Risultati per: Identificate le origini evolutive di SARS-CoV-2

Medico marchigiano fu tra i primi a riconoscere il virus

New England Journal of Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Transient symptomatic or viral rebound was observed in up to one third of subjects with untreated mild to moderate COVID-19.

Finding SARS-CoV-2 RNA on floors of long-term care facilities predicted COVID-19 outbreaks at these facilities.

Objectives
To identify the association between maternal SARS-CoV-2 infection in pregnancy and individual neonatal morbidities and outcomes, particularly longer-term outcomes such as neurodevelopment.

Design
Systematic review of outcomes of neonates born to pregnant women diagnosed with a SARS-CoV-2 infection at any stage during pregnancy, including asymptomatic women.

Data sources
MEDLINE, Embase, Global Health, WHOLIS and LILACS databases, last searched on 28 July 2021.

Eligibility criteria
Case–control and cohort studies published after 1 January 2020, including preprint articles were included. Study outcomes included neonatal mortality and morbidity, preterm birth, caesarean delivery, small for gestational age, admission to neonatal intensive care unit, level of respiratory support required, diagnosis of culture-positive sepsis, evidence of brain injury, necrotising enterocolitis, visual or hearing impairment, neurodevelopmental outcomes and feeding method. These were selected according to a core outcome set.

Data extraction and synthesis
Data were extracted into Microsoft Excel by two researchers, with statistical analysis completed using IBM SPSS (Version 27). Risk of bias was assessed using a modified Newcastle-Ottawa Scale.

Results
The search returned 3234 papers, from which 204 were included with a total of 45 646 infants born to mothers with SARS-CoV-2 infection during pregnancy across 36 countries. We found limited evidence of an increased risk of some neonatal morbidities, including respiratory disease. There was minimal evidence from low-income settings (1 study) and for neonatal outcomes following first trimester infection (17 studies). Neonatal mortality was very rare. Preterm birth, neonatal unit admission and small for gestational age status were more common in infants born following maternal SARS-CoV-2 infection in pregnancy in most larger studies.

Conclusions
There are limited data on neonatal morbidity and mortality following maternal SARS-CoV-2 infection, particularly from low-income countries and following early pregnancy infections. Large, representative studies addressing these outcomes are needed to understand the consequences for babies born to women with SARS-CoV-2.

PROSPERO registration number
CRD42021249818.

After relaxing its “zero-COVID policy” in early December 2022, China’s SARS-CoV-2 infections surged, stoking concerns that new variants might appear. But none emerged in a genomic analysis of 413 COVID-19 cases collected in Beijing between November 14 and December 20, 2022. Two Omicron subvariants—BA.5.2 and BF.7—represented more than 90% of local infections, researchers in China reported in The Lancet.

Objective
Examine changes in SARS-CoV-2 seropositivity before and during the national vaccination campaign in the Czech Republic.

Design
Prospective national population-based cohort study.

Setting
Masaryk University, RECETOX, Brno.

Participants
22 130 persons provided blood samples at two time points approximately 5–7 months apart, between October 2020 and March 2021 (phase I, before vaccination), and between April and September 2021 (during vaccination campaign).

Outcome measures
Antigen-specific humoral immune response was analysed by detection of IgG antibodies against the SARS-CoV-2 spike protein by commercial chemiluminescent immunoassays. Participants completed a questionnaire that included personal information, anthropometric data, self-reported results of previous RT-PCR tests (if performed), history of symptoms compatible with COVID-19 and records of COVID-19 vaccination. Seroprevalence was compared between calendar periods, previous RT-PCR results, vaccination and other individual characteristics.

Results
Before vaccination (phase I), seroprevalence increased from 15% in October 2020 to 56% in March 2021. By the end of phase II, in September 2021, prevalence increased to 91%; the highest seroprevalence was seen among vaccinated persons with and without previous SARS-CoV-2 infection (99.7% and 97.2%, respectively), while the lowest seroprevalence was found among unvaccinated persons with no signs of disease (26%). Vaccination rates were lower in persons who were seropositive in phase I but increased with age and body mass index. Only 9% of unvaccinated subjects who were seropositive in phase I became seronegative by phase II.

Conclusions
The rapid increase in seropositivity during the second wave of the COVID-19 epidemic (covered by phase I of this study) was followed by a similarly steep rise in seroprevalence during the national vaccination campaign, reaching seropositivity rates of over 97% among vaccinated persons.

Objective
To explore the pattern of health services utilisation of people who had had a documented SARS-Cov-2 infection.

Design
Retrospective cohort study.

Setting
The Italian province of Reggio Emilia.

Participants
36 036 subjects who recovered from SARS-CoV-2 infection during the period September 2020–May 2021. These were matched for age, sex and Charlson Index with an equal number of subjects never found positive at the SARS-Cov-2 swab test over the study period.

Main outcome measures
Hospital admissions for all medical conditions and for respiratory or cardiovascular conditions only; access to emergency room (for any cause); outpatient specialist visits (pneumology, cardiology, neurology, endocrinology, gastroenterology, rheumatology, dermatology, mental health) and overall cost of care.

Results
Within a median follow-up time of 152 days (range 1–180), previous exposure to SARS-Cov-2 infection was always associated with higher probability of needing access to hospital or ambulatory care, except for dermatology, mental health and gastroenterology specialist visits. Post-COVID subjects with Charlson Index≥1 were hospitalised more frequently for heart disease and for non-surgical reasons than subjects with Charlson index=0, whereas the opposite occurred for hospitalisations for respiratory diseases and pneumology visits. A previous SARS-CoV-2 infection was associated with 27% higher cost of care compared with people never infected. The difference in cost was more evident among those with Charlson Index >1. Subjects who had anti-SARS-CoV-2 vaccination had lower probability of falling in the highest cost quartile.

