Health-care workers are thought to be highly exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to investigate the prevalence of antibodies against SARS-CoV-2 ...in health-care workers and the proportion of seroconverted health-care workers with previous symptoms of COVID-19.
In this observational cohort study, screening was offered to health-care workers in the Capital Region of Denmark, including medical, nursing, and other students who were associated with hospitals in the region. Screening included point-of-care tests for IgM and IgG antibodies against SARS-CoV-2. Test results and participant characteristics were recorded. Results were compared with findings in blood donors in the Capital Region in the study period.
Between April 15 and April 23, 2020, we screened 29 295 health-care workers, of whom 28 792 (98·28%) provided their test results. We identified 1163 (4·04% 95% CI 3·82–4·27) seropositive health-care workers. Seroprevalence was higher in health-care workers than in blood donors (142 3·04% of 4672; risk ratio RR 1·33 95% CI 1·12–1·58; p<0·001). Seroprevalence was higher in male health-care workers (331 5·45% of 6077) than in female health-care workers (832 3·66% of 22 715; RR 1·49 1·31–1·68; p<0·001). Frontline health-care workers working in hospitals had a significantly higher seroprevalence (779 4·55% of 16 356) than health-care workers in other settings (384 3·29% of 11 657; RR 1·38 1·22–1·56; p<0·001). Health-care workers working on dedicated COVID-19 wards (95 7·19% of 1321) had a significantly higher seroprevalence than other frontline health-care workers working in hospitals (696 4·35% of 15 983; RR 1·65 1·34–2·03; p<0·001). 622 53·5% of 1163 seropositive participants reported symptoms attributable to SARS-CoV-2. Loss of taste or smell was the symptom that was most strongly associated with seropositivity (377 32·39% of 1164 participants with this symptom were seropositive vs 786 2·84% of 27 628 without this symptom; RR 11·38 10·22–12·68). The study is registered at ClinicalTrials.gov, NCT04346186.
The prevalence of health-care workers with antibodies against SARS-CoV-2 was low but higher than in blood donors. The risk of SARS-CoV-2 infection in health-care workers was related to exposure to infected patients. More than half of seropositive health-care workers reported symptoms attributable to COVID-19.
Lundbeck Foundation.
People living with HIV (PLWH) were not included in the first efficacy studies of mRNA vaccines against SARS-CoV-2. In this literature review, we investigate evidence of humoral and cellular immunity ...after a third dose of an mRNA vaccine in PLWH. We performed a literature search in PubMed, Embase, Web of Science and SCOPUS published between 1 January 2020 and 31 December 2022. Selection criteria were studies on immunological responses in PLWH, who were given an mRNA-based vaccine as a third vaccine dose against SARS-CoV-2. Eight articles complied with our selection criteria. All studies found a strong humoral response after the third dose. Five studies investigated cellular immunity and found an increased cellular response after the third vaccine dose in PLWH. No difference in humoral response was observed between PLWH and controls after three doses. However, some of the studies suggested a weaker cellular response among PLWH than in controls, which was associated with lower nadir or current CD4+ T-cell counts. In conclusion, we found evidence of strong humoral immunity in PLWH after receiving an mRNA-based COVID-19 vaccine as a third dose, while the cellular immunity may be impaired compared to controls.
SARS-CoV-2 vaccines are crucial in controlling COVID-19, but knowledge of which factors determine waning immunity is limited. We examined antibody levels and T-cell gamma-interferon release after two ...doses of BNT162b2 vaccine or a combination of ChAdOx1-nCoV19 and BNT162b2 vaccines for up to 230 days after the first dose. Generalized mixed models with and without natural cubic splines were used to determine immunity over time. Antibody responses were influenced by natural infection, sex, and age. IgA only became significant in naturally infected. A one-year IgG projection suggested an initial two-phase response in those given the second dose delayed (ChAdOx1/BNT162b2) followed by a more rapid decrease of antibody levels. T-cell responses correlated significantly with IgG antibody responses. Our results indicate that IgG levels will drop at different rates depending on prior infection, age, sex, T-cell response, and the interval between vaccine injections. Only natural infection mounted a significant and lasting IgA response.
