Revue de bibliographie quotidienne Covid-19 (archives du 24 mai au 9 juillet 2021)

Publié par Bernard Pradines

Revue de bibliographie quotidienne Covid-19 (archives du 24 mai au 9 juillet 2021)

Sans me livrer à une vraie