December 15, 2023

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Flu

Developmental Impairment in Children Exposed During Pregnancy to Maternal SARS-COV2: A Brazilian Cohort Study
Was published in the International Journal of Infectious Diseases. Results published in the International Journal of Infectious Diseases of a prospective cohort of babies exposed to SARS-CoV-2 during pregnancy, and a control group of unexposed babies in a low-income area in Brazil. Children's neurodevelopment was assessed. They followed 127 children for one year, 69 in the COVID-19-exposed Group (EG), and 68 in the control group (CG). All mothers were unvaccinated at the time of cohort inclusion and maternal demographics were similar in the two groups. 20.3% of EG children and 5.9% of the CG received a diagnosis of neurodevelopmental delay within 12 months of life (p=0.013, RR= 3.44; 95% CI, 1.19- 9.95). For the exposed group, the prevalence of neurodevelopment impairment using ASQ-3 was 35.7% at 4 months, 7% at 6 months, and 32.1% at 12 months.

COVID: Children and other Vulnerable Populations

SARS-CoV-2 Neutralizing Antibody Titers in Maternal Blood, Umbilical Cord Blood, and Breast Milk
One hundred women were enrolled on admission for delivery. Previous SARS-CoV-2 infection was defined by anti-nucleocapsid antibodies. Levels of nAb and binding antibodies against spike receptor binding domain were measured in maternal blood, cord blood, and milk. They found that Levels of nAb in cord blood and milk correlated with maternal levels and were higher in cord blood than maternal. Spike protein binding antibody levels correlated with nAb and suggested that SARS-CoV-2 vaccination near delivery may boost antibody-mediated immunity in the peripartum period. They point out that this study demonstrates that neutralizing antibodies are passed transplacentally and into milk. They did find that Maternal nAb levels were higher after vaccine and infection than vaccine alone but waned rapidly.

COVID: Testing

COVID-19 Rapid Antigen Tests with Self-Collected vs Health Care Worker–Collected Nasal and Throat Swab Specimens: A Randomized Clinical Trial
An investigator-initiated, multicenter randomized clinical trial (NCT05209178) was conducted at two public COVID-19 test centers in Copenhagen, Denmark, from February 15 until March 25, 2022. The participants had 4 specimens collected: 2 health care worker (HCW)–collected nasal and throat swab specimens for RT-PCR testing (reference standard) and, afterward, 2 nasal and throat swab specimens (randomized to either self- or HCW-collected) for rapid antigen testing.

Flocked nasal swabs from a rapid antigen test kit (Standard Q COVID-19 Ag test, SD; Biosensor Inc) were used for both nasal and throat specimen collection for rapid antigen testing in the intervention and control groups. The detection rate was 86.6% (95% CI, 84.3%-88.9%) for a nasal specimen and 94.2% (95% CI, 92.6%-95.8%) for a throat specimen. The median Ct value was lower for an HCW-collected nasal specimen than for an HCW-collected throat specimen (16.7 [IQR, 13.8-21.7] vs 22.8 [IQR, 20.2-25.7]; P < .001). For a single specimen, the mean sensitivity for rapid antigen testing was lower for a self-collected throat specimen than for an HCW-collected throat specimen (53.7% [95% CI, 48.7%-58.7%] vs 69.4% [95% CI, 65.1%-73.6%]; P < .001) and was comparable for self-collected and HCW-collected nasal specimens (57.9% [95% CI, 52.9%-62.9%] vs 60.0% [95% CI, 55.4%-64.5%]; P = .53). They reported that no difference was found between self-collected throat specimens vs nasal specimens for rapid antigen testing (53.7% [95% CI, 48.7%-58.7%] vs 57.9% [95% CI, 52.9%-62.9%]; P = .17). Then they tell us that in a subgroup analysis of participants with symptoms revealed that self-collected nasal specimens had significantly higher mean sensitivity than self-collected throat specimens (71.5% [95% CI, 65.3%-77.6%] vs 58.0% [95% CI, 51.2%-64.7%]; P < .001). Really encouraging was that with this particular rapid test the specificity was greater than 99.5% for rapid antigen testing of all sample types. The authors point out that these results demonstrated that the throat sample technique is more challenging than obtaining a nasal sample, as they found a lower sensitivity and a higher number of inconclusive rapid antigen test results for self-collected throat specimens compared with HCW-collected throat specimens. In contrast, no difference was found between HCW-collected and self-collected nasal specimens. The authors discuss that current tests are only authorized with nasal specimens and that redesigning the current rapid antigen tests to include throat specimens will increase medical manufacturers’ costs and the complexity of home-based rapid antigen testing.

COVID: Ventilation/Transmission

Four Methods for Monitoring SARS-CoV-2 and Influenza A Virus Activity in Schools
Air samplers (ThermoFisher AerosolSense) were placed in communal gathering spaces (e.g., cafeterias) in all seven Oregon School District schools, and cartridges were analyzed twice weekly for the presence of IAV and SARS-CoV-2. IAV and SARS-CoV-2 genetic material captured in air samples and detected using quantitative RT-PCR assays targeting the influenza A virus (IAV) M gene, SARS-CoV-2 N1 and N2, and RNaseP as an internal control. They found that air sampling provided equivalent results to home-based specimen collection using RT-PCR, cause-specific absenteeism monitoring, school-based RAT.