To investigate markers of systemic inflammation in pre- and postmenopausal women and identify possible predictors of systemic inflammation with menopause. Cross-sectional study of 69 healthy women ...between 45- and 60 years. Blood samples were collected to assess leukocyte subsets and plasma cytokines. MRI and DXA scans were performed to assess body composition. Through uni- and multivariate analyses, follicle-stimulating hormone (FSH), visceral fat mass and age were evaluated as predictors of systemic inflammation in relation to menopause. Postmenopausal women tended to have higher leukocyte counts (5.4 x10.sup.9 vs. 4.9 x10.sup.9 cells/l, p = 0.05) reflected in increased total lymphocytes (1.8 x10.sup.9 vs. 1.6 x10.sup.9 cells/l, p = 0.01) and monocytes (0.5 x10.sup.9 vs. 0.4 x10.sup.9 cells/l, p = 0.02), compared to premenopausal women. Increased visceral fat mass was a strong predictor of high leukocyte subsets. Postmenopausal women had higher plasma TNF-alpha (2.24 vs. 1.91 pg/ml, p = 0.01) and IL-6 (0.45 vs. 0.33 pg/ml, p = 0.004) compared to premenopausal women and high FSH was a significant predictor of increased plasma TNF-alpha, IL-1beta and IL-6. Menopause was further associated with increased T-cells (1,336 vs. 1,128 cells/mul, p = 0.04) reflected in significantly higher counts of exhausted-, senescent-, and memory CD4+ T-cell subsets. Menopause is associated with increased systemic inflammation as well as exhausted- and senescent T-cells. We suggest, that both increased visceral fat mass and declining sex hormone levels might contribute to postmenopausal systemic inflammation and calls for further large-scale studies to confirm these findings.
Many adolescents have been affected by the COVID-19 pandemic either directly by being infected with the virus or indirectly by lockdowns and restrictions influencing normal living. We aimed to ...investigate health, including symptoms of long COVID, in adolescents (aged 15-18 years) who tested positive for SARS-CoV-2 compared with a control group.
LongCOVIDKidsDK was a national, cross-sectional study carried out in Denmark, which included SARS-CoV-2-positive adolescents and matched controls. All Danish adolescents aged 15-18 years with a positive SARS-CoV-2 test during the period Jan 1, 2020, to July 12, 2021, and a control group matched (1:4) by age and sex were sent a survey from July 20, 2021. Participants had until Sept 15, 2021, to respond. Symptoms associated with COVID-19, school attendance, and health-related quality of life were investigated using ancillary questions and validated questionnaires (Paediatric Quality of Life Inventory PedsQL and Children's Somatic Symptoms Inventory-24 CSSI-24). Statistical analyses included descriptive statistics and logistic regression. This study is registered at ClinicalTrials.gov, NCT04786353.
24 315 adolescents with a positive SARS-CoV-2 test (case group) and 97 257 matched controls were invited to participate. 3013 matched controls were excluded because of suspected SARS-CoV-2 infection. 6630 (27·3%) responded in the case group and 21 640 (22·3%) responded and were eligible to participate in the control group. Across both groups, median age was 17·6 years (IQR 16·4-18·5), 16 277 (57·6%) of 28 270 responders were female, and 11 993 (42·4%) were male. Participants in the case group had greater odds of having at least one long COVID symptom lasting at least 2 months compared with the control group (3159 61·9% vs 12 340 57·0%, odds ratio 1·22 95% CI 1·15-1·30; p<0·0001). Participants in the case group reported significantly lower symptom scores (ie, less somatic distress) on the CSSI-24 than in the control group: mean 10·7 (SD 11·4, median 7·0 IQR 2·0-15·0) versus 11·9 (10·6, 9·0 4·0-17·0; p<0·0001). Participants in the case group had better quality of life scores on the PedsQL than in the control group: physical functioning mean score 88·7 (SD 13·9, median 93·8 IQR 84·4-100·0) versus 86·5 (14·3, 90·6 81·3-96·9; p<0·0001); emotional functioning 77·1 (20·3, 80·0 65·0-95·0) versus 71·7 (21·4, 75·0 60·0-90·0; p<0·0001); social functioning 93·1 (12·5, 100·0 90·0-100·0) versus 88·4 (16·2, 95·0 80·0-100·0; p<0·0001); and school functioning 66·9 (22·5, 65·0 60·0-85·0) versus 62·9 (22·1, 65·0 50·0-80·0; p<0·0001). More participants in the case group than in the control group reported 16 or more sick days (1205 18·2% vs 2518 11·6%; p<0·0001) and 16 or more days of school absence (695 10·5% vs 1777 8·2%; p<0·0001).
Participants with SARS-CoV-2-positive tests had more long-lasting symptoms and sick leave, whereas participants in the control group had more short-lasting symptoms and worse quality of life. Knowledge of long COVID in adolescents is important to guide clinical recognition and management of this condition.
AP Møller and Chastine McKinney Møller Foundation.
Background
People with HIV (PWH) are at increased risk of severe COVID‐19. We aimed to determine humoral responses in PWH and controls who received two doses of BNT162b2.
Methods
In 269 PWH and 538 ...age‐matched controls, we measured IgG and neutralizing antibodies specific for the receptor‐binding domain of SARS‐CoV‐2 at baseline, 3 weeks and 2 months after the first dose of BNT162b2.
