infected SOT recipients were hospitalized. These findings highlight the need for further studies to assess uptake and immunogenicity of vaccines against S. pneumoniae and H. influenzae in SOT recipients.
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Affiliation(s)
- Omid Rezahosseini
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
| | - Dina Leth Møller
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
| | - Michael Perch
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
- Section for Lung Transplantation, Department of Cardiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Marco Gelpi
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
| | - Jenny Knudsen
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Susanne Dam Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
| | - Zitta Barrella Harboe
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, 2100 Copenhagen, Denmark
- Department of Pulmonary and Infectious Diseases, Hospital of Nordsjælland, University of Copenhagen, 2100 Copenhagen, Denmark
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31
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Benfield T, Bodilsen J, Brieghel C, Harboe ZB, Helleberg M, Holm C, Israelsen SB, Jensen J, Jensen TØ, Johansen IS, Johnsen S, Madsen BL, Lundgren J, Meyer CN, Mohey R, Pedersen LM, Nielsen H, Nielsen SL, Obel N, Omland LH, Podlekareva D, Poulsen BK, Ravn P, Sandholdt H, Starling J, Storgaard M, Søborg C, Søgaard OS, Tranborg T, Wiese L, Christensen HR. Improved survival among hospitalized patients with COVID-19 treated with remdesivir and dexamethasone. A nationwide population-based cohort study. Clin Infect Dis 2021; 73:2031-2036. [PMID: 34111274 PMCID: PMC8344480 DOI: 10.1093/cid/ciab536] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background There are limited data on outcomes of moderate to severe coronavirus disease 2019 (COVID-19) among patients treated with remdesivir and dexamethasone in a real-world setting. We sought to compare the effectiveness of standard of care (SOC) alone versus SOC plus remdesivir and dexamethasone. Methods Two population-based nationwide cohorts of individuals hospitalized with COVID-19 during February through December 2020 were studied. Death within 30 days and need of mechanical ventilation (MV) were compared by inverse probability of treatment weighted (ITPW) logistic regression analysis and shown as odds ratio (OR) with 95% confidence interval (CI). Results The 30-days mortality rate of 1694 individuals treated with remdesivir and dexamethasone in addition to SOC was 12.6% compared to 19.7% for 1053 individuals receiving SOC alone. This corresponded to a weighted OR of 30-day mortality of 0.47 (95% CI: .38–.57) for patients treated with remdesivir and dexamethasone compared to patients receiving SOC alone. Similarly, progression to MV was reduced (OR 0.36; 95% CI: .29–.46). Conclusions Treatment of moderate to severe COVID-19 during June through December that included remdesivir and dexamethasone was associated with reduced 30-day mortality and need of MV compared to treatment in February through May.
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Affiliation(s)
- Thomas Benfield
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Brieghel
- Department of Infectious Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Zitta Barrella Harboe
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Claire Holm
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Simone Bastrup Israelsen
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Janne Jensen
- Department of Medicine, Kolding Hospital, Kolding, Denmark
| | - Tomas Østergaard Jensen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Isik Somuncu Johansen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Stine Johnsen
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Birgitte Lindegaard Madsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Lundgren
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,CHIP, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Rajesh Mohey
- Department of Medicine, Herning Hospital, Herning, Denmark
| | - Lars Møller Pedersen
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Lønberg Nielsen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Niels Obel
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Daria Podlekareva
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Pernille Ravn
- Department of Infectious Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Haakon Sandholdt
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Jonathan Starling
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Søborg
- Department of Infectious Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | | | - Lothar Wiese
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Hanne Rolighed Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Andersen MA, Niemann CU, Rostgaard K, Dalby T, Sørrig R, Weinberger DM, Hjalgrim H, Harboe ZB. Differences and Temporal Changes in Risk of Invasive Pneumococcal Disease in Adults with Hematological Malignancies: Results from a Nationwide 16-Year Cohort Study. Clin Infect Dis 2021; 72:463-471. [PMID: 32463435 DOI: 10.1093/cid/ciaa090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 10/07/2019] [Accepted: 02/06/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with hematological malignancies (HM) are known to carry an increased risk of invasive pneumococcal disease (IPD). However, temporal variations in IPD risks following a cancer diagnosis remain poorly characterized. To inform vaccine guidelines and patient management, we assessed the IPD incidence among patients with HM and other malignancies. METHODS The study population included all individuals aged ≥15 years during 2000-2016 in Denmark. Variations in incidences of IPD over time and between different types of hematological malignancies and diagnoses were assessed by Poisson regression. RESULTS During 85 002 224 person-years of observation, 13 332 episodes of a first IPD were observed, of which 765 (5.7%) occurred among individuals with HM. Among HM patients, the IPD incidence rate decreased continuously during the study period (rate ratio per year, 0.91; 95% confidence interval, .90-.92). The risk of IPD in patients with HM was up to 39 times higher when compared to the background population and was highest for multiple myeloma, acute lymphoblastic leukemia, and chronic lymphocytic leukemia. Unlike other malignancies, the increased IPD risk did not wane with the time since HM diagnosis. We found a vaccination uptake of only ≤2% in patients with HM and ≤1% for those with other types of malignancies. CONCLUSIONS Adults with HM in general and patients with lymphoid malignancies in particular have an increased risk for IPD, compared with patients with other types of cancer and with individuals free of cancer. The pneumococcal vaccination uptake is extremely low in this at risk-population. Efforts to prevent IPD in HM patients are continuously warranted.
