Neutralizing antibody levels detected early after mRNA-based vaccination do not predict by themselves subsequent breakthrough infections of SARS-CoV-2.

The development of mRNA vaccines represented a significant achievement in response to the global health crisis during the SARS-CoV-2 pandemic. Evaluating vaccine efficacy entails identifying different anti-SARS-CoV-2 antibodies, such as total antibodies against the Receptor Binding Domain (RBD) of the S-protein, or neutralizing antibodies (NAbs). This study utilized an innovative PETIA-based kit to measure NAb, and the investigation aimed to assess whether levels of anti-RBD IgG and NAb uniformly measured 30 days after vaccination could predict individuals at a higher risk of subsequent infection in the months following vaccination. Among a cohort of healthy vaccinated healthcare workers larger than 6,000, 12 mRNA-1273- and 115 BNT162b2-vaccinated individuals contracted infections after the first two doses. The main finding is that neither anti-RBD IgG nor NAb levels measured at day 30 post-vaccination can be used as predictors of breakthrough infections (BI). Therefore, the levels of anti-SARS-CoV-2 antibodies detected shortly after vaccination are not the pivotal factors involved in antiviral protection, and other characteristics must be considered in understanding protection against infection. Furthermore, the levels of anti-RBD and NAbs followed a very similar pattern, with a correlation coefficient of r = 0.96. This robust correlation would justify ceasing the quantification of NAbs, as the information provided by both determinations is highly similar. This optimization would help allocate resources more efficiently and speed up the determination of individuals' humoral immunity status.

IgG anti-RBD levels during 8-month follow-up post-vaccination with BNT162b2 and mRNA-1273 vaccines in healthcare workers: A one-center study.

Introduction: Since the COVID-19 outbreak, specific mRNA-based anti-SARS-CoV-2 vaccines have been developed and distributed worldwide. Because this is the first time that mRNA vaccines have been used, there are several questions regarding their capacity to confer immunity and the durability of the specific anti-SARS-CoV-2 response. Therefore, the objective of this study was to recruit a large cohort of healthcare workers from the Gregorio Marañón Hospital vaccinated with the mRNA-1273 or BNT126b2 vaccines and to follow-up on IgG anti-RBD levels at 8 months post-vaccination. Methods: We recruited 4,970 volunteers and measured IgG anti-RBD antibodies on days 30 and 240 post-vaccination. Results: We observed that both vaccines induced high levels of antibodies on day 30, while a drastic wane was observed on day 240, where mRNA-1273 vaccinated induced higher levels than BNT162b2. Stratifying by vaccine type, age, gender, and comorbidities, we identified that older mRNA-1273-vaccinated volunteers had higher antibody levels than the younger volunteers, contrary to what was observed in the BNT162b2-vaccinated volunteers. Discussion: In conclusion, we observed that mRNA-1273 has a higher capacity to induce a humoral response than BNT162b2 and that age is a factor in the specific response.

Cellular and Humoral Responses Follow-up for 8 Months after Vaccination with mRNA-Based Anti-SARS-CoV-2 Vaccines.

Vaccination against SARS-CoV-2 has become the main method of reducing mortality and severity of COVID-19. This work aims to study the evolution of the cellular and humoral responses conferred by two mRNA vaccines after two doses against SARS-CoV-2. On days 30 and 240 after the second dose of both vaccines, the anti-S antibodies in plasma were evaluated from 82 volunteers vaccinated with BNT162b2 and 68 vaccinated with mRNA-1273. Peripheral blood was stimulated with peptides encompassing the entire SARS-CoV-2 Spike sequence. IgG Anti-S antibodies (humoral) were quantified on plasma, and inflammatory cytokines (cellular) were measured after stimulation. We observed a higher response (both humoral and cellular) with the mRNA-1273 vaccine. Stratifying by age and gender, differences between vaccines were observed, especially in women under 48 and men over 48 years old. Therefore, this work could help to set up a vaccination strategy that could be applied to confer maximum immunity.

Nosocomial Transmission of SARS-CoV-2 Involving Vaccinated Health Care Workers.

