Actus Santé

The physio-affective phenome of major depression is strongly associated with biomarkers of astroglial and neuronal projection toxicity which in turn are associated with peripheral inflammation, insulin resistance and lowered calcium

Background. Major depressive disorder (MDD) is characterized by elevated activity of peripheral neuro-immune and neuro-oxidative pathways, which may cause neuro-affective toxicity by disrupting neuronal circuits in the brain. No study has explored peripheral indicators of neuroaxis damage in MDD in relation to serum inflammatory and insulin resistance (IR) biomarkers, calcium, and the physio-affective phenome consisting of depressive, anxious, chronic fatigue, and physiosomatic symptoms. Methods. Serum levels of phosphorylated tau protein 217 (P-tau217), platelet-derived growth factor receptor beta (PDGFR), neurofilament light chain (NF-L), glial fibrillary acidic protein (GFAP), C-reactive protein (CRP), calcium and the HOMA2-insulin resistance (IR) index were measured in 94 MDD patients and 47 controls. Results. 61.1% of the variance in the physio-affective phenome (conceptualized as a factor extracted from depression, anxiety, fatigue and physiosomatic symptoms) is explained by the regression on GFAP, NF-L, P-tau2017, PDGFR{beta} and HOMA2-IR (all positively associated), and decreased calcium. In addition, CRP and HOMA2-IR predicted 28.9% of the variance in the neuroaxis index. We observed significant indirect effects of CRP and calcium on the physio-affective phenome which were partly mediated by the four neuroaxis biomarkers. Annotation and enrichment analysis revealed that the enlarged GFAP, P-tau217, PDGFR, and NF-L network was enriched in glial cell and neuronal projections, the cytoskeleton and axonal transport, including a mitochondrion. Conclusions: Peripheral inflammation and IR may damage the astroglial and neuronal projections thereby interfering with mitochondrial transport. This toxicity, combined with inflammation, IR and lowered calcium, may, at least in part, induce the phenome of MDD.
Catégories: Actus Santé

Comparing children's night cough with wheeze: phenotypic characteristics, healthcare use and treatment

Population-based studies of children presenting with dry night cough alone compared with those who also wheeze are few and inconclusive. Luftibus in the school is a population-based study of schoolchildren conducted between 2013-2016 in Zurich, Switzerland. We divided children into four mutually exclusive groups based on reported dry night cough ("cough") and wheeze and compared parent-reported symptoms, comorbidities and exposures using multinomial regression, FeNO using quantile regression, spirometry using linear regression and healthcare use and treatments using descriptive statistics. Among 3457 schoolchildren aged 6--17 years, 294 (9%) reported "cough", 181 (5%) reported "wheeze", 100 (3%) reported "wheeze and cough" and 2882 (83%) were "asymptomatic." Adjusting for confounders in a multinomial regression, children with "cough" reported more frequent colds, rhinitis and snoring than "asymptomatic" children; children with "wheeze" or "wheeze and cough" more often reported hay fever, eczema and parental histories of asthma. FeNO and spirometry were similar among "asymptomatic" and children with "cough," while children with "wheeze" or "wheeze and cough" had higher FeNO and evidence of bronchial obstruction. Children with "cough" used healthcare less often than those with "wheeze," and they attended mainly primary care. Twenty-two children (7% of those with "cough") reported a physician diagnosis of asthma and used inhalers. These had similar characteristics as children with wheeze. Our representative population-based study suggests only a small subgroup (7%) of schoolchildren reporting dry night cough without wheeze have features typical of asthma, yet the majority (93%) should be investigated for alternative aetiologies, particularly upper airway disease.
Catégories: Actus Santé

How long and effective does a mask protect you from an infected person who emits corona virus-laden particles: by implementing physics-based modeling

