Before the Surge: Molecular Evidence of SARS-CoV-2 in New York City Prior to the First Report

New York City (NYC) emerged as a coronavirus disease 2019 (COVID-19) epicenter in March 2020, but there is limited information regarding potentially unrecognized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections before the first reported case. We utilized a sample pooling strategy to screen for SARS-CoV-2 RNA in de-identified, respiratory pathogen-negative nasopharyngeal specimens from 3,040 patients across our NYC health system who were evaluated for respiratory symptoms or influenza-like illness during the first 10 weeks of 2020. We obtained complete SARS-CoV-2 genome sequences from samples collected between late February and early March. Additionally, we detected SARS-CoV-2 RNA in pooled specimens collected in the week ending 25 January 2020, indicating that SARS-CoV-2 caused sporadic infections in NYC a full month before the first officially documented case.

Cytotoxic lymphocytes are dysregulated in multisystem inflammatory syndrome in children

Multisystem inflammatory syndrome in children (MIS-C) presents with fever, inflammation and multiple organ involvement in individuals under 21 years following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To identify genes, pathways and cell types driving MIS-C, we sequenced the blood transcriptomes of MIS-C cases, pediatric cases of coronavirus disease 2019, and healthy controls. We define a MIS-C transcriptional signature partially shared with the transcriptional response to SARS-CoV-2 infection and with the signature of Kawasaki disease, a clinically similar condition. By projecting the MIS-C signature onto a co-expression network, we identified disease gene modules and found genes downregulated in MIS-C clustered in a module enriched for the transcriptional signatures of exhausted CD8+ T-cells and CD56dimCD57+ NK cells. Bayesian network analyses revealed nine key regulators of this module, including TBX21, a central coordinator of exhausted CD8+ T-cell differentiation. Together, these findings suggest dysregulated cytotoxic lymphocyte response to SARS-Cov-2 infection in MIS-C.

Introductions and early spread of SARS-CoV-2 in the New York City area

New York City (NYC) has emerged as one of the epicenters of the current SARS-CoV2 pandemic. To identify the early events underlying the rapid spread of the virus in the NYC metropolitan area, we sequenced the virus causing COVID19 in patients seeking care at the Mount Sinai Health System. Phylogenetic analysis of 84 distinct SARS-CoV2 genomes indicates multiple, independent but isolated introductions mainly from Europe and other parts of the United States. Moreover, we find evidence for community transmission of SARS-CoV2 as suggested by clusters of related viruses found in patients living in different neighborhoods of the city.

Intent to participate in future cervical cancer screenings is lower when satisfaction with the decision to be vaccinated is neutral.

BACKGROUND: HPV vaccination programs have adversely affected participation in future cervical cancer screening. The purpose of this study is to determine the influence of decision satisfaction with accepting/rejecting the HPV vaccine, as well as traditional clinical factors, on the intent to participate in future screening. METHODS AND FINDINGS: From January 2011 through August 2012 women 18-26 years old presenting for health care in an urban college student health and wellness clinic in the US Midwest were asked to complete a descriptive and medical history survey including a six element decisional satisfaction survey scored on 5-point Likert scales, where the intent to participate in future cervical cancer screening was measured. Of the 568 women who completed the decisional satisfaction survey, 17% of those <21 years and 7% ≥ 21 years indicated no intent to participate in future cervical cancer screenings. Among women of current screening age, the univariate risk factors of race/ethnicity, contraceptive use, number of lifetime sexual partners, and receipt of HPV vaccine were not predictors of intent for future cervical cancer screening. Instead, only a history of a prior Pap test was a significant positive predictor and only a decisional satisfaction of 'neutral' (Likert score = 3) for any of the four decisional satisfaction elements was a significant negative predictor. For the decisional satisfaction element "best for me personally", there was a 78% decreased likelihood of intending to participate in future screening if the satisfaction was neutral rather than firm (aOR = 0.22, 95% CI: 0.05-0.91) and a 26 fold increased likelihood if she had had a prior Pap test (aOR = 26, 95% CI: 5-133). CONCLUSIONS: HPV vaccination implementation programs must help women be the owner of their decision around HPV vaccination and understand the importance of future participation in cervical cancer screening.