COVID-19 vaccination has proven to be effective at preventing symptomatic disease but there are scarce data to fully understand whether vaccinated individuals can still behave as SARS-CoV-2 transmission vectors. Based on viral genome sequencing and detailed epidemiological interviews, we report a nosocomial transmission event involving two vaccinated health care-workers (HCWs) and four patients, one of them with fatal outcome. Strict transmission control measures, as during the prevaccination period, must be kept between HCWs and HCWs-patients in nosocomial settings. IMPORTANCE COVID-19 vaccination has proven to be effective at preventing symptomatic disease. Although some transmission events involving vaccinated cases have also been reported, scarce information is still available to fully understand whether vaccinated individuals may still behave as vectors in SARS-CoV-2 transmission events. Here, we report a SARS-CoV-2 nosocomial transmission event, supported on whole genome sequencing, in early March 2021 involving two vaccinated HCWs and four patients in our institution. Strict transmission control measures between HCWs and HCWs - patients in nosocomial settings must not be relaxed, and should be kept as strictly as during the prevaccination period.

Overlapping of Independent SARS-CoV-2 Nosocomial Transmissions in a Complex Outbreak.

SARS-CoV-2 nosocomial outbreaks in the first COVID-19 wave were likely associated with a shortage of personal protective equipment and scarce indications on control measures. Having covered these limitations, updates on current SARS-CoV-2 nosocomial outbreaks are required. We carried out an in-depth analysis of a 27-day nosocomial outbreak in a gastroenterology ward in our hospital, potentially involving 15 patients and 3 health care workers. Patients had stayed in one of three neighboring rooms in the ward. The severity of the infections in six of the cases and a high fatality rate made the clinicians suspect the possible involvement of a single virulent strain persisting in those rooms. Whole-genome sequencing (WGS) of the strains from 12 patients and 1 health care worker revealed an unexpected complexity. Five different SARS-CoV-2 strains were identified, two infecting a single patient each, ruling out their relationship with the outbreak; the remaining three strains were involved in three independent, overlapping, limited transmission clusters with three, three, and five cases. Whole-genome sequencing was key to understand the complexity of this outbreak. IMPORTANCE We report a complex epidemiological scenario of a nosocomial COVID-19 outbreak in the second wave, based on WGS analysis. Initially, standard epidemiological findings led to the assumption of a homogeneous outbreak caused by a single SARS-CoV-2 strain. The discriminatory power of WGS offered a strikingly different perspective consisting of five introductions of different strains, with only half of them causing secondary cases in three independent overlapping clusters. Our study exemplifies how complex the SARS-CoV-2 transmission in the nosocomial setting during the second COVID-19 wave occurred and leads to extending the analysis of outbreaks beyond the initial epidemiological assumptions.

Application of 3D printing and distributed manufacturing during the first-wave of COVID-19 pandemic. Our experience at a third-level university hospital.

BACKGROUND: 3D printing and distributed manufacturing represent a paradigm shift in the health system that is becoming critical during the COVID-19 pandemic. University hospitals are also taking on the role of manufacturers of custom-made solutions thanks to 3D printing technology. CASE PRESENTATION: We present a monocentric observational case study regarding the distributed manufacturing of three groups of products during the period of the COVID-19 pandemic from 14 March to 10 May 2020: personal protective equipment, ventilatory support, and diagnostic and consumable products. Networking during this period has enabled the delivery of a total of 17,276 units of products manufactured using 3D printing technology. The most manufactured product was the face shields and ear savers, while the one that achieved the greatest clinical impact was the mechanical ventilation adapters and swabs. The products were manufactured by individuals in 57.3% of the cases, and our hospital acted as the main delivery node in a hub with 10 other hospitals. The main advantage of this production model is the fast response to stock needs, being able to adapt almost in real time. CONCLUSIONS: The role of 3D printing in the hospital environment allows the reconciliation of in-house and distributed manufacturing with traditional production, providing custom-made adaptation of the specifications, as well as maximum efficiency in the working and availability of resources, which is of special importance at critical times for health systems such as the current COVID-19 pandemic.

Vaccination adjuvated against hepatitis B in Spanish National Healthcare System (SNS) workers typed as non-responders to conventional vaccines.

TRIAL DESIGN: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B. METHODS: 67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. INCLUSION CRITERIA: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 µg doses (two complete guidelines). The objective of this study was to provide Health workers-staff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix® dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking. RESULTS: The participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix®, administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix®. 57.14% (12 out 21) had a positive response to second dose of Fendrix®. 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix®. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix®. No serious adverse event occurred. CONCLUSIONS: The use of Fendrix®, is a viable vaccine alternative for NHS workers classified as "non-responders". Revaccination of healthy non-responders with Fendrix®, resulted in very high proportions of responders without adverse events. TRIAL REGISTRATION: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23). FUNDING: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013-2016 and co-financed by and the European Regional Development Fund (ERDF).