SARS-CoV-2 spreads via droplets, aerosols, and smear infection. From the beginning of the COVID-19 pandemic, using a facemask in different locations was recommended to slow down the spread of the virus. To evaluate facemasks' performance, masks' filtration efficiency is tested for a range of particle sizes. Although such tests quantify the blockage of the mask for a range of particle sizes, the test does not quantify the cumulative amount of virus-laden particles inhaled or exhaled by its wearer. In this study, we quantify the accumulated viruses that the healthy person inhales as a function of time, activity level, type of mask, and room condition using a physics-based model. We considered different types of masks, such as surgical masks and filtering facepieces (FFPs), and different characteristics of public places such as office rooms, buses, trains, and airplanes. To do such quantification, we implemented a physics-based model of the mask. Our results confirm the importance of both people wearing a mask compared to when only one wears the mask. The protection time before the healthy wearer has an infection risk of 50% reduces by 80% if only one wears the facemask instead of both people. The protection time is further reduced if the infected person starts to cough or increases the activity level by 85% and 99%, respectively. Results show the leakage of the mask can considerably affect the performance of the mask. For the surgical mask, the apparent filtration efficiency reduces by 75% with such a leakage, which cannot provide sufficient protection despite the high filtration efficiency of the mask. The facemask model presented provides key input in order to evaluate the protection of masks for different conditions in public places. The physics-based model of the facemask is provided as an online application.
Catégories: Actus Santé

Real-world experience with molnupiravir during the period of SARS-CoV-2 Omicron variant dominance.

Background. The real-world effectiveness of molnupiravir (MOL) during the dominance of Omicron SARS-CoV-2 lineage is urgently needed since the available data relates to the period of circulation of other viral variants. Therefore, this study assessed the efficacy of MOL in patients hospitalized for COVID-19 in a real-world clinical practice during the wave of Omicron infections. Methods. Among 11822 patients hospitalized after 1 March 2020 and included in the SARSTer national database, 590 were treated between 1 January and 31 April 2022, a period of dominance of the Omicron SARS-CoV-2 variant. MOL was administered to 203 patients, whereas 387 did not receive any antiviral regimen. Both groups were similar in terms of sex, BMI and age allowing for direct comparisons Results. Patients who did not receive antiviral therapy significantly more often required the use of Dexamethasone and Baricitinib. Treatment with MOL resulted in a statistically significant reduction in mortality during the 28-day follow-up (9.9 vs. 16.3%), which was particularly evident in the population of patients over 80 years of age treated in the first 5 days of the disease (14.6 vs. 35.2%). MOL therapy did not affect the frequency of the need for mechanical ventilation, but patients treated with MOL required oxygen supplementation less frequently than those without antivirals (31.7 vs. 49.2%). The time of hospitalization did not differ between groups. Conclusions. The use of molnupiravir in patients hospitalized for COVID-19 during the dominance of Omicron variant reduced mortality. This effect is particularly evident in patients over 80 years of age.
Catégories: Actus Santé

ELISA on Chip: High throughput antibody profiling using antigen microarrays

Vaccination and natural infection both elicit potent humoral responses that provide protection from subsequent infections. The immune-history of an individual following such exposures is in part encoded by antibodies. While there are multiple immunoassays for measuring antibody responses, the majority of these methods measure responses to a single antigen. A commonly used method for measuring antibody responses is the enzyme-linked immunosorbent assay (ELISA) assay - a semi-quantitative assay that is simple to perform in research and clinical settings. Here we present the ELISA-on-Chip assay - a novel antigen microarray based assay for rapid high-throughput antibody profiling. The assay can be used for profiling IgG, IgA and IgM responses to multiple antigens simultaneously, requiring minimal amounts of sample and antigens. Using three different types of influenza antigen microarrays, we demonstrated the specificity and sensitivity of our novel assay and compared it to the traditional ELISA assay, using samples from mice, chickens and humans. We also showed that our assay can be readily used with dried blood spots, which can be collected from wild birds, as well as from newborns and children. The ELISA-on-Chip assay can be readily used to profile hundreds of samples against dozens of antigens in a single day, and therefore offers an attractive alternative to the traditional ELISA assay.
Catégories: Actus Santé