COVID: Cytokine Storm Week

Efficacy and Safety of Baricitinib for the Treatment of Hospitalized Adults with COVID-19: A Systematic Review and Meta-analysis
The authors searched in PubMed, Embase, and Cochrane Library databases on January 31, 2023. They performed a meta-analysis to estimate the efficacy and safety of baricitinib for the treatment of hospitalized adults with COVID-19. They report that 3,010 patients were included in this analyses. All included studies were randomized controlled trials or prospective studies. There was no difference in 14-day mortality between the two groups [OR 0.23 (95% CI 0.03-1.84), I2 = 72%, P = 0.17]. In subgroup analyses they found that baricitinib did not seem to improve significantly in 24-day mortality critically ill patients [OR 0.60 (95% CI 0.35-1.02), I2 = 0%, P = 0.06]. Fortunately, baricitinib have led to faster recovery and shorter hospital stays for COVID-19 patients.

COVID: The Late Phase/PASC/Long COVID

A Synbiotic Preparation (SIM01) for Post-acute COVID-19 Syndrome in Hong Kong (RECOVERY): A Randomised, Double-blind, Placebo-controlled Trial
These are the results from a randomized, double-blind, placebo-controlled trial at a tertiary referral center in Hong Kong. Patients with PACS (PASC) according to the US Centers for Disease Control and Prevention criteria were randomly assigned (1:1) by random permuted blocks to receive SIM01 (10 billion colony-forming units in sachets twice daily) or placebo orally for 6 months. The synbiotic preparation (SIM01) is a micro-encapsulated lyophilised powder containing 20 billion colony-forming units of three bacterial strains, B adolescentis, Bifidobacterium bifidum, and Bifidobacterium longum with three prebiotic compounds including galacto-oligosaccharides, xylo-oligosaccharides, and resistant dextrin, which has been shown to promote the growth of these bacterial strains but also other probiotic strains. A synbiotic is defined as a “mixture of probiotics and prebiotics that beneficially affects the host by improving the survival and activity of beneficial microorganisms in the gut”. The probiotics are the Bifidobacterium species and the prebiotics, which are described as “a non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health” are those galacto-oligosaccharides, xylo-oligosaccharides, and resistant dextrin compounds. Ultimately there were 463 participants with 232 individuals allocated to SIM01 and 231 allocated to the placebo. At 6 months, a significantly higher proportion of individuals who received SIM01 had alleviations in fatigue (OR 2·273, p=0·0001), memory loss (1·967, p=0·0024), difficulty in concentration (2·644, p<0·0001), gastrointestinal upset (1·995, p=0·0014), and general unwellness (2·360, p=0·0008) compared with the placebo group. This held even after adjusting for multiple comparisons. The relative benefit increase after SIM01 were 47% for fatigue, 56% for memory loss, 62% for difficulty in concentration, 30% for gastrointestinal upset, and 31% for general unwellness.
COVID-19 Recovery: Consistent Absence of Cerebrospinal Fluid Biomarker Abnormalities in Patients With Neurocognitive Post-COVID Complications
The authors report they found no evidence of ongoing viral replication, immune activation, or CNS injury in plasma or CSF in patients with neurocognitive PCC compared with COVID-19 controls or healthy volunteers, suggesting that neurocognitive PCC is a consequence of events suffered during acute COVID-19 rather than persistent viral CNS infection or residual CNS inflammation. In this study 31 participants (25 with neurocognitive PCC) underwent clinical examination, lumbar puncture, and venipuncture ≥3 months after COVID-19 symptom onset. Healthy volunteers were included. CSF and plasma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid and spike antigen (N-Ag, S-Ag), and CSF biomarkers of immune activation and neuronal injury were analyzed. SARS-CoV-2 N-Ag or S-Ag were undetectable in all samples and no participant had pleocytosis. Authors detected no significant differences in CSF and plasma cytokine concentrations, albumin ratio, IgG index, neopterin, β2M, or in CSF biomarkers of neuronal injury and astrocytic damage. Furthermore, principal component analysis (PCA1) analysis did not indicate any significant differences between the study groups in the marker sets cytokines, neuronal markers, or anti-cytokine autoantibodies.
Risk of New-Onset Long COVID Following Reinfection with Severe Acute Respiratory Syndrome Coronavirus 2: A Community-Based Cohort Study
Investigators estimated the likelihood of new-onset, self-reported Long COVID after a second SARS-CoV-2 infection, compared to a first infection. They included UK COVID-19 Infection Survey participants who tested positive for SARS-CoV-2 between 1 November 2021 and 8 October 2022. The primary outcome was self-reported Long COVID 12–20 weeks after each infection. Separate analyses were performed for those <16 years and ≥16 years. The estimated adjusted odds ratios (aORs) for new-onset Long COVID, comparing second to first infections, controlling for sociodemographic characteristics and calendar date of infection, plus vaccination status in participants ≥16 years of age. Overall, Long COVID was reported by those ≥16 years after first infection 4.0% and after second infection 2.4%; the corresponding estimates among those aged <16 years were 1.0% and 0.6%. The aOR for Long COVID after second compared to first infections was 0.72 (95% confidence interval [CI], .63–.81) for those ≥16 years and 0.93 (95% CI, .57–1.53) for those <16 years.