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Affiliation(s)
- Michael Asger Andersen
- Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Tine Dalby
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Rasmus Sørrig
- Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Henrik Hjalgrim
- Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.,Department of Pulmonary and Infectious Diseases, Hospital of Nordsjælland, University of Copenhagen, Copenhagen, Denmark
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33
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Holler JG, Eriksson R, Jensen TØ, van Wijhe M, Fischer TK, Søgaard OS, Israelsen SB, Mohey R, Fabricius T, Jøhnk F, Wiese L, Johnsen S, Søborg C, Nielsen H, Kirk O, Madsen BL, Harboe ZB. First wave of COVID-19 hospital admissions in Denmark: a Nationwide population-based cohort study. BMC Infect Dis 2021; 21:39. [PMID: 33421989 PMCID: PMC7794638 DOI: 10.1186/s12879-020-05717-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 08/25/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease coronavirus disease 2019 (COVID-19), is a worldwide emergency. Demographic, comorbidity and laboratory determinants of death and of ICU admission were explored in all Danish hospitalised patients. METHODS National health registries were used to identify all hospitalized patients with a COVID-19 diagnosis. We obtained demographics, Charlson Comorbidity Index (CCI), and laboratory results on admission and explored prognostic factors for death using multivariate Cox proportional hazard regression and competing risk survival analysis. RESULTS Among 2431 hospitalised patients with COVID-19 between February 27 and July 8 (median age 69 years [IQR 53-80], 54.1% males), 359 (14.8%) needed admission to an intensive care unit (ICU) and 455 (18.7%) died within 30 days of follow-up. The seven-day cumulative incidence of ICU admission was lower for females (7.9%) than for males (16.7%), (p < 0.001). Age, high CCI, elevated C-reactive protein (CRP), ferritin, D-dimer, lactate dehydrogenase (LDH), urea, creatinine, lymphopenia, neutrophilia and thrombocytopenia within ±24-h of admission were independently associated with death within the first week in the multivariate analysis. Conditional upon surviving the first week, male sex, age, high CCI, elevated CRP, LDH, creatinine, urea and neutrophil count were independently associated with death within 30 days. Males presented with more pronounced laboratory abnormalities on admission. CONCLUSIONS Advanced age, male sex, comorbidity, higher levels of systemic inflammation and cell-turnover were independent factors for mortality. Age was the strongest predictor for death, moderate to high level of comorbidity were associated with a nearly two-fold increase in mortality. Mortality was significantly higher in males after surviving the first week.
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Affiliation(s)
- Jon Gitz Holler
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Hillerød, Denmark.
