Immunogenicity after two and three doses of mRNA vaccine in patients with cancer treated with exclusive radiotherapy.

BACKGROUND AND PURPOSE: Data on immunoresponse after SARS-CoV-2 vaccines for patients treated with exclusive radiotherapy (RT) are scarce. Since RT may affect the immune system, we conducted the MORA trial (Antibody response and cell-mediated immunity of MOderna mRNA-1273 vaccine in patients treated with RAdiotherapy). MATERIALS AND METHODS: Data regarding humoral and cellular immune response of patients treated with RT were prospectively collected after the second and third dose of mRNA vaccines. RESULTS: Ninety-two patients were enrolled. With a median of 147 days after the second dose, the median SARS-CoV-2 IgG titer was 300 BAU/mL: six patients were seronegative (Spike IgG titer ≤ 40 BAU/mL), whereas 24, 46 and 16 were poor responders (Spike IgG titer:41-200 BAU/mL), responders (Spike IgG titer:201-800 BAU/mL) and ultraresponders (Spike IgG titer > 800 BAU/mL), respectively. Among seronegative patients, two patients were negative also for cell mediated response, as tested with IFN-γ release Assay (IGRA) test. With a median of 85 days after the third dose, the median SARS-CoV-2 IgG titer was 1632 BAU/mL in 81 patients: only two patients were seronegative, whereas 16 and 63 patients were responders and ultraresponders, respectively. Among the 2 persistently seronegative patients, IGRA test was negative in one who had previously received anti-CD20 therapy. Documented paucisymptomatic (n = 3) or asymptomatic (n = 4) infection occurred after the third dose, during the Omicron wave. CONCLUSION: In patients treated with exclusive RT, even during the Omicron breakthrough, robust humoral response and clinical protection from severe SARS-CoV-2 disease were achievable with three doses of mRNA vaccine.

The national COVID-19 vaccination campaign targeting the extremely vulnerable: the Florence Medical Oncology Unit experience in patients with cancer.

BACKGROUND: International and national oncology societies had released recommendations in favor of COVID-19 vaccination in cancer patients. In the context of the national vaccination campaign targeting the so called extremely vulnerable, we aimed to assess the safety and efficacy of the mRNA vaccines in a cohort of 623 patients. METHODS: Between March 26 and April 04, 2021, the Pfizer and BioNTech BNT162b2 mRNA and the Moderna mRNA-1273 vaccines were given as a two-dose prime-boost regimen. Starting on September 25th 2021 a third dose was offered to patients in whom a suboptimal immunogenicity with COVID-19 vaccination could be expected. Safety assessments were performed by phone call 7 days after each dose. Electronic health records were accessed to review demographic information, disease history, treatment detail, and outcome events of participants patients'. FINDINGS: No toxicities were reported in 63.7%, 54%, and in 48.7% patients with cancer after each dose. Mild-to-moderate pain at the injection site was the most commonly adverse event. After the second dose, 46% of the 610 patients reported toxicity, with more systemic side-effects observed. Fever was reported in 45% of patients, with a temperature ≥ 38 °C in 21.4% of them. Of the 335 patients receiving a third vaccine dose, 51% reported toxicity, with 13% of patients reporting more than one effect. Logistic regression analysis reported mixed results, with limited variables or categories reporting a significant odd ratio. The type of vaccine reported a significant value at first dose (OR = 0.12; CI 0.52, 0.26; p = 0.00). Thirty-four cases of COVID-19 infection were reported with only one patient requiring a short-term hospitalization for monitoring. INTERPRETATION: The safety profile of the mRNA vaccines does not raise any specific concerns and support prioritization of vaccination for cancer patients.

[Audit & Feedback: an example of use to improve adherence to therapies.] / Audit & Feedback: un esempio di utilizzo per migliorare l'aderenza alle terapie.

Although the Audit & Feedback (A&F) strategy is widely used in the healthcare context, a margin of uncertainty remains regarding the actual effectiveness in actually improving healthcare quality. Effectiveness research on A&F should be improved, without replicating studies and results already consolidated over the years. Comparative efficacy studies are needed in order to evaluate A&F strategies in poorly explored research areas, such as community care or home care. In these areas, a translational research framework has been developed by the Tuscan Regional Health Agency: its aim is to make the results available to the professionals involved in the territorial management of chronic patients. Doctors coordinating the territorial functional aggregations and referring community physicians are the main targets. A&F can also be a tool to improve the performance of general practitioners in their actions aimed at maintaining patients' adherence to clinical prescriptions, highlighting any significant difference between the monitored performances.

Adherence to Mediterranean Diet among Students from Primary and Middle School in the Province of Taranto, 2016-2018.

The Mediterranean diet represents one of the healthiest dietary patterns, but nowadays it is increasingly being ignored in schools and by families. The aim of this study is to assess the adherence to the Mediterranean diet by pupils living in a small Southern Italian municipality, and whether it is a predictor of nutritional status.The degree of adherence to the Mediterranean diet, the socio-economic status and the nutritional status of 314 students (6-14 years) were tested during the 2016/2017 and 2017/2018 school years with the help of a questionnaire comprising the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) test. Multivariate logistic regression analysis was used to assess the predictive role of the KIDMED score and the other variables with respect to nutritional status. Adherence to the Mediterranean diet is high, medium and poor in, respectively, 24.8, 56.4 and 18.8% of students; it varies depending on gender and age, with females and older students showing higher values. In the multivariate logistic regression model, sex and KIDMED level are become significant predictors of nutritional status. This study highlights the need for intervention in the form of school projects-also involving families-to promote healthier eating habits in younger generations.

The Experience of VaccinarSinToscana Website and the Role of New Media in Promoting Vaccination.

The Department of Health Sciences (University of Florence) developed a regional website "VaccinarSinToscana" in order to provide information on vaccines and communicate with the general population, as well as the healthcare community, at a regional and local level. The aim of this paper is to present the VaccinarSinToscana website framework and analyze the three-year activity of the website and the related social network account on Facebook in terms of dissemination and visibility. In the first three years since its launch, the VaccinarSinToscana portal has increased its visibility: the number of single users, visits and single web pages has grown exponentially. Our results also demonstrate how the Facebook account launch contributed enormously to the increase in the visibility of the website. The objective for the future of the VaccinarSinToscana portal is to grow further, in order to reach out to an even wider audience.