Women have a preference for their male partner to be HPV vaccinated.

BACKGROUND: Peer influence and social networking can change female adolescent and young adult behavior. Peer influence on preferences for male human papillomavirus (HPV) vaccination has not been documented. The primary aim of this study was to determine if women had preferences about male sexual partner HPV vaccination receipt. METHODS AND FINDINGS: A prospective survey of women 18-26 years of age was conducted at an urban university student health clinic. Education about the two HPV vaccines, cervical cancer and genital warts was provided. Women self-reported their demographic and medical history data, as well as their own preferences for HPV vaccine and their preferences for their male partner HPV vaccine using a 5 point Likert scale. 601 women, mean age of 21.5 years (SD 2.4), participated between 2011 and 2012. Nearly 95% of respondents were heterosexual; condoms and contraceptives were used in over half of the population. Regardless of the woman's vaccination status, women had significantly higher (strongly agree/agree) preferences for the male partner being vaccinated with HPV4 than not caring if he was vaccinated (63.6% vs. 13.1%, p<0.001). This preference was repeated for sexual risk factors and past reproductive medical history. Women who received HPV4 compared to those choosing HPV2 had a significantly lower proportion of preferences for not caring if the male partner was vaccinated (13% vs. 22%, p = 0.015). CONCLUSIONS: Women preferred a HPV vaccinated male partner. Peer messaging might change the male HPV vaccination uptake.

Condição periodontal da população de 3 a 14 anos assistida em serviço odontológico universitário / Periodontal health within a population of children aged 3 to 14 years old, attending an Odontological University Service

Neste estudo foram descritas as condições gengivais e a prevalência de placa bacteriana da população infantil assistida pela Clínica de Odontopediatria da Faculdade de Odontologia da Universidade de Santo Amaro. Foram examinadas 102 crianças/adolescentes, de 3 a 14 anos, de ambos os sexos. Foram empregados os índices de sangramento gengival proposto por AINAMO & BAY (1975) para o exame das condições gengivais e o índice proposto por LÕE & SILNESS (1963) para a mensuração da placa bacteriana. Os exames clínicos foram realizados por um único examinador sob condições adequadas de biossegurança. As mães das crianças/adolescentes examinadas responderam um questionário contendo questões sobre características sócio-econômicas, higiene bucal, conhecimento sobre prevenção das doenças bucais, promoção de saúde bucal, e auto-percepção relativa à condição dentária dos filhos. Os dados foram registrados e transcritos para o aplicativo Epi-Info 6.04b. Para análise estatística dos dados foram empregados os testes de Kruskal-Wallis e de correlação de Pearson. Os resultados mostraram que a maioria das crianças/adolescente compartilha um perfil sócio-econômico semelhante: a maioria das mães (71,6 por cento) possuía escolaridade na faixa entre a 4º e 8º série do 1º grau, 53 por cento possuíam televisor, a maioria (54,9 por cento) não possuía videocassete e nem computador (87,9 por cento), 63,7 por cento tinham um banheiro em casa, 87,3 por cento tinham 3 cômodos ou mais em casa, 85,3 por cento das crianças/adolescentes usavam transporte público, 87,3 por cento das crianças/adolescentes estudavam em escolas públicas. A prevalência de gengivite foi alta e a saúde periodontal das crianças/adolescentes foi deficiente. Foram detectadas 79,4 por cento crianças/adolescentes com sangramento gengival, 10 por cento do total delas mostraram índice de placa elevado o que indica higiene bucal muito precária. Gengivite e placa apresentaram correlação estatisticamente significativa (r = 0,422; p< 0,01). Foram observadas diferenças estatisticamente significativas na presença de placa bacteriana entre meninos e meninas. É necessário que mais esforços preventivos e educativos sejam empregados para controlar a prevalência de placa bacteriana e doenças periodontais na população de crianças e adolescentes pertencentes a famílias de condição sócio-econômico semelhante