| | - Robert Eriksson
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Hillerød, Denmark
- Department of Disease Systems Biology, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Tomas Østergaard Jensen
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Hillerød, Denmark
| | - Maarten van Wijhe
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Hillerød, Denmark
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea Kølsen Fischer
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Hillerød, Denmark
- University of Southern Denmark, Odense, Denmark
| | | | | | - Rajesh Mohey
- Department of Internal Medicine, Aarhus University Hospital, Herning, Denmark
| | - Thilde Fabricius
- Department of Infectious Diseases, University Hospital of Southern Denmark, Odense, Denmark
| | - Frederik Jøhnk
- Department of Infectious Diseases, Lillebaelt Hospital, Vejle, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Stine Johnsen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Christian Søborg
- Department of Infectious Diseases, Copenhagen University Hospital, and Gentofte, Herlev, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lindegaard Madsen
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Hillerød, Denmark
- Centre for Physical Activity, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Hillerød, Denmark
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34
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Dalager-Pedersen M, Lund LC, Mariager T, Winther R, Hellfritzsch M, Larsen TB, Thomsen RW, Johansen NB, Søgaard OS, Nielsen SL, Omland L, Lundbo LF, Israelsen SB, Harboe ZB, Pottegård A, Nielsen H, Bodilsen J. Venous thromboembolism and major bleeding in patients with COVID-19: A nationwide population-based cohort study. Clin Infect Dis 2021; 73:2283-2293. [PMID: 33400771 PMCID: PMC7929126 DOI: 10.1093/cid/ciab003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 11/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a potentially fatal complication of SARS-CoV-2 infection and thromboprophylaxis should be balanced against risk of bleeding. This study aimed to examine risks of VTE and major bleeding in hospitalized and community-managed SARS-CoV-2 patients compared with control populations. Methods Using nationwide population-based registries, 30-day risks of VTE and major bleeding in SARS-CoV-2 positive patients were compared with those of SARS-CoV-2 test-negative patients and with an external cohort of influenza patients. Medical records of all COVID-19 patients at six departments of infectious diseases in Denmark were reviewed in detail. Results The overall 30-day risk of VTE was 0.4% (40/9,460) among SARS-CoV-2 patients (16% hospitalized), 0.3% (649/226,510) among SARS-CoV-2 negative subjects (12% hospitalized), and 1.0% (158/16,281) among influenza patients (59% hospitalized). VTE risks were higher and comparable in hospitalized SARS-CoV-2 positive (1.5%), SARS-CoV-2 negative (1.8%), and influenza patients (1.5%). Diagnosis of major bleeding was registered in 0.5% (47/9,460) of all SARS-CoV-2 positive individuals and in 2.3% of those hospitalized. Medical record review of 582 hospitalized SARS-CoV-2 patients observed VTE in 4% (19/450) and major bleeding in 0.4% (2/450) of ward patients, of whom 31% received thromboprophylaxis. Among intensive care patients (100% received thromboprophylaxis), risks were 7% (9/132) for VTE and 11% (15/132) for major bleeding. Conclusions Among people with SARS-CoV-2 infection in a population-based setting, VTE risks were low to moderate and were not substantially increased compared with SARS-CoV-2 test-negative and influenza patients. Risk of severe bleeding was low for ward patients, but mirrored VTE risk in the intensive care setting.
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Affiliation(s)
- Michael Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej, Aalborg, Denmark
| | - Lars Christian Lund
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, J B Winsløws Vej, Odense C, Denmark
| | - Theis Mariager
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej, Aalborg, Denmark
| | - Rannva Winther
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej, Aalborg, Denmark
| | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, J B Winsløws Vej, Odense C, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Vennelyst Boulevard, Aarhus C, Denmark
| | - Torben Bjerregaard Larsen
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Søndre Skovvej, Aalborg, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle, Aarhus N, Denmark
| | - Nanna Borup Johansen
- Department of Clinical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark
| | - Ole Schmeltz Søgaard
- Department of Infectious Diseases, Aarhus University Hospital, Palle-Juul Jensens Boulevard, Aarhus N, Denmark
| | - Stig Lønberg Nielsen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej, Odense C, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Lars Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Fogt Lundbo
- Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospitals, Amager and Hvidovre, Hvidovre, Denmark
| | - Simone Bastrup Israelsen
- Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospitals, Amager and Hvidovre, Hvidovre, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital North Zealand, Dyrehavevej, Hillerød, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, J B Winsløws Vej, Odense C, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej, Aalborg, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej, Aalborg, Denmark
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Weinberger DM, Warren JL, Dalby T, Shapiro ED, Valentiner-Branth P, Slotved HC, Harboe ZB. Differences in the Impact of Pneumococcal Serotype Replacement in Individuals With and Without Underlying Medical Conditions. Clin Infect Dis 2020; 69:100-106. [PMID: 30321313 DOI: 10.1093/cid/ciy875] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/07/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) have had a well-documented impact on the incidence of invasive pneumococcal disease (IPD). However, declines in IPD due to vaccine-targeted serotypes have been partially offset by increases in IPD due to nonvaccine serotypes (NVTs). The goal of this study was to quantify serotype-specific changes in the incidence of IPD that occurred in different age groups, with or without certain comorbidities, following the introduction of 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood vaccination program in Denmark. METHODS We used nationwide surveillance data for IPD and a hierarchical Bayesian regression framework to estimate changes in the incidence of IPD associated with the introduction of PCV7 (2007) and PCV13 (2010) while controlling for serotype-specific epidemic cycles and unrelated secular trends. RESULTS Following the introduction of PCV7 and PCV13 in children, the net impact of serotype replacement varied considerably by age group and comorbidities. Differences in the magnitude of serotype replacement were due to variations in the incidence of NVTs in the different risk groups before the introduction of PCVs. The relative increases in the incidence of IPD caused by specific NVTs did not differ appreciably between risk groups in the postvaccination period. Serotype replacement offset a greater proportion of the benefit of PCVs in strata in which the NVTs comprised a larger proportion of cases prior to the introduction of the vaccines. CONCLUSIONS These findings could help to predict the impact of next-generation PCVs in specific risk groups.