The causal effect of cigarette smoking on healthcare costs

Knowledge of the impact of smoking on healthcare costs is important for establishing the external effects of smoking and for evaluating policies intended to modify this behavior. Conventional analysis of this association is difficult because of omitted variable bias, reverse causality, and measurement error. We approached these challenges using a Mendelian Randomization study design, in which genetic variants associated with smoking behaviors were used as instrumental variables. We undertook genome wide association studies to identify genetic variants associated with smoking initiation and a composite index of lifetime smoking on up to 300,045 individuals in the UK Biobank cohort. These variants were used in two-stage least square models and a variety of sensitivity analyses. All results were concordant in indicating a substantial impact of each smoking exposure on annual inpatient hospital costs Our results indicate a substantial impact of smoking on hospital costs. Genetic liability to initiate smoking (ever versus never having smoked) was estimated to increase mean per-patient annual hospital costs by GBP477 (95% confidence interval (CI): GBP187 to GBP766). A one unit change in genetic liability a composite index reflecting the cumulative health impacts of smoking was estimated to increase these costs by GBP204 (95% CI: GBP105 to GBP303). Models conditioning on the causal effect of risk tolerance were not robust to weak instruments for this exposure. Our findings have implications for the scale of external effects that smokers impose on others, and on the probable cost-effectiveness of smoking interventions.
Catégories: Actus Santé

Genome-wide association meta-analysis of spontaneous coronary artery dissection reveals common variants and genes related to artery integrity and tissue-mediated coagulation

Spontaneous coronary artery dissection (SCAD) is an understudied cause of acute myocardial infarction primarily affecting women. It is not known to what extent SCAD is genetically distinct from other cardiovascular diseases, including atherosclerotic coronary artery disease (CAD). Through a meta-analysis of genome-wide association studies including 1917 cases and 9292 controls of European ancestry, we identified 17 risk loci, including 12 new, with odds ratios ranging from 2.04 (95%CI 1.77-2.35) on chr21 to 1.25 (95%CI 1.16-1.35) on chr4. A locus on chr1 containing the tissue factor gene (F3), which is involved in blood coagulation cascade, appears to be specific for SCAD risk. Prioritized genes were mainly expressed in vascular smooth muscle cells and fibroblasts of arteries and are implicated predominantly in extracellular matrix biology (e.g. COL4A1/A2, HTRA1 and TIMP3). We found that several variants associated with SCAD had diametrically opposite associations with CAD suggesting that shared biological processes contribute to both diseases but through different mechanisms. We also demonstrated an inferred causal role for high blood pressure, but not other CAD risk factors, in SCAD. Our findings provide novel pathophysiological insights involving arterial integrity and tissue-mediated coagulation in SCAD and set the stage for future specific therapeutics and prevention for this disease.
Catégories: Actus Santé

Polygenic Risk Score Comparative Analyses Reveals Risk Disparity of Genetic Predisposition to Chronic Kidney Disease- A Multi Ancestry Approach

Polygenic Risk Score (PRS) models are used extensively to find the population/individual risk towards disease. These predictive scores are of great help as risk scores if predicted earlier the life of individual can be saved from the chronic/ complex diseases. In this empirical assessments study, the polygenic risk score was calculated in three different ancestries (SAS, EAS and African Americans) based on more than three hundred markers. The risk score we observed indicated that average population risk scores are varied but on cumulating the ancestries the average risk score increased ~1.3 times than individual population average risk. The parameter which varies greatly while calculating the PRS is the ancestry; it should be prerequisite that individuals of same ancestry should be taken as a one population groups while calculating the scores.
Catégories: Actus Santé

A Qualitative Study Exploring the Consumer Experience of Receiving Self-Initiated Polygenic Risk Scores from a Third-Party Website

The number of people accessing their own polygenic risk scores (PRSs) online is rapidly increasing, yet little is known about why people are doing this, how they react to the information, and what they do with it. We conducted a qualitative interview-based study with people who pursued PRSs through Impute.me, to explore their motivations for seeking PRS information, their emotional reactions, and actions taken in response to their results. Using interpretive description, we developed a theoretical model describing the experience of receiving PRSs in a direct-to-consumer (DTC) context. Dissatisfaction with healthcare was an important motivator for seeking PRS information. Participants described having medical concerns dismissed, and experiencing medical distrust, which drove them to self-advocate for their health, which in turn ultimately led them to seek PRSs. Polygenic risk scores were often empowering for participants, but could be distressing when PRS information did not align with participants perceptions of their personal or family histories. Behavioural changes made in response to PRS results included dietary modifications, changes in vitamin supplementation and talk-based therapy. Our data provides the first qualitative insight into how peoples lived experience influence their interactions with DTC PRSs.
Catégories: Actus Santé

