Abstract
Background
Healthcare workers (HCWs) are at heightened risk of exposure to respiratory pathogens, and occupy an important epidemiologic position in the COVID-19 pandemic. PAIVED, a ...multicenter, multiservice study assessing influenza vaccine effectiveness in the Department of Defense over four consecutive influenza seasons (2018-22), provides an opportunity to describe influenza like illness (ILI) experience and assess the impact of SARS-CoV-2 in HCWs compared to non-HCWs.
Methods
PAIVED participants were randomized to receive either egg-based, cell-based, or recombinant-derived influenza vaccine and then surveyed weekly for ILI. At enrollment, participants provided key demographic data including whether they were HCWs with direct patient contact. ILI was defined a priori as 1) having cough or sore throat plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a symptom diary for seven days and submitted a nasal swab for pathogen detection. Study recruitment was conducted from September-January over four consecutive years.
Results
Of 13188 eligible participants enrolled, 4819 (36%) were HCWs. Overall, HCWs were more likely to be female (43% vs 31%), active duty military (86% vs 69%), and to identify as white (61% vs 56%). HCWs more commonly reported ILI than non-HCWs (25% vs 21%, p< 0.01). Of those experiencing ILI, SARS-CoV-2 was identified in a higher proportion of HCWs than non-HCWs (17% vs 12%, p< 0.01). Influenza was isolated in similar proportion of HCWs and non-HCWs (5% vs 4%). Each group reported similar ILI duration and severity (p< 0.01).
Conclusion
In a prior analysis of the 2019-20 PAIVED season, HCWs were more likely than non-HCWs to report ILI, have shorter illness duration, and isolate influenza A (H1N1). The propensity for HCWs to report ILI persisted over the four years. While SARS-CoV-2 emerged as a major pathogen in both groups, HCWs were more likely to have it identified as a cause of ILI, suggesting increased risk of symptomatic SARS-CoV-2 in our HCW population. Influenza incidence was lower than that of SARS-COV-2, and did not differ between HCWs and non-HCWs. Mean duration of illness did not differ between groups over four years; this equalization may relate to the higher incidence of SARS-CoV-2 in HCWs.
Disclosures
Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
Abstract
Background
Novel SARS-CoV-2 (SCV2) variants may differ in epidemiology and clinical impact. PAIVED, a randomized trial comparing the efficacy of 3 different platforms of inactivated ...influenza vaccines in adult military health system beneficiaries, actively surveils participants for influenza-like illness (ILI), including COVID-19, and conducts targeted investigations among those who develop ILI. The current season (2021/22) offered an opportunity to assess symptomatology associated with emerging SCV2 variants in this prospective cohort.
Methods
Following receipt of influenza vaccine, PAIVED participants receive a weekly email or text message querying for ILI symptoms. Those who reported ILI completed a validated symptom diary (FLU-PRO Plus) daily for 7 days and collected a nasal swab. Nasal specimens underwent multiplex PCR testing, followed by SCV2 genome sequencing as applicable. PAIVED study participants from the 2021-22 influenza season who reported an ILI, had confirmed infection with SCV2 for which sequence data is available, and completed at least one FLU-PRO Plus survey were included in this analysis.
Results
To date, 293 participants (7% of active cohort; 22.5% reporting ILI) tested positive for SCV2; sequencing has identified 23 Delta and 200 Omicron variants (199 BA.1, 1 BA.2). Among the 212 participants with sequenced SCV2 and symptom data, 55% were male, 57% were white, and 85% were active-duty military (Table 1). Overall, peak symptom severity was classified as mild to moderate in 79.3% of cases, fever duration averaged 2.5±2.2 days, and there were activity limitations for a mean of 5.2±3.8 days. No differences in maximum symptom scores (total or by domain) were detected for participants infected with Omicron compared to Delta. Figure 1 depicts variation in mean symptom scores by day of ILI, grouped by variant. Table 1.Demographic characteristics of PAIVED study participants with Delta and Omicron SARS-CoV-2 variants during the 2021/22 season.Figure 1.Mean FLU-PRO Plus domain and total scores by days since identification of an influenza-like illness in participants with Omicron or Delta variants of SARS-CoV-2 in the 2021/22 season of PAIVED.
Conclusion
Omicron emerged as the predominant SCV2 variant causing ILI in our cohort this season, typically manifesting with mild symptoms. Further exploration of potential differences in ILI experience between SCV2 variants and other ILI causes, plus the impact and timing of vaccination, will add insight into the relative contribution of such factors on symptomatology.
Disclosures
John H. Powers, III, MD, Arrevus: Advisor/Consultant|Eicos: Advisor/Consultant|Evofem: Advisor/Consultant|Eyecheck: Advisor/Consultant|Gilead: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|OPKO: Advisor/Consultant|Resolve: Advisor/Consultant|Romark: Advisor/Consultant|SpineBioPharma: Advisor/Consultant|UTIlity: Advisor/Consultant|Vir: Advisor/Consultant Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
This paper presents a case study from a project in Arusha region (north Tanzania), aiming at improving access to electricity in secondary schools through the establishment of a social enterprise, in ...charge of promoting rural electrification by applying the "4As Framework" with an innovative way and business structure. The work highlights benefits and challenges from the field, in order to drawn some key recommendations.