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Affiliation(s)
- Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Tine Dalby
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Eugene D Shapiro
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.,Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.,Department of Infectious Diseases and Pulmonary Medicine, Nordsjaellands Hospital, Copenhagen University Hospital, Denmark
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36
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Taj K, Lindegaard B, Harboe ZB. [Severe adenovirus pneumonia in an immunocompetent man]. Ugeskr Laeger 2020; 182:V02200106. [PMID: 32734863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We describe a case of severe community-acquired adenovirus pneumonia in an immunocompetent 66-year-old man. He presented with one-day history of malaise, fever and emesis. Initial laboratory tests showed increased C-reactive protein level, normal white blood cell count and mild anaemia. The chest X-ray was unremarkable. A few days following admission his condition deteriorated to respiratory failure and sepsis. Chest CT-images showed bilateral infiltrates and pleural effusion. Pleural fluid and tracheal aspirates were positive for adenovirus by polymerase chain reaction assay. No other microbial pathogens were identified.
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Fuglebjerg NJU, Jensen TO, Hoyer N, Ryrsø CK, Lindegaard B, Harboe ZB. Silent hypoxia in patients with SARS CoV-2 infection before hospital discharge. Int J Infect Dis 2020; 99:100-101. [PMID: 32663601 PMCID: PMC7836996 DOI: 10.1016/j.ijid.2020.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the degree of hypoxia and subjective dyspnea elicited by a 6-minute walking test (6MWT) in COVID-19 patients prior to discharge. METHODS A 6MWT was performed in 26 discharge-ready COVID-19 patients without chronic pulmonary disease or cardiac failure. Heart rate, oxyhemoglobin saturation (SpO2), respiratory rate, and subjective dyspnea measured on the Borg CR-10 scale were measured before and immediately after the 6MWT, with continuous monitoring of SpO2 and heart rate during the 6MWT. The 6MWT was terminated if SpO2 dropped below 90%. A historical cohort of 204 patients with idiopathic pulmonary fibrosis (IPF) was used for comparison. RESULTS 13 (50%) of the COVID-19 patients developed exercise-induced hypoxia (SpO2 < 90%) during the 6MWT, of which one third had pulmonary embolism. COVID-19 patients experienced less hypoxia-related dyspnea during the 6MWT compared with patients with IPF. CONCLUSION The 6MWT is a potential tool in the diagnosis of asymptomatic exercise-induced hypoxia in hospitalized COVID-19 patients prior to discharge. Due to important methodological limitations, further studies are needed to confirm our findings and to investigate their clinical consequences.
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Affiliation(s)
| | - Tomas Oestergaard Jensen
- Department of Infectious Diseases and Pulmonary Medicine, Nordsjællands University Hospital, Denmark
| | - Nils Hoyer
- Department of Infectious Diseases and Pulmonary Medicine, Nordsjællands University Hospital, Denmark
| | - Camilla Koch Ryrsø
- Department of Infectious Diseases and Pulmonary Medicine, Nordsjællands University Hospital, Denmark
| | - Birgitte Lindegaard
- Department of Infectious Diseases and Pulmonary Medicine, Nordsjællands University Hospital, Denmark
| | - Zitta Barrella Harboe
- Department of Infectious Diseases and Pulmonary Medicine, Nordsjællands University Hospital, Denmark.
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38
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Fuglebjerg NJU, Eriksson R, Buch SV, Sundstrup M, Dadzam E, Jensen TØ, Harboe ZB. [Pulmonary thromboembolism as contributing cause of severe respiratory insufficiency in a patient with COVID-19 infection]. Ugeskr Laeger 2020; 182:V04200267. [PMID: 32943140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report a case of multiple peripheral pulmonary thromboembolisms in a 69-year-old male hospitalised due to SARS-CoV-2 infection. There were no evident risk factors for pulmonary thromboembolism, the patient had a Wells' score of zero, and the diagnosis only became evident after repeated CT pulmonary angiographies.