Association between skull bone mineral density and periodontitis: evidence from the National Health and Nutrition Examination Survey (2011-2014)

Background and Objective: Bone mineral density (BMD) and periodontitis have been the subject of many studies. However, the relationship between skull (including mandible) BMD and periodontitis has not been extensively studied. An objective of this cross-sectional study was to examine the relationship between skull BMD and periodontitis using data from the National Health and Nutrition Examination Surveys (NHANES) for 2011-2012 and 2013-2014. Materials and Methods: From 19,931 participants, 3,802 were screened and included with no missing values in the study. We examined the distribution of variables by grouping the skull BMD levels into quartiles. Periodontitis is defined by the Centers for Disease Control and Prevention (CDC) and the American Periodontal Association (AAP) in 2012. An interaction test was conducted using stratified and adjusted logistic regression models, and multivariate logistic regression analysis was performed, along with curve fitting and a threshold effect analysis were performed on the relationship between skull BMD and periodontitis. Results: The results showed a negatively relationship between skull BMD and the risk of periodontitis. Although the inflection point was found (the skull BMD= 2.89g/cm 2 ), it was not statistically significant, indicating that the skull BMD and periodontitis are linearly related, which 1 unit increase in the skull BMD (g/cm 2 ) was associated with a 30% (OR=0.70; CI=0.57, 0.87; p=0.0010) reduction in the risk of periodontitis events. Conclusions: Periodontal disease may be related to low skull BMD, for those people, oral hygiene and health care should be more closely monitored. Validation of our findings will require further research.
Catégories: Actus Santé

Design and Performance Characteristics of the Elecsys Anti-SARS-CoV-2 S assay

Background: Automated, high throughput assays are required to quantify the immune response after infection with or vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study on the Roche Elecsys(R) Anti-SARS-CoV-2 S (ACOV2S) assay provides insights on the assay design and performance. Methods: The ACOV2S assay quantifies antibodies to the receptor-binding domain of the SARS-CoV-2 spike protein. The assigned units and the underlying standardization were compared to the international reference standard in BAU/mL. Assay specificity was assessed in samples (n=5981) collected prior to the COVID-19 pandemic and in samples from patients with non-COVID-19 respiratory infections (n=697) or other infectious diseases (n=771). Sensitivity was measured in 1313 samples from patients with mild COVID-19 and 297 samples from patients hospitalized with COVID-19. Comparison of results was performed to a comparator semi-quantitative anti-S1 assay of indirect detection format as well as a commercially available and an in-house version of a surrogate neutralization assay (ACE2-RBD). Results: The originally assigned units for the ACOV2S assay were shown to be congruent to the units of the First International WHO Standard for anti-SARS-CoV-2 immunoglobulins. Overall specificity was 99.98% with no geographical differences noted and no loss of specificity in samples containing potentially cross-reacting antibodies. High sensitivity was observed, with 98.8% of samples reported to be reactive >14 days after infection and sustained detection of antibodies over time. For all samples, ACOV2S titers and neutralization capacities developed with comparable dynamics. Robust standardization and assay setup enable excellent reproducibility of results, independent of lot or analyzer used. Conclusion: The results from this study confirmed that ACOV2S is a highly sensitive and specific assay and correlates well with surrogate neutralization assays. The units established for ACOV2S are also interchangeable with the units of the First International WHO Standard for anti-SARS-CoV-2 immunoglobulins. Worldwide availability of the assay and analyzers render ACOV2S a highly practical tool for population-wide assessment and monitoring of the humoral response to SARS-CoV-2 infection or vaccination
Catégories: Actus Santé

Efficacy of Anakinra in the Management of Patients with COVID-19 Infection: A Randomized Clinical Trial

