Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination

Acute exacerbations due to COVID-19 vaccination in patients with interstitial lung disease (ILD) have been reported, but their incidence is unknown. We investigated the incidence of exacerbations of ILD and respiratory symptoms due to the mRNA COVID-19 vaccines. A questionnaire survey was conducted on adverse reactions to the mRNA COVID-19 vaccination in 545 patients with ILD attending our hospital and retrospectively examined whether the eligible patients actually developed acute exacerbations of ILD induced by the vaccine. Of the 545 patients, 17 (3.1%) patients were aware of the exacerbation of respiratory symptoms, and four (0.7%) patients developed an acute ILD exacerbation after vaccination. Of the four patients who experienced exacerbations, two had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. Four patients were treated using steroid pulse therapy with a steroid taper, and two of the four also received intravenous cyclophosphamide pulse therapy. Tacrolimus was started in one patient with myositis-associated interstitial lung disease. Eventually, all patients exhibited improvement with immunosuppressive treatment and were discharged. COVID-19 vaccination for patients with ILD should be noted for developing acute exacerbations of ILD with low incidence, although manageable with early diagnosis and treatment. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

The Current Status of Thrombosis and Anticoagulation Therapy in patients with COVID-19 in Japan: From the CLOT-COVID Study

Background: Data on thrombosis and current real-world management strategies for anticoagulation therapy are important for an optimal management of patients with coronavirus disease 2019 (COVID-19) Methods: The CLOT-COVID Study (thrombosis and antiCoaguLatiOn Therapy in patients with COVID-19 in Japan Study) was a retrospective, multicenter cohort study enrolling consecutive hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021. Also subanalysis is performed for D-dimer at the admission and influence of sex with adjustment confounders with multivariable logistic regression model. Result(s): Among 2894 patients with COVID-19, 1245 (43%) received pharmacological thromboprophylaxis. The proportion of pharmacological thromboprophylaxis increased according to the severity of the COVID-19 in9.8% with mild COVID-19, 61% with moderate COVID-19, and 97% with severe COVID-19. During the hospitalization, 38 patients (1.3%)and 126 (4.4%) underwent ultrasound examinations for the lower extremities and contrastenhanced computed tomography examinations, respectively, and 55 (1.9%) developed thrombosis, mostly venous thromboembolism(71%). The incidence of thrombosis increased according to the severity of the COVID-19 in 0.2% with mild COVID-19, 1.4%withmoderate COVID-19, and 9.5%with severe COVID-19. Major bleeding occurred in 57 patients (2.0%) and 158 (5.5%) died, and 81% of them were due to respiratory failure from COVID-19 pneumonia. The higher D-dimer levels in the 3rd tertile (>=1.1 mug/mL) in 2,771 patients who had D-dimer levels measured at admission. were independently associated with a higher risk of VTE during hospitalization (adjusted odds ratio 4.83 [95% confidence interval 1.93-12.11;P<0.001];reference=1st tertile).Men had more severe status of the COVID-19 at admission compared with women (Mild: 57% versus 66%, Moderate: 34% versus 29%, and Severe: 9.1% versus 5.7%, P < 0.001). During the hospitalization, men more often developed thrombosis than women (2.5% [95%CI, 1.9-3.3%] versus 0.8% [95%CI, 0.4- 1.6%], P = 0.001). Men had numerically higher incidences of thrombosis than women in all subgroups of the worst severity of COVID-19during the hospitalization (Mild: 0.3% versus 0.0%, Moderate: 1.6% versus 1.0%, and Severe: 11.1% versus 4.3%) Conclusion(s): In the large-scale observational study, pharmacological thromboprophylaxis for hospitalized patients was common especially in patients with severe COVID-19. The overall incidence of thrombosis was substantially low with an increased incidence according to the severity of the COVID-19 in Japan. In contrast to previous studies outside Japan, the risk of thrombosis in Japanese patients with COVID-19 may be relatively low, and racial differences may have to be considered. In subanalysis higher D-dimer levels at admission were associated with a higher risk of VTE events during hospitalization. Men had more severe status of the COVID-19 than women, and the risk of development of thrombosis was higher in men compared with women.

Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination

Acute exacerbations due to COVID-19 vaccination in patients with interstitial lung disease (ILD) have been reported, but their incidence is unknown. We investigated the incidence of exacerbations of ILD and respiratory symptoms due to the mRNA COVID-19 vaccines. A questionnaire survey was conducted on adverse reactions to the mRNA COVID-19 vaccination in 545 patients with ILD attending our hospital and retrospectively examined whether the eligible patients actually developed acute exacerbations of ILD induced by the vaccine. Of the 545 patients, 17 (3.1%) patients were aware of the exacerbation of respiratory symptoms, and four (0.7%) patients developed an acute ILD exacerbation after vaccination. Of the four patients who experienced exacerbations, two had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. Four patients were treated using steroid pulse therapy with a steroid taper, and two of the four also received intravenous cyclophosphamide pulse therapy. Tacrolimus was started in one patient with myositis-associated interstitial lung disease. Eventually, all patients exhibited improvement with immunosuppressive treatment and were discharged. COVID-19 vaccination for patients with ILD should be noted for developing acute exacerbations of ILD with low incidence, although manageable with early diagnosis and treatment.