Absence of IgG antibodies among high-risk contacts of two confirmed cases of Crimean-Congo haemorrhagic fever in the autonomous region of Madrid (Spain).

Crimean-Congo haemorrhagic fever (CCHF) is a widely distributed tick-borne disease. In Spain, the disease has emerged as outbreak associated with high-risk exposures. Our goal was to evaluate the prevalence of antibodies against the CCHF virus (CCHFV) in high-risk contacts. A cross-sectional study was conducted. Three hundred eighty-six high-risk contacts were identified comprising family contacts and hospital workers who had attended the cases. Fifty-seven cases with closer exposure were selected. However, forty-nine cases participated in the study. IgG antibodies were detected by immunoenzymatic techniques. All determinations tested negative for anti-CCHFV IgG antibodies. Most of the responders were women (73.5%), and belong to the intensive care department (53.1%). In relation to other possible sources of exposures, 18.4% travelled to countries with CCHF transmission risk. No CCHF positivity was recorded among selected high-risk contacts. This highlights the importance of standard precautions which might have protected healthcare workers and care providers from CCHF infection.

Bursitis por mercurio tras accidente laboral: a propósito de un caso / Bursitis due to Mercury after a work accident: a case report

Auxiliar de enfermería de 28 años que acude al Servicio de Urgencias porque refiere dolor y dificultad para la movilización en rodilla derecha, tras accidente laboral, hace dos días. Refiere que se resbaló mientras transportaba 32 termómetros de mercurio, rompiéndose éstos sobre su rodilla, creando una pequeña herida,siendo la puerta de entrada del metal. En la radiografía, se objetiva el cuerpo extraño metálico, correspondiente a mercurio, en bursa rotuliana. Tras el diagnóstico, se realizó la extracción de la bursa, recuperándose la trabajadora totalmente tras la intervención.Con este caso clínico que aportamos, queremos conocer los efectos del mercurio en la salud de las personas expuestas a dicho metal, estudiar los errores acontecidos en este accidente laboral, valorando cuáles hubieran sido las medidas de actuación preventiva adecuadas para evitar la repetición de este tipo de accidentes y, por último, reflexionar acerca de la relación beneficio-riesgo del uso del mercurio en aparatos de medición en el ámbito sanitario (AU)

A 28-year-old woman, nursing assistant, who attends to emergency service, referring pain and difficulty mobilizing right knee after a work accident two days ago. She relates that slipped while carrying 32 mercury thermometers, breaking them on her knee, creating a small wound, being the gateway to the metal. In the radiograph, we objective a metallic foreign body, corresponding to mercury, in patellar bursa. After the diagnosis, the bursa was extracted, and the worker recovered completely, after surgery.With this case report we bring, we want to know the health effects of mercury in people exposed to this metal, studying the errors occurred in this accident, assessing measures of preventive action that would have been neccesary to preclude recurrence of this type accidents and, finally, think about the risk-benefit balance the use of mercury in measuring devices in healthcare (AU)

El trabajo nocturno como riesgo laboral de cáncer de mama. Una revisión de medicina basada en la evidencia / No disponible

Estudios epidemiológicos han puesto de manifiesto una asociación consistente entre la exposición a la luz durante el trabajo nocturno y un incremento en el riesgo de cáncer de mama. La exposición a la luz durante la noche suprime la normal secreción de melatonina lo que puede aumentar la producción de estrógenos ováricos, estimular el recambio celular del epitelio mamario e incrementar el riesgo de enfermedad maligna. También se conocen otros efectos oncostáticos y citotóxicos sobre líneas celulares malignas de tumores mamarios. Se ha realizado una revisión bibliográfica de toda la literatura publicada. Se seleccionaron finalmente seis artículos que cumplen las características de calidad metodológica marcadas por los autores y un meta análisis reciente publicado en el año 2005. El nivel de evidencia disponible para la asociación entre trabajo nocturno y cáncer de mama es nivel C. Las principales limitaciones de los estudios son los factores de confusión, así como la definición de qué es exposición al riesgo, lo que dificulta aislar el efecto de la nocturnidad de otros factores de riesgo de cáncer de mama Son necesarios más estudios que aclaren si la nocturnidad puede considerarse un factor de riesgo independiente para cáncer de mama