Background The global pandemic of COVID-19 infections continues to grow worldwide, with rising number of deaths day by day. The hyperinflammation state contributes to the multiorgan failure associated with COVID-19 infections. This study aims to explore the efficacy and safety of anakinra in COVID-19 patients with both respiratory distress and cytokine release syndromes. Methods This was an open-label, multicenter, randomized clinical trial. Patients were randomized in 1:1 ratio to receive standard of care (SOC) alone, or anakinra plus SOC. Adults with confirmed COVID-19 infection with evidence of both respiratory distress and cytokine release syndrome were included. The primary outcome was treatment success at day 14, defined as WHO clinical progression score of [≤]3. The primary analysis was based on intention-to-treat population, with p-value of <0.05. Results A total of 80 patients were enrolled in the study. The mean age was 49.9 years (SD=11.7), with 82.5% (n=66) male patients. The primary outcome was not statistically different (87.5% (n=35) in anakinra group vs. 92.5% (n=37) in SOC group, p=0.712). The majority of reported adverse events were mild in severity and not related to the study treatment. Increased aspartate aminotransferase was the only significant adverse event (35% (n=14) in anakinra group vs. 15% (n=6) in SOC group, p=0.039); yet, was not associated with treatment discontinuation. Conclusion In patients with severe COVID-19 infection, the addition of anakinra to SOC treatment was not associated with significant improvement in the WHO clinical progression scale. Further studies investigating patients' subgroups that might benefit from anakinra are warranted. The trial was registered at ClinicalTrials.gov (NCT04643678).
Catégories: Actus Santé

Emergency Department Quality of Care for Sickle Cell Disease in Ontario, Canada: A Population-Based Matched Cohort Study

Background: Acute vaso-occlusive crisis (VOC) in sickle cell disease (SCD) often leads patients to seek emergency department (ED) care. The landscape of SCD ED care within Canada's universal and publicly funded healthcare system remains largely undefined. Here, we sought to address this knowledge gap by characterizing the quality of SCD VOC ED and inpatient care in Ontario, Canada. Methods: We used population-level health administrative data to identify patients with SCD in Ontario who presented to the ED with SCD VOC (ICD-10-CA code D57.0) from 2006 to 2018. We evaluated ED and inpatient metrics for this population and compared these with a general ED patient population and a validated Crohn's disease cohort matched by age, sex, neighbourhood income quintile, geography, date range of visit, and ED triage score. Results: We identified 2,123 patients who presented to the ED with SCD VOC for a total of 18,712 unscheduled ED visits. Annual ED visit rates ranged from a mean of 2.6 to 14.2 visits per patient, with 4.6% of patients having incurred 38.4% of all SCD VOC ED visits. Subgroup analyses showed that adult patients with SCD VOC visited the ED 2.5 times more than pediatric patients, but their wait times for initial physician assessment were significantly longer (90.6 vs. 51.1 minutes, p < 0.0001) with a difference that was disproportionately larger than the reference cohorts. Males with SCD VOC experienced significantly shorter ED and inpatient stays compared to females (e.g. admission length of stay: 4.4 vs. 5.8 days, p < 0.0001), but their ED return rates within 30-days were significantly higher (0.89 vs. 0.35 times, p < 0.0001) with a difference that was disproportionately larger relative to the reference cohorts. Lower-income neighbourhoods correlated with lower acuity triage scores for SCD VOC visits and increased repeat ED visit rates at more pronounced levels than the reference cohorts. Higher acuity triage scores for adults with SCD VOC correlated with improved metrics for quality of ED and inpatient care with fewer longer-term ED visits. Interpretation: Patients with SCD VOC carry a significant burden of acute care needs, with a smaller patient subset whose high ED visit rates have distinctly increased over time in Ontario, Canada. Adults, males and those from lower income quintile neighbourhoods with SCD VOC experienced poorer quality of ED and inpatient care compared to their counterparts, with differences that are disproportionately larger than those found in the general ED population and in patients with Crohn's disease. Higher acuity triage scoring may improve and standardize the quality of ED care for adult patients with SCD VOC. Future work should address these identified care quality disparities for SCD VOC that remain present within a universal and publicly funded healthcare system.
Catégories: Actus Santé

Caregiving in a Tertiary Health Institution in North Central Nigeria: Support Types and Financial Burden