We have observed the cataclysmic variable AE Aqr for a total of 68.7 hours over the epoch 1991–1995 using the Whipple Observatory 10 m gamma-ray telescope. An analysis of these data has revealed no ...evidence for any steady, pulsed or episodic TeV emission. We have calculated an upper limit for steady emission of 4.0 × 10
−12 photons cm
−2s
−1 at an energy threshold of 900 GeV. This is three orders of magnitude less than the flux reported by others during burst activity. Our upper limits coherent pulsed emission at the first and second harmonics of the white dwarf frequency are 1.5 × 10
−12 photons cm
−2s
−1 in each case.
Available data conflict regarding the possible relation between chronic gastritis, Helicobacter pylori (Hp), and gastric motor disorders in nonulcer dyspepsia. The aim of this study, therefore, was ...(1) to evaluate both gastroduodenal fasting motility and gastric emptying in subjects with functional dyspepsia, with and without gastritis, and (2) to correlate the motility pattern to Hp infection.
Thirty-eight patients were studied, 20 positive for Hp infection (15 with gastritis) and 18 Hp-negative (8 with gastritis). All the subjects underwent 240-minute manometric recording of the interdigestive migrating motor complex, with evaluation of gastric and duodenal motility pattern and scintigraphic study of gastric emptying.
Whereas gastric emptying half-time did not differ in the subgroups of dyspeptic patients, a significant reduction of gastric phase IIIs of the migrating motor complex was detected between Hp-positive and Hp-negative subjects, both in overall patients (p < .01) and in patients with gastritis (p < .05).
Hp infection seems to be related to a reduction of interdigestive gastric activity fronts, though it does not affect gastric emptying. The conflicting data regarding gastric emptying and interdigestive motility in Hp infection could be explained as probably investigating two different functional aspects.
Abstract
Background
Defining the magnitude and quality of antibodies induced by infection and vaccination for SARS-CoV-2 during pregnancy and that cross the placenta can improve strategies to protect ...both mothers and infants.
Methods
Maternal peripheral and neonatal cord blood were collected from participants enrolled in a prospective longitudinal cohort study, the Epidemiology, Immunology, and Clinical Characteristics of pathogens with pandemic potential (EPICC), after presenting to a military treatment facility between March 2020 and March of 2022 with either COVID-19 or receipt of the COVID-19 vaccine. SARS-CoV-2 spike-specific IgG and neutralizing titers (NT) were measured with a multiplex microsphere immunoassay and a pseudovirus assay, respectively. Antibody dependent cellular cytotoxicity (ADCC), antibody dependent cellular phagocytosis (ADCP) and opsonization were measured with cell and bead-based assays.
Results
During the study period 20 pregnant participants were enrolled. Paired biospecimens (maternal blood/cord blood) were collected near birth from 17; 11 had a history of SARS-CoV-2 infection and 6 had both infection and received the BNT162b2 vaccine during pregnancy. The average anti-spike IgG at time of birth from mothers who were infected versus infected and vaccinated during pregnancy was 165.5 and 2592.7 BAU/ml, respectively (p=0.006). Average NT titers in infected versus infected and vaccinated mothers were 131.7 and 971.5 IC50, respectively (p = 0.0001). Anti-spike IgG and NT were not significantly different within dyads. Interestingly, ADCC was generally higher in newborn cord blood compared to maternal peripheral blood by 2.5-fold in both groups, while ADCP and opsonization was not.
Conclusion
Our study showed that hybrid immunity, comprised of infection and vaccination during pregnancy, increased the total magnitude and neutralizing potential of anti-SARS-CoV-2 antibodies in mothers and infants. Both hybrid immunity and isolated infection resulted in an increased transfer of ADCC activity across the placenta. Hybrid immunity is now common and determining the effect on maternal antibody levels and the characteristics of those antibodies can help inform maternal immunization strategies and protocols.
Disclosures
Julia Rozman, BS, AstraZeneca: TBD Mark P. Simons, PhD, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response David Tribble, MD, DrPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID response Timothy Burgess, MD, MPH, AstraZeneca: The IDCRP and the Henry M. Jackson Foundation (HJF) were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial Simon Pollett, MBBS, AstraZeneca: The IDCRP and the Henry M. Jackson Foundation (HJF) were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial
Many trials confirmed the safety of omitting axillary dissection in the selected patients treated for early breast cancer. The external validity of these trials is questionable. Our study aimed to ...evaluate the accuracy of the French population representativity in the SERC trial and the differences between these two populations as well as comparing the French and the Swedish populations (the SENOMIC trial population and the Swedish National Breast Cancer Registry (NKBC) cohort) of patients with sentinel node (SN) micro-metastasis. A higher rate of smaller tumors and grade 1 tumors was observed in the French cohort when compared to the SERC population. Our findings conclude that both French populations show similar characteristics. Positive non-sentinel node (NSN) rates at completion axillary lymph node dissection (ALND) were 10.28 % and 11.3 % in the SERC trial and French cohort, respectively (p = 0.5). The rate of grade 1 tumors was lower in the SENOMIC trial (16.2%) and in the NKBC cohort (17.4%) compared to the SERC trial population (27.3%) and the French cohort (34.4%). Our findings in addition to the previously demonstrated concordance between the SENOMIC trial and the NKBC populations imply that the results of both the SERC and the SENOMIC trials can be applied to both French and Swedish real populations.
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