Immunogenicity of COVID-19 Vaccination in Patients With End-Stage Renal Disease Undergoing Maintenance Hemodialysis: The Efficacy of a Mix-and-Match Strategy

BackgroundThe objective of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19) vaccination in patients with end-stage renal disease (ESRD) on hemodialysis.MethodsESRD patients at the hemodialysis center of a tertiary-care university-affiliated hospital and healthy employees at the clinical laboratory center were prospectively recruited between March and June 2021. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody analysis, blood samples were collected serially on days 0, 14, 28, and 56 after the first vaccine dose, and on days 7 and 50 after the second dose. Antibodies against the SARS-CoV-2 spike protein were quantified, and SARS-CoV-2 neutralizing antibodies were measured in the serum and plasma.ResultsThirty-one ESRD patients and 55 healthy employees were regularly monitored. Twenty-five (80.6%) ESRD patients on hemodialysis received a mix-and-match strategy with ChAdOx1-BNT162b2 (AZ–Pf group) and six (19.4%) received two doses of ChAdOx1 (AZ–AZ group). ESRD patients on hemodialysis showed lower binding antibody titers and neutralizing antibody activities compared to healthy participants following the first vaccination with ChAdOx1. After the second dose, AZ-Pf group had higher immunogenicity than healthy people on days 7 and 50. The binding antibody titer and neutralizing antibody activities on days 7 and 50 were significantly higher in the AZ–Pf group than in the AZ–AZ group.ConclusionESRD patients on hemodialysis receiving the mix-and-match strategy (ChAdOx1–BNT162b2) have COVID-19 vaccine immunogenicity comparable to healthy individuals receiving two doses of ChAdOx1.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT04871945","term_id":"NCT04871945"}}NCT04871945     

浙江省1997至2000年肾综合征出血热监测分析

目的：通过对肾综合征出血热（HFRS）监测分析,掌握全省HFRS的流行规律,控制其暴发流行,进一步降低该病的发病率,为制定防制措施提供依据。方法：采用直接免疫荧光（FAT）法,检测鼠肺HV抗原,采用间接免疫荧光（IFAT）法检测HFRS病人,健康人血清及鼠血中HV抗体,结果：1997－2000年全省共发病9041例,年均发病率为5．08／10万,死亡48人,病死率为0．53％,病例仍主要分布在沿钱塘江两岸的浙东和浙西丘陵区,浙南山区次之,浙北平原区和海岛区病例较少,全省11个地市均有发病,以浙东和浙西丘陵区的绍兴,宁波,台洲,衢州,杭州和金华6市发病最多。宿主动物野外以黑线姬鼠为优势种,占80．79％,室内以褐家鼠为优势种,占80．91％,结论：需要进一步加大监测力度,同时接种HFRS疫苗。     

不同人群接种重组(汉逊酵母)乙肝疫苗后免疫效果观察

目的:探讨重组(汉逊酵母)乙型肝炎(乙肝)疫苗对不同人群的免疫效果。方法:在沈阳市选择未接种过乙肝疫苗、且经ELISA法检测HBsAg、抗-HBs、抗-HBc三项指标全部为阴性的109名健康人群作为本次的观察对象,按照0、1、6的免疫程序接种10 g/0.5 ml重组(汉逊酵母)乙肝疫苗,于全程免疫1个月后采血,测定血清中抗-HBs水平。结果:109名受试者全部完成了3针全程接种,未发现明显的局部和全身反应。总抗-HBs阳转率为97.25%,几何平均浓度(GMC)为324.34 mIU/ml。15岁以下和15岁以上两组人群的抗-HBs阳转率分别为95.65%和98.41%,差异无统计学(2=0.757,P=0.384)。两组人群抗-HBs几何平均浓度分别为397.66 mIU/ml和270.80 mIU/ml,经t检验,差异有统计学意义(t=2.854,P<0.005)。男女间抗-HBs阳转率和几何平均浓度差异均无统计学意义(P>0.05)。结论:重组(汉逊酵母)乙肝疫苗具有良好的安全性和免疫效果,低年龄人群产生的保护性抗体水平较高年龄组高。     