Background Caregivers play an important role in informal patient management. Identification of the support types and the challenges faced by caregivers will provide information on strategies to ease this burden. This study aimed to describe the support types and financial burden among caregivers in a tertiary hospital in North Central Nigeria. Methods This was a cross-sectional study conducted among caregivers of in-patients admitted in a tertiary hospital in North Central Nigeria. Data was collected using a pre-tested interviewer-administered questionnaire. Data was analysed using the Statistical Package for Social Sciences package version 23. Results were reported in frequencies and proportions, and presented in prose, tables and charts. Results A total of 400 caregivers were recruited. Mean age was 38.32 +/- 12.82 years and most (66.0%) were females. Caregivers supported their patients by running errands (96.3%) and 85.3% reported caregiving as stressful. The reported errands were purchase of medications (92.3%), supply of non-medical needs (63.3%), submission of laboratory samples and collection of results (52.3%) and service payment (47.5%). About two thirds (63.2%) reported loss of income while caregiving and about half (50.8%) provided financial support to the patients. Conclusion This study suggests that majority of caregivers experience significant physical and financial burden while caregiving. This burden can be eased off by the simplification of payment and laboratory processes, and employment of more staff to support patients admitted in the wards. The financial burden experienced by caregivers reinforces the need to encourage more Nigerians to enrol in a health insurance scheme.
Catégories: Actus Santé

A personalized antibody score for predicting individual COVID-19 vaccine-elicited antibody levels from basic demographic and health information

Antibody titers wane after two-dose COVID-19 vaccinations, but individual variation in vaccine-elicited antibody dynamics remains to be explored. Here, we created a personalized antibody score that enables individuals to infer their antibody status by use of a simple calculation. We recently developed a mathematical model of B cell differentiation to accurately interpolate the longitudinal data from a community-based cohort in Fukushima, Japan, which consists of 2,159 individuals who underwent serum sampling two or three times after a two-dose vaccination with either BNT162b2 or mRNA-1273. Using the individually reconstructed time course of the vaccine- elicited antibody response, we first elucidated individual background factors that contributed to the main features of antibody dynamics, i.e., the peak, the duration, and the area under the curve. We found that increasing age was a negative factor and a longer interval between the two doses was a positive factor for individual antibody level. We also found that the presence of underlying disease and the use of medication affected antibody levels negatively, whereas the presence of adverse reactions upon vaccination affected antibody levels positively. We then applied to these factors a recently proposed computational method to optimally fit clinical scores, which resulted in an integer-based score that can be used to evaluate the antibody status of individuals from their basic demographic and health information. This score can be easily calculated by individuals themselves or by medical practitioners. There is a potential usefulness of this score for identifying vulnerable populations and encouraging them to get booster vaccinations.
Catégories: Actus Santé

Functional genomics for curation of variants in telomere biology disorder associated genes, a systematic review.

Background Patients with an underlying telomere biology disorder (TBD) have variable clinical presentations and can be challenging to diagnose clinically. A genomic diagnosis for patients presenting with TBD is vital for optimal treatments. Unfortunately, many variants identified during diagnostic testing are variants of uncertain significance (VOUS). This complicates management decisions, delays treatment and risks non-uptake of a potentially curative therapies. Improved application of functional genomic evidence may reduce VOUS classifications. Methods We systematically searched the literature for published functional assays interrogating TBD gene variants. Where possible, established likely benign/benign and likely pathogenic/pathogenic variants were used to estimate the assay sensitivity, specificity, positive predictive value, negative predictive value and odds of pathogenicity. Results 3131 articles were screened and 152 met inclusion criteria. Sufficient data to enable a PS3/BS3 recommendation was available for TERT variants only. We recommend PS3 and BS3 can be applied at a moderate and supportive level respectively. PS3/BS3 application was limited by a lack of assay standardisation and limited inclusion of benign variants. Conclusions Further assay standardisation and assessment of benign variants is required for optimal use of the PS3/BS3 criterion for TBD gene variant classification.
Catégories: Actus Santé

Efficacy and longevity of immune response to 3rd COVID-19 vaccine and effectiveness of a 4th dose in severely immunocompromised patients with cancer