Results
IgG antibodies increased from baseline to 3 weeks and from 3 weeks to 2 months in both groups, but the concentrations of IgG antibodies were lower in PWH than that in controls at 3 weeks and 2 months (p = 0.025 and <0.001), respectively. The IgG titres in PWH with a humoral response at 2 months were 77.9% (95% confidence interval 62.5%–97.0%, age‐ and sex‐adjusted p = 0.027) of controls.
Conclusions
Reduced IgG antibody response to vaccination with BNT162b2 was found in PWH, and thus increased awareness of breakthrough infections in PWH is needed.
Abstract
Background
Liver fibrosis is associated with poor liver-related outcomes and mortality. People with human immunodeficiency virus (PWH) may be at increased risk. We aimed to estimate the ...prevalence and factors associated with liver fibrosis in PWH compared to population controls.
Methods
This was a cross-sectional cohort study comparing 342 PWH with 2190 population controls aged 50–70 years.
Transient elastography was performed and elevated liver stiffness measurement (LSM) defined as 7.6 kPa as a proxy for significant liver fibrosis. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were computed by logistic regression.
Results
The prevalence of elevated LSM was higher in PWH than in uninfected controls (12% vs 7%; P < .01). Human immunodeficiency virus (HIV) infection was independently associated with elevated LSM. In multivariate analysis, elevated LSM was associated with HIV (aOR, 1.84 95% CI, 1.17–2.88; P < .01); higher age (per decade: aOR, 3.34 95% CI, 1.81–6.18; P < .01); alanine aminotransferase (ALT) (per 10 IU/L: aOR, 1.25 95% CI, 1.05–1.49; P < .01); body mass index (BMI) (per 1 kg/m2: aOR, 1.17 95% CI, 1.05–1.29; P < .01), and previous exposure to didanosine (per year: aOR, 2.26 95% CI, 1.01–5.06; P = .04).
Conclusions
The prevalence of elevated LSM was higher in PWH compared to population controls. Higher age, BMI, ALT, previous exposure to didanosine, and positive HIV status were independently associated with higher odds of elevated LSM.
Prevalence of elevated liver stiffness (LS) was higher in people with HIV compared to population controls. Higher age, body mass index, alanine aminotransferase, exposure to didanosine, and positive HIV status were independently associated with higher odds of elevated LS.
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.
This large retrospective cohort study with real‐life data shows that liver and kidney transplant recipients remain at high risk of SARS‐CoV‐2 infection and subsequent adverse outcomes but that vaccinated compared to unvaccinated recipients are at lower risk of adverse outcomes.
Abstract
Background
The purpose of this study was to assess whether influenza vaccination has an impact on the risk of coronavirus disease 2019 (COVID-19).
Methods
A cohort of 46 112 healthcare ...workers were tested for antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and filled in a survey on COVID-19 symptoms, hospitalization, and influenza vaccination.
Results
The risk ratio of hospitalization due to SARS-CoV-2 for influenza vaccinated compared with unvaccinated participants was 1.00 for the seasonal vaccination in 2019/2020 (confidence interval, .56–1.78, P = 1.00). Likewise, no clinical effect of influenza vaccination on development of antibodies against SARS-CoV-2 was found.
Conclusions
The present findings indicate that influenza vaccination does not affect the risk of SARS-CoV-2 infection or COVID-19.
This cohort study of 46 112 healthcare workers examined the effect of influenza vaccination on hospitalization and symptoms due to COVID-19 and development of antibodies against SARS-CoV-2. Influenza vaccination had no effect on the specified outcomes.
Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls.
We ...performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral Treatment Pulmonary Substudy (n=425) and frequency matched population controls from the Copenhagen General Population Study (n=2895) in a 1:3 ratio. Eligible participants were ≥25 years old and had two spirometry tests separated by at least 2 years of follow-up. Forced expiratory volume in 1 s (FEV
) decline (mL/year) was compared between PLWH and controls using a linear mixed model adjusted for age, sex, ethnicity and smoking status. Effect modification by smoking was investigated in subgroup analyses.
The majority of PLWH were virally suppressed (96.1%). The adjusted mean annual decline in FEV
was faster in PLWH than in controls with 36.4 (95% CI 33.7 to 39.1) vs 27.9 (95% CI 26.9 to 28.8) mL/year, yielding a difference of 8.5 (95% CI 5.6 to 11.4) mL/year. The association between HIV and FEV
decline was modified by smoking, with the largest difference in current smokers (difference: 16.8 (95% CI 10.5 to 23.0) mL/year) and the smallest difference in never-smokers (difference: 5.0 (95% CI 0.7 to 9.3) mL/year). FEV
decline >40 mL/year was more prevalent in PLWH (adjusted OR: 1.98 (95% CI 1.67 to 2.34)).
Well-treated PLWH have faster lung function decline than controls and smoking seems to modify this association, suggesting that smoking may lead to more rapid lung function decline in PLWH than in controls.
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