The association between light exposure during night work and breast cancer risk increase has been analyzed in many epidemiologic studies. Light exposure at night suppresses physiological melatonin secretion- which may result in a higher ovarian estrogen production and in a epithelial mammary cell replacement activation- and therefore an increase of breast cancer risk. Other oncostatic and cytotoxic effects on malignant cell lines of breast tumours are known. A bibliographic research of all published literature was done. Finally, only six articles were selected -as the ones which accommodate with the methodological quality standards settled by the authors- and a recent meta-analysis published on the year 2005. The association between night work and breast cancer risk increase has a C evidence level. The main limitations of these studies are the lack of both multi-variant analysis and clear risk exposure definition. These limitations make it difficult to isolate the effect of light exposure at night from the effects of other breast cancer risk factors. More studies are needed to clarify if light exposure at night can be considered as an independent risk factor for breast cancer

[Treatment of latent tuberculosis among homeless population. Comparison between wo therapeutic approaches]. / Infección tuberculosa latente en población indigente. Comparación de dos pautas terapéuticas.

BACKGROUND AND OBJECTIVE: We aimed to compare treatment adherence and toxicity of isoniazide (H) (6 months) compared with rifampicine (R) + pirazinamide (Z) (2 months) in homeless patients in latent tuberculous infection (LTBI). PATIENTS AND METHOD: Randomized and controlled prospective study. RESULTS: We included 172 patients (116 males and 56 females) with an age average of 42.3 (12.8) years; 31 (18%) had recent conversion and 72 (41.8%) had some risk factor of hepatotoxicity. Both bivariate and multivariate analysis (p < 0.001; OR = 5.15 [2.34-11.35]) showed that the treatment was completed by 61.5% of patients administered the R+Z regimen, while it was completed only by 28.2% of those administered H for 6 months. Moreover, treatment was completed by 48.4% of Spanish or foreign patients with legal residence, while it was completed only by 28.6% of immigrant patients with no legal residence (p = 0.044 in bivariate analysis). CONCLUSIONS: The R+Z regimen for 2 months as treatment of LTBI in homeless patients displays a higher adherence than H for 6 months. There were no differences in toxicity.

Infección tuberculosa latente en población indigente. Comparación de dos pautas terapéuticas / Treatment of latent tuberculosis among homeless population. Comparison between two therapeutic approaches

FUNDAMENTO Y OBJETIVO: Evaluar si los pacientes con fibrilación auricular crónica atendidos en un centro de salud siguen un tratamiento antitrombótico correcto. PACIENTES Y MÉTODO: Estudio descriptivo transversal, en el que se incluyó a 416 pacientes diagnosticados de fibrilación auricular crónica, de una población de 28.847 pacientes. Se recogieron las siguientes variables: edad, sexo, factores de riesgo embolígeno, tratamiento antitrombótico pautado, condicionantes y contraindicaciones para la anticoagulación, tratamiento antitrombótico correcto o no y estratificación del riesgo. Tras un análisis bivariante, realizamos un modelo de regresión logística para analizar las variables asociadas a un riesgo de mal tratamiento. RESULTADOS: El 81 por ciento recibía tratamiento antitrombótico correcto, un 96,8 por ciento se hallaba en fibrilación auricular valvular y un 78,2 por ciento, en no valvular. A mayor edad, el porcentaje de pacientes con mal tratamiento antitrombótico fue mayor (t = 3,184; p = 0,002). Un mayor riesgo embolígeno se asoció a mejor tratamiento antitrombótico (p < 0,001). La existencia de al menos un factor de riesgo se asoció a un tratamiento correcto (p < 0,001). Entre los factores de riesgo, sólo la hipertensión arterial, la valvulopatía mitral y la presencia de prótesis valvular tenían significación estadística. En el análisis multivariante, la calidad de vida limitada (odds ratio [OR] = 0,13; intervalo de confianza [IC] del 95 por ciento, 0,02-0,59), la existencia de valvulopatía mitral (OR = 0,13; IC del 95 por ciento, 0,03-0,57), la hipertensión arterial (OR = 0,36; IC del 95 por ciento, 0,20-0,63) y el antecedente de embolia sistémica (OR = 0,41; IC del 95 por ciento, 0,17-0,99) se comportaron como factores protectores de un mal tratamiento. La edad superior a 80 años se asoció a un riesgo de mal tratamiento 2,89 veces mayor que el de las personas de esa edad o menores (OR = 2,89; IC del 95 por ciento, 1,68-4,95). CONCLUSIONES: En nuestro centro, la mayoría de los pacientes con fibrilación auricular crónica, valvular y no valvular, reciben un tratamiento antitrombótico correcto, y la edad es el factor que más se asocia a un mal tratamiento (AU)