Rapid establishment of a COVID-19 convalescent plasma program in a regional health care delivery network.

BACKGROUND: COVID-19 convalescent plasma (CCP) represents an appealing approach to the treatment of patients with infections due to SARS-CoV-2. We endeavored to quickly establish a sustainable CCP transfusion program for a regional network of health care facilities. STUDY DESIGN AND METHODS: A regional collaborative group was activated to address the issues necessary to implementing a CCP transfusion program and making the program sustainable. A wide range of health care providers including physicians (critical care, infectious disease, transfusion medicine), nurses, pharmacists, laboratorians, and information technology (IT) specialists were required to make the program a success. RESULTS: The CCP implementation team initially consisted of four members but quickly grew to a group of nearly 20 participants based on different issues related to program implementation. Overall, six major implementation "themes" were addressed: (a) registration of individual hospitals and principal investigators with a national investigational new drug research protocol; (b) collaboration with a regional blood donor center; (c) targeted recruitment of convalesced donors; (d) IT issues related to all aspects of CCP ordering, distribution, and transfusion; (e) prioritization of patients to receive CCP; and (f) evaluation of CCP products including antibody characteristics and patient response to therapy. CONCLUSION: Within 4 weeks of initiation, CCP was successfully transfused at multiple hospitals in our regional health care delivery system. A program infrastructure was established that will make this program sustainable into the future. This approach has broader implications for the success of multi-institutional programs requiring rapid implementation.

Evolution of vaccinia virus-specific CD8+ cytotoxic T-lymphocyte responses in primary vaccinees and revaccinees.

Determination of successful vaccination with vaccinia virus is based on visual confirmation of a dermal response (take). Some revaccinees do not manifest a take, which may be due to a preexisting immunity rather than to poor technique or inadequate virus. Cytotoxic T-lymphocyte (CTL) response appears to be the most important immune defense in limiting response to vaccination. We evaluated vaccinia virus-specific CTL responses in revaccinees. Subjects with and without takes displayed comparable CTL responses. Vaccinia virus-specific CD8+ CTL responses may be useful in interpreting the response to vaccination, particularly in individuals who are revaccinated and have difficult-to-interpret visual takes.