Meningococcal disease: treatment and prevention

Many countries have been experiencing a significant increase in meningococcal disease. With the strains currently circulating, septicaemia is now a more frequent manifestation than meningitis and early recognition of disease manifestations by patient, parent or physician as well as early recognition of disease severity are the most important factors in attempting to reduce mortality and morbidity. Ceftriaxone is the treatment of choice but must be accompanied by aggressive supportive therapy in those with severe disease. The role of steroids is unknown. The evidence to support their use in both meningitis and severe systemic sepsis is discussed. The purified polysaccharide vaccines that have been available for some years may play a limited role in disease prevention. The recently introduced conjugate vaccine for preventing serogroup C disease represents a major advance but no vaccine is currently available to prevent serogroup B disease, cases of which will continue to challenge clinical practice.     

An autopsy case report of aortic dissection complicated with histiolymphocytic pericarditis and aortic inflammation after mRNA COVID-19 vaccination

A male in his 90 s consulted a doctor because he experienced several days of general fatigue and dyspnea. He was diagnosed with heart failure, and diuretic medications taken for 3 days relieved his symptoms. However, he was found dead on the morning of the fourth day after consultation. He had received a third dose of coronavirus disease 2019 (COVID-19) vaccine approximately 2 weeks before death. An autopsy revealed dissection of the ascending aorta and pericardial hemotamponade. The heart showed a white villous surface, and the pericardium was fibrously thick. Microscopic examination revealed pericarditis with predominantly macrophage and lymphocyte infiltration. These histological findings were compatible with those of post-vaccination myocarditis. To the best of our knowledge, histopathologically proven pericarditis after COVID-19 vaccination has not been reported. In the present case, extended inflammation of the aortic adventitia was a possible cause of aortic wall fragility followed by dissection.     

宜昌市2005-2014年18岁以下人群疫苗针对呼吸道传染病特征

目的 了解宜昌市近年来18岁以下人群疫苗针对呼吸道传染病的流行特征,为制定免疫策略提供科学依据.方法 收集2005-2014来宜昌市麻疹、流行性腮腺炎、风疹、流脑、流感疫情资料,用描述流行病学方法分析流行病学特征.结果 宜昌市2005-2014间共报告18岁以下人群麻疹、流腮、风疹、流脑、流感疫苗针对疾病17 532例,年均发病率依次为:0.17/10万、3.38/10万、0.25/10万、0.003/10万、0.48/10万;麻疹、流脑流行类型为散在发生,流行性腮腺炎、风疹、流行性感冒以暴发出现;各年间报告发病数差别较大,呈季节性分布,不同年份发生强度不尽相同,但近年来发病总体呈下降趋势;地区分布差异除流脑外有统计学意义(P均＜0.01);人群特征分布上差异有统计学意义(P匀＜0.01),男性平均发病率高于女性(男性发病率依次为:麻疹0.20/10万、流腮3.91/10万、风疹0.27/10万、流脑0.006/10万、流感0.53/10万;女性发病率依次为:麻疹0.14/10万、流腮2.71/10万、风疹0.22/10万、流脑0.001/10万、流感0.41/10万),麻疹发病集中在＜3岁的婴幼儿及中学生.结论 宜昌市疫苗针对性五种呼吸道传染病的控制效果不同,各年间发生数变化较大,需进一步加强宣传教育普及呼吸道传染病防治知识,提高未成年人疫苗接种率,有效建立人群免疫屏障,控制针对性疾病的发生率.     

顽固性扁平疣患者接种新型冠状病毒灭活疫苗后皮损自行消退一例

患者,男,26岁。2年前无明显诱因面部、上肢出现多发扁平丘疹,曾多次就诊于我院,诊断为"扁平疣"给予维A酸类药物外用、CO₂点阵激光治疗,效果欠佳。2021年5月13日患者行COVID-19-1(Vero Cell)(新型冠状病毒灭活疫苗-北京生物?,批号2021020088)首剂接种,1天后扁平疣皮损变红,自觉瘙痒明显,于2021年5月17日来我院就诊,未予药物治疗,嘱观察,2021年5月23日复诊时疣体枯萎脱落。