Convalescent Plasma in Hospitalized Pediatric and Obstetric patients with COVID-19

Background. Published data on COVID-19 convalescent plasma (CCP) use in children and obstetric patients is limited. We describe a single-center experience of hospitalized patients who received CCP for acute COVID-19. Methods. We performed a retrospective review of children 0-18-years-old and pregnant patients hospitalized with laboratory-confirmed acute COVID-19 who received CCP from March 1st, 2020 to March 1st, 2021. Clinical and laboratory data were collected to assess the safety of CCP administration. Antibodies to SARS-CoV-2 were measured before and at various timepoints post CCP transfusion. Correlation between SARS-CoV-2 immunoglobulin administered versus the SARS-CoV-2 anti-Spike immunoglobulin response in patient serum was assessed. Results. Twenty-two children and 10 obstetric patients were eligible. 12 pediatric and 8 obstetric patients had moderate disease and 10 pediatric and 2 obstetric patients had severe disease. 5 pediatric patients died. 18/37 (48.6%) CCP units that were measured met FDA criteria for a high IgG titer. There were no complications with transfusion based on CDC, NHSN Biovigilance Component: Hemovigilance Module Surveillance Protocol. Two pediatric patients had fevers a few hours after CCP with low suspicion for a transfusion reaction. Median SARS-CoV-2 anti-spike antibody levels of pediatric patients post-transfusion for 0-7 days was 80.6AU/mL (range: 2-1070), 8-21 days was 180AU/mL (range: 12-661) and >21 days was 210AU/mL (range: 4.1-1220). For obstetric patients, post-transfusion antibody levels were only obtained 0-7 days post-transfusion with median 45AU/mL (range: 9.5-100). High-titer CCP showed a positive correlation with rise in patient immunoglobulin levels only in the obstetric patients but not in pediatric patients. Conclusion. CCP was administered safely to our moderately to severely ill pediatric and obstetric patients. Among pediatric patients, the median serum antibody level increased over time after transfusion and suggested that CCP did not interfere with the endogenous antibody production. Antibody dose of high-titer CCP correlated with post-transfusion response in only obstetric patients. Randomized trials in pediatric and obstetric patients are needed to further understand how to dose CCP and evaluate efficacy.

The role of a federally qualified health center during a pandemic

The COVID-19 pandemic has caused a signicant loss of life and dramatically upended the livelihood of communities across the world. However, as with other health crises, the pandemic has hit low-income communities particularly hard. Epidemiological data have shown that individuals in poorer communities are not only at a higher risk for severe COVID-19 illness and fatality, but are also at a heightened risk of suffering long-term economic and social consequences as indirect effects of the pandemic, highlighting the need for community-wide interventions. As community-based institutions, whose primary role is to provide primary care and divert patients from emergency care, Federally Qualied Health Centers (FQHCs) have a particularly important role to play. The purpose of this presentation is to describe the efforts of a FQHC located in the South Bronx, to prevent the disruption of health care services during the COVID-19 pandemic, and to facilitate critical continuity of care for medically and socially vulnerable patients in an eeffort to mitigate adverse health outcomes. Our FQHC mobilized a COVID-19 response to address two primary goals: 1) to prevent disruption inprimary care during a pandemic and shelter-in-place mandate through targeted outreach and telehealthservices to medically and socially vulnerable populations, and 2) to identify and address the increased socialneeds of families adversely impacted by the pandemic through referrals to in-house and communityresources. Our data team compiled lists of patients for outreach based on the aforementioned goals anddistributed them to clinical teams. Priorities for outreach included patients who rely on continuous clinicalcare and families at increased economic and social risk, such as newly-arrived immigrant families and familiesexperiencing homelessness. Telehealth and in-person visits were systematically prioritized to include infants 0to 2 years for well-child visits and vaccinations, children with persistent asthma, and adolescents withcontraceptive needs (e.g. depo provera). Additional outreach was done to patients at heightened risk ofadverse outcomes from a disruption of clinical care, specically pregnant women, patients 70 years of age andolder, and patients with comorbid medical conditions. Social needs were addressed through the expansion ofan existing emergency food pantry to offer household cleaning supplies, personal hygiene products, facemasks, and health education material, and through referrals to community resources. Contactless delivery ofthese supplies was provided for homebound patients. As this work is ongoing, future analysis will describe theextent of need during the COVID-19 pandemic and the impact of our efforts through analysis of clinicaloutcomes including timely immunizations, asthma outcomes, and adherence to reproductive healthtreatments. Lessons learned in our systematic response to this pandemic may be valuable for other healthcenters in planning for how to provide care for children and families during this, and future crises.