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39
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Lundbo LF, Harboe ZB, Smith-Hansen L, Benfield T. Increased Risk of Invasive Meningococcal Disease Associated with Primary and Secondary Immunodeficiency. Open Forum Infect Dis 2017. [PMCID: PMC5631989 DOI: 10.1093/ofid/ofx162.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Risk of invasive meningococcal disease (IMD) is increased for persistent complement deficiency and HIV infection. However, risk associated with other primary and secondary immunodeficiency is unknown. Methods Nationwide case–control study of adults aged >18 years. Cases and matched controls were identified by registry linkage. Primary and secondary immunodeficiencies diagnosed prior to IMD were based on International Classification of Disease (ICD), eight or tenth revision. Odds ratios (OR) with 95% confidence intervals (CI) were estimated by conditional logistic regression after adjustment for sex, age, and the year of IMD. Results We identified 2,179 IMD cases (46% male) with a median age of 44 years (interquartile range: 24–63 years). Increased risk of IMD was associated with HIV infection (OR 10.03 [95% confidence interval (CI), 2.91–34.66]), splenectomy/splenic resection (OR 6.88 [95% CI, 3.9–14.82]), solid organ transplantation (SOT) (OR 20.00 [95% CI, 5.00–79.96]), hemolytic anemia (OR 7.78 [95% CI, 2.90–20.90]), antibody deficiency (OR 6.67 [1.11–39.90]) and autoimmune diseases (OR 1.80 [95% CI, 1.44–2.14]). Primary immunodeficiency overall was not associated with an increased risk (OR 1.43 (95% CI, 0.61–3.36)). Conclusion This large study of Danish adults with IMD over four decades showed an increased risk of IMD associated with HIV infection, SOT, asplenia, hemolytic anemia, antibody deficiency, and autoimmune disease ranging from 2- to a 20-fold increased risk. Vaccination may be warranted in these populations. Disclosures Z. Barrella Harboe, Pfizer: independent physician, Travel grants.
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Affiliation(s)
- Lene Fogt Lundbo
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Zitta Barrella Harboe
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Lars Smith-Hansen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Thomas Benfield
- Department of Infectious Disease, Hvidovre University Hospital, Hvidovre, Denmark
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Karlsson WK, Harboe ZB, Roed C, Monrad JB, Lindelof M, Larsen VA, Kondziella D. Early trigeminal nerve involvement in Listeria monocytogenes rhombencephalitis: case series and systematic review. J Neurol 2017; 264:1875-1884. [PMID: 28730571 DOI: 10.1007/s00415-017-8572-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 05/22/2017] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 01/26/2023]
Abstract
Listeria monocytogenes is associated with rhombencephalitis. However, the exact mechanisms of brainstem invasion remains poorly understood. Here, we demonstrate clinical and radiological data suggesting that Listeria may invade the brainstem via the trigeminal nerve. Three females (41, 64 and 70 years) with culture proven L. monocytogenes bacteremia and rhombencephalitis were investigated in the period of 2014-16. T2-weighted and contrast-enhanced T1-weighted MRI revealed a cerebellopontine abscess in all three patients, including the involvement of the trigeminal nerve root. In two patients, MRI also revealed selective contrast enhancement of the sensory trigeminal tract in the pons and medulla oblongata. Prior to any other neurological symptoms, two patients complained of hypoesthesia and a tingling sensation in the ipsilateral half of the face, consistent with sensory trigeminal nerve dysfunction on that side. In addition, we identified another 120 cases of Listeria rhombencephalitis following a systematic review. Cranial nerves VII, V, IX, and X, respectively, medulla oblongata, cerebellum and pons, were the most frequently involved brain structures. The present clinical and radiological findings corroborate earlier data from animal experiments, indicating that L. monocytogenes may be capable of retrograde intra-axonal migration along the cranial nerves. We suggest that in a subset of patients with rhombencephalitis L. monocytogenes enters the cerebellopontine angle through the trigeminal nerve, invading the brainstem via the sensory trigeminal nuclei.