Conclusions
Our findings reflect the burden of post-COVID sequelae, providing some specific insight on their impact on the extra-use of health services according to patients’ characteristics and vaccination status. Vaccination is associated with lower cost of care following SARS-CoV-2 infection, highlighting the favourable impact of vaccines on the use of health services even when they do not prevent infection.

The study by Lee et al1 showed that the short-term current use of proton pump inhibitors (PPIs) for less than 1 month was associated with severe clinical outcomes for patients with COVID-19. The authors speculated that individuals taking PPIs had increased gastric pH, leading to higher SARS-CoV-2 viral loads associated with a severe course of COVID-19. Many studies suggested that a proportion of patients with COVID-19 experiencing GI symptoms such as diarrhoea, nausea and vomiting had overall more severe disease.2 However, it is not clearly understood how SARS-CoV-2 could survive the passage through the harsh gastric acidity and persist through the intestinal contents to infect the intestinal epithelia. It is known that the gastric pH varies greatly, depending on whether the individual is in a fasting or feeding state (between 1.23 and 6.7, respectively).3 Similarly, bile concentrations in the small intestine can fluctuate from…

We read with interest the article by Kennedy et al, which demonstrated adequate serological responses to two-dose regimens of SARS-CoV-2 vaccination in individuals with IBD.1 However, a decay in antibody levels has been shown in the IBD population after two vaccine doses, with anti-tumour necrosis factor (anti-TNF) therapies associated with a more rapid decline.2–4 Despite recommendations for three-dose vaccine regimens for individuals with IBD,5 the uptake has been low in this population.6 We examined the serological response following three doses of mRNA SARS-CoV-2 vaccines in persons with IBD, the factors associated with antibody titres and the decay of antibody titres over time. Adults aged 18 years or older with a confirmed diagnosis of IBD who received three doses of an mRNA SARS-CoV-2 vaccine (Pfizer-BioNTech BNT162b2 mRNA (Comirnaty) or NIH-Moderna mRNA-1273 (Spikevax)) were recruited from 25 June 2021…

Circulation, Volume 147, Issue 10, Page 843-845, March 7, 2023.

Circulation, Volume 147, Issue 10, Page e653-e654, March 7, 2023.

Circulation, Volume 147, Issue 10, Page e655-e656, March 7, 2023.

Objective
To describe and synthesise studies of SARS-CoV-2 seroprevalence by occupation prior to the widespread vaccine roll-out.

Methods
We identified studies of occupational seroprevalence from a living systematic review (PROSPERO CRD42020183634). Electronic databases, grey literature and news media were searched for studies published during January–December 2020. Seroprevalence estimates and a free-text description of the occupation were extracted and classified according to the Standard Occupational Classification (SOC) 2010 system using a machine-learning algorithm. Due to heterogeneity, results were synthesised narratively.

Results
We identified 196 studies including 591 940 participants from 38 countries. Most studies (n=162; 83%) were conducted locally versus regionally or nationally. Sample sizes were generally small (median=220 participants per occupation) and 135 studies (69%) were at a high risk of bias. One or more estimates were available for 21/23 major SOC occupation groups, but over half of the estimates identified (n=359/600) were for healthcare-related occupations. ‘Personal Care and Service Occupations’ (median 22% (IQR 9–28%); n=14) had the highest median seroprevalence.

Conclusions
Many seroprevalence studies covering a broad range of occupations were published in the first year of the pandemic. Results suggest considerable differences in seroprevalence between occupations, although few large, high-quality studies were done. Well-designed studies are required to improve our understanding of the occupational risk of SARS-CoV-2 and should be considered as an element of pandemic preparedness for future respiratory pathogens.

Objectives
The aim of this study was to determine the risk factors associated with SARS-CoV-2 infection in a cohort of homeless people using survival analysis. Seroprevalence in the homeless community was also compared with that of the general population.

Design
Cohort study.

Setting
Data were collected across two testing sessions, 3 months apart, during which each participant was tested for anti-SARS-CoV-2 antibodies and completed a face-to-face survey.

Participants
All homeless adults sleeping rough, in slums or squats, in emergency shelters or transitional accommodation in Marseille were eligible.

Primary outcome measures
Occurrence of a seroconversion event defined as a biologically confirmed SARS-CoV-2 infection. Local data from a national seroprevalence survey were used for comparison between homeless people and the general population.

Results
A total of 1249 people were included. SARS-CoV-2 seroprevalence increased from 6.0% (4.7–7.3) during the first session to 18.9% (16.0–21.7) during the second one, compared with 3.0% (1.9–4.2) and 6.5% (4.5–8.7) in the general population. Factors significantly associated with an increased risk of COVID-19 infection were: having stayed in emergency shelters (1.93 (1.18–3.15)), being an isolated parent (1.64 (1.07–2.52)) and having contact with more than 5–15 people per day (1.84 (1.27–2.67)). By contrast, smoking (0.46 (0.32–0.65)), having financial resources (0.70 (0.51–0.97)) and psychiatric or addictive comorbidities (0.52 (0.32–0.85)) were associated with a lower risk.

Conclusion
We confirm that homeless people have higher infection rates than the general population, with increased risk in emergency shelters. There is growing evidence that, in addition to usual preventive measures, public policies should pay attention to adapt the type of accommodation and overall approach of precariousness.

Trial registration number
NCT04408131