Cancer patients show increased morbidity with COVID-19 and need effective immunization strategies. We demonstrate that a 3rd dose of COVID-19 vaccine leads to seroconversion in 57% of patients that were seronegative after primary vaccination. The immune response is durable as assessed by anti-S antibody titers, T-cell activity and neutralization activity against wild-type SARS-CoV2 and BA1.1.529 at 6 months of follow up. A subset of severely immunocompromised hematologic malignancy patients were unable to mount adequate immune response after the 3rd dose and were treated with a 4th dose in a prospective clinical trial which led to adequate immune-boost in 67% of patients. Low baseline IgM levels and CD19 counts were associated with inadequate seroconversion. Booster doses induced limited neutralization activity against the Omicron variant. These results indicate that vaccine booster-induced immunity is durable in cancer patients and additional doses can further stimulate immunity in a subset of hematologic malignancy patients
Catégories: Actus Santé

Reductions in stillbirths and preterm birth in COVID-19 vaccinated women: a multi-center cohort study of vaccination uptake and perinatal outcomes

Background: COVID-19 infection in pregnancy is associated with a higher risk of progression to severe disease, but vaccine uptake by pregnant women is hindered by persistent safety concerns. COVID-19 vaccination in pregnancy has been shown to reduce stillbirth, but its relationship with preterm birth is uncertain. Objective: The aim of this study was to investigate the sociodemographic characteristics associated with vaccine uptake in Melbourne, Australia, and to compare perinatal outcomes by vaccination status. Study design: Retrospective multicenter cohort study in Melbourne following the national recommendations for mRNA COVID-19 vaccination during pregnancy in June 2021. Routinely collected data from all 12 public maternity hospitals in Melbourne were extracted on births > 20 weeks gestation from 1st July 2021 to 31 March 2022. Maternal sociodemographic characteristics were analyzed from the total birth cohort. Perinatal outcomes were compared between vaccinated and unvaccinated women for whom weeks 20-43 of gestation fell entirely within the 9-month data collection period. The primary outcome was the rate of congenital anomaly in singleton infants >= 20 weeks gestation among women vaccinated during pregnancy. Secondary perinatal outcomes including stillbirth, preterm birth (spontaneous and iatrogenic), birthweight <= 3rd centile, and newborn intensive care unit admissions were examined for singleton infants >= 24 weeks gestation without congenital anomalies. We calculated the adjusted odds ratio of congenital anomalies and perinatal outcomes among vaccinated versus unvaccinated women using inverse propensity score weighting regression adjustment with multiple covariates; p< 0.05 was considered statistically significant. Results: Births from 32,536 women were analyzed: 17,365 (53.4%) were vaccinated and 15,171 (47.6%) were unvaccinated. Vaccinated women were significantly more likely to be older, nulliparous, non-smoking, not requiring an interpreter, of higher socioeconomic status, and vaccinated against pertussis and influenza. Vaccination status also varied by region of birth: compared with women born in Australia, women born in South and Eastern Europe, the Middle East, Africa and Oceania had lower adjusted odds of vaccination. There was no significant increase in the rate of congenital anomalies or birth weight <= 3rd centile in vaccinated women. Vaccinated women were significantly less like to have an infant with a major congenital anomaly compared with the unvaccinated group (2.4% vs 3.0%, aOR 0.72, 95%CI 0.56-0.94, p=0.02). This finding remained significant even when the analysis was restricted to women vaccinated before 20 weeks gestation. Vaccinated women had a significantly lower rate of stillbirth (0.2% vs 0.8%, aOR 0.18, 95%CI 0.09-0.37, P < 0.001. Vaccination was associated with a significant reduction in total preterm births < 37 weeks (5.1% vs 9.2%, aOR 0.60, 95% CI 0.51-0.71, p< 0.001), spontaneous preterm birth (2.4% vs 4.0%, aOR 0.73 95% CI 0.56-0.96, p=0.02) and iatrogenic preterm birth (2.7% vs 5.2%, aOR 0.52, 95%CI 0.41-0.65, p< 0.001). Conclusions COVID-19 Vaccine coverage was significantly influenced by known social determinants of health, which is likely to influence the strong association between COVID-19 vaccination and lower risks of stillbirth and preterm birth. We did not observe any adverse impacts of vaccination on fetal growth or development.
Catégories: Actus Santé

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