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Affiliation(s)
- William K Karlsson
- Department of Neurology, Herlev Sygehus, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeppe B Monrad
- Department of Neurology, Herlev Sygehus, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Lindelof
- Department of Neurology, Herlev Sygehus, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Neuroradiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Lundbo LF, Harboe ZB, Smith-Hansen L, Benfield T. Increased Risk of Invasive Meningococcal Disease in Children With Underlying Medical Conditions. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lene Fogt Lundbo
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Zitta Barrella Harboe
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen S, Denmark
| | - Lars Smith-Hansen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Thomas Benfield
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen N, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
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42
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Slotved HC, Dalby T, Harboe ZB, Valentiner-Branth P, Casadevante VFD, Espenhain L, Fuursted K, Konradsen HB. The incidence of invasive pneumococcal serotype 3 disease in the Danish population is not reduced by PCV-13 vaccination. Heliyon 2016; 2:e00198. [PMID: 27957553 PMCID: PMC5133732 DOI: 10.1016/j.heliyon.2016.e00198] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022] Open
Abstract
Since 2010, Denmark has included the 13-valent pneumococcal conjugated vaccine (PCV-13) in the childhood immunization programme. However, serotype 3 remains as an important cause of invasive pneumococcal disease (IPD) in Denmark. IPD surveillance data (1999-2016) was used to calculate the incidence and age-distribution of serotype 3 IPD, and the effect of PCV-13 on serotype 3 IPD incidence was examined. The incidence of serotype 3 IPD in the age group below 65 years was 0.51/100,000 pre PCV-13, and 0.45/100,000 post PCV-13. In the group 0-4 years, serotype 3 IPD incidence was 0.28/100,000 pre PCV-13, and 0.16/100,000 post PCV-13. Serotype 3 IPD incidence in the elderly showed a mean of 4.27/100,000 pre PCV-13, and 4.32/100,000 post PCV-13. PCV-13 childhood immunization in Denmark has not lead to a reduction of the incidence of IPD caused by serotype 3. The reason behind this missing effect needs to be investigated further.
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Affiliation(s)
- Hans-Christian Slotved
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Tine Dalby
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Laura Espenhain
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Kurt Fuursted
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Helle Bossen Konradsen
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Lundbo LF, Sørensen HT, Clausen LN, Hollegaard MV, Hougaard DM, Konradsen HB, Harboe ZB, Nørgaard M, Benfield T. Mannose-Binding Lectin Gene, MBL2, Polymorphisms Do Not Increase Susceptibility to Invasive Meningococcal Disease in a Population of Danish Children. Open Forum Infect Dis 2015; 2:ofv127. [PMID: 26464842 PMCID: PMC4602025 DOI: 10.1093/ofid/ofv127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/27/2015] [Indexed: 01/17/2023] Open
Abstract
Background. Neisseria meningitidis is the cause of meningococcal bacteremia and meningitis, and nasopharyngeal colonization with this pathogen is common. The incidence of invasive disease is highest in infants, whereas adolescents more often are carriers. Altered regulation or dysfunction of the innate immune system may predispose to invasive meningococcal disease (IMD). In this study, we investigated the effect of genetic variation in the mannose-binding lectin gene, MBL2, and its promoter on susceptibility to IMD and IMD-associated mortality among children. Methods. Children (<5 years) diagnosed during 1982-2007 with IMD and controls were identified through Danish national registries. DNA was obtained from the Danish Neonatal Screening Biobank. The associations between MBL2 diplotypes and IMD susceptibility and 30- and 90-day mortality were investigated using logistic regression analysis. Results. We included 1351 children: 406 with meningitis, 272 with bacteremia, and 673 age- and sex-matched controls. Of the children studied, 1292 (96%) were successfully genotyped and assigned MBL2 diplotypes. The median age in IMD cases was 19.1 months (interquartile range [IQR], 8.8-32.2 months). Children with defective MBL2 diplotypes were not at higher risk for meningococcal meningitis than children with intermediate and normal diplotypes (odds ratio [OR] = 0.69; 95% confidence interval [CI], .47-1.02). Similar results were found for children with bacteremia and defective diplotypes (OR = 0.84; 95% CI, .53-1.32) as well as for all cases (OR = 0.75; 95% CI, .56-1.01). There was no association between MBL2 diplotypes and mortality. Conclusions. Defective MBL2 diplotypes did not predict either an increased IMD susceptibility or mortality in a Danish population of children.
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Affiliation(s)
- Lene F Lundbo
- Department of Infectious Diseases ; Clinical Research Centre , Hvidovre Hospital ; Faculty of Health Sciences , University of Copenhagen
| | | | | | - Mads V Hollegaard
- Danish Centre for Neonatal Screening, Department for Congenital Disorders
| | - David M Hougaard
- Danish Centre for Neonatal Screening, Department for Congenital Disorders
| | | | - Zitta Barrella Harboe
- Department of Microbiological Surveillance and Research , Statens Serum Institut , Copenhagen ; Department for Pulmonary and Infectious Diseases , North Zealand Hospital Hillerød , Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology , Aarhus University Hospital
| | - Thomas Benfield
- Department of Infectious Diseases ; Clinical Research Centre , Hvidovre Hospital ; Faculty of Health Sciences , University of Copenhagen
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Harboe ZB, Larsen MV, Ladelund S, Kronborg G, Konradsen HB, Gerstoft J, Larsen CS, Pedersen C, Pedersen G, Obel N, Benfield T. Incidence and risk factors for invasive pneumococcal disease in HIV-infected and non-HIV-infected individuals before and after the introduction of combination antiretroviral therapy: persistent high risk among HIV-infected injecting drug users. Clin Infect Dis 2014; 59:1168-76. [PMID: 25038114 DOI: 10.1093/cid/ciu558] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. METHODS Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995-2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. RESULTS The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk [RR], 24.4 [95% confidence interval [CI], 23.7-25.1]), male sex (RR, 1.20 [95% CI, 1.16-1.24]), increasing age (per year) (RR, 1.03 [95% CI, 1.03-1.04]), and calendar period (pre-cART RR, 2.80 [95% CI, 2.70-2.91] compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 [95% CI, 1.49-1.66]), smoking (RR, 1.34 [95% CI, 1.26-1.42]), and injecting drug use (RR, 2.51 [95% CI, 2.26-2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79-1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350-500 CD4 T cells/µL: RR, 1.29 [95% CI, 1.21-1.37] and <100 cells/µL: RR, 7.4 [95% CI, 6.87-8.02]). The risk of IPD declined over time, although this was not the case for IDUs where the risk remained unchanged. CONCLUSIONS The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected subjects, despite the widespread use of cART. IDUs have a persistently high risk of IPD. Injecting drug use, smoking, and the receipt of cART are suitable targets for preventive measures in the future.
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Affiliation(s)
- Zitta Barrella Harboe
- Department of Infectious Diseases, Rigshospitalet Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen
| | - Mette Vang Larsen
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre
| | - Steen Ladelund
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre
| | - Gitte Kronborg
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Helle Bossen Konradsen
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet
| | | | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Thomas Benfield
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
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45
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Harboe ZB, Dalby T, Weinberger DM, Benfield T, Mølbak K, Slotved HC, Suppli CH, Konradsen HB, Valentiner-Branth P. Impact of 13-valent pneumococcal conjugate vaccination in invasive pneumococcal disease incidence and mortality. Clin Infect Dis 2014; 59:1066-73. [PMID: 25034421 DOI: 10.1093/cid/ciu524] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) at the population level is unclear. We explored PCV13's effect in reducing invasive pneumococcal disease (IPD)-related morbidity and mortality, and whether serotype-specific changes were attributable to vaccination or expected as a part of natural, cyclical variations. METHODS This was a Danish nationwide population-based cohort study based on the linkage of laboratory surveillance data and the Danish Civil Registration System. Changes in IPD incidence and mortality during baseline (2000-2007), 7-valent pneumococcal conjugate vaccine (PCV7) (2008-2010), and PCV13 (2011-2013) periods were estimated. Predicted incidences of serotypes were estimated controlling for cyclical trends from historical patterns observed during the past 20 years. RESULTS We observed a 21% reduction (95% confidence interval [CI], 17%-25%) in IPD incidence in the total population after PCV13's introduction, and a 71% reduction (95% CI, 62%-79%) in children aged <2 years, considered as the vaccine effectiveness. We estimated a 28% reduction (95% CI, 18%-37%) in IPD-related 30-day mortality, from 3.4 deaths (95% CI, 3.2-3.6) per 100 000 population in the pre-PCV period to 2.4 (95% CI, 2.2-2.7) in the PCV13 period. The decline in mortality was observed across all age groups but was mainly related to mortality reductions in the nonvaccinated population. For serotypes 1 and 3, there were no significant changes in incidence beyond what would be expected from natural cyclical patterns. Serotype 19A significantly increased following PCV7's introduction, but the incidence declined toward baseline in 2012. CONCLUSIONS PCV13 has brought greater benefits than we had expected in our setting. We observed a further decline on IPD incidence shortly after the shift from PCV7 to PCV13 in the national immunization program. This decline was accompanied by a substantial population-level decline in pneumococcal-related mortality of nearly 30% among nonvaccinated persons.
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Affiliation(s)
- Zitta Barrella Harboe
- National Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Tine Dalby
- National Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Thomas Benfield
- Department of Infectious Diseases Clinical Research Centre, Copenhagen University Hospital, Hvidovre Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Kåre Mølbak
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Hans Christian Slotved
- National Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut
| | - Camilla H Suppli
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Helle Bossen Konradsen
- National Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut
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46
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Larsen MV, Harboe ZB, Ladelund S, Skov R, Gerstoft J, Pedersen C, Larsen CS, Obel N, Kronborg G, Benfield T. Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV-infected individuals from 1995 to 2007: a nationwide cohort study*. HIV Med 2011; 13:45-53. [PMID: 21819526 DOI: 10.1111/j.1468-1293.2011.00937.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Incidence rates (IRs) of Staphylococcus aureus bacteraemia (SAB) are known to be higher in HIV-infected individuals than in the general population, but have not been assessed in the era of highly active antiretroviral therapy. METHODS From 1 January 1995 to 31 December 2007, all Danish HIV-infected individuals (n=4871) and population controls (n=92 116) matched on age and sex were enrolled in a cohort and all cases of SAB were registered. IRs and risk factors were estimated using time-updated Poisson regression analysis. RESULTS We identified 329 cases of SAB in 284 individuals, of whom 132 individuals were infected with HIV and 152 were not [crude IR ratio (IRR) 24.2; 95% confidence interval (CI) 19.5-30.0, for HIV-infected vs. non-HIV-infected individuals]. Over time, IR declined for HIV-infected individuals (IRR 0.40). Injecting drug users (IDUs) had the highest incidence and the smallest decline in IR, while men who have sex with men (MSM) had the largest decline over time. Among HIV-infected individuals, a latest CD4 count <100 cells/μL was the strongest independent predictor of SAB (IRR 10.2). Additionally, HIV transmission group was associated with risk of SAB. MSM were more likely to have hospital-acquired SAB, a low CD4 cell count and AIDS at the time of HIV acquisition compared with IDUs. CONCLUSIONS We found that the incidence of SAB among HIV-infected individuals declined during the study period, but remained higher than that among HIV-uninfected individuals. There was an unevenly distributed burden of SAB among HIV transmission groups (IDU>MSM). Low CD4 cell count and IDU were strong predictors of SAB among HIV-infected individuals.
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Affiliation(s)
- M V Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
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47
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Affiliation(s)
- Christian Fabiansen
- Médecins Sans Frontières-Denmark, Kristianiagade 8, DK-2100 København Ø, Denmark.
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48
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Howitz M, Christiansen AH, Harboe ZB, Mølbak K. Surveillance of bacterial meningitis in children under 2 y of age in Denmark, 1997–2006. ACTA ACUST UNITED AC 2009; 40:881-7. [DOI: 10.1080/00365540802325914] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Dalby T, Seier-Petersen M, Kristiansen MP, Harboe ZB, Krogfelt KA. Problem solved: a modified enzyme-linked immunosorbent assay for detection of human antibodies to pertussis toxin eliminates false-positive results occurring at analysis of heat-treated sera. Diagn Microbiol Infect Dis 2009; 63:354-60. [DOI: 10.1016/j.diagmicrobio.2008.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 12/08/2008] [Accepted: 12/15/2008] [Indexed: 11/16/2022]
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50
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Harboe ZB, Qureshi KM, Skinhøj P, Heegaard ED. [Marburg haemorrhagic fever in Angola, 2005]. Ugeskr Laeger 2005; 167:4087-90. [PMID: 16251096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The current outbreak of Marburg haemorrhagic fever (MHF) in Angola is the largest recorded to date. The article provides an overview of MHF, including historical and clinical aspects, and summarises the status of the present outbreak. Until now, the main components of the public health response in Angola have been effective diagnosis and isolation of patients and contacts, and implementation of hygiene procedures by health workers at local health facilities. Involvement of the local community still constitutes the main challenge for successful control of MHF in Angola.
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Affiliation(s)
- Zitta Barrella Harboe
- Statens Serum Institut, Sektor for Epidemiologi, Center for Biologisk Beredskab og Epidemiologisk Afdeling, og H:S Rigshospitalet, Finsencenteret, Epidemiklinikken, DK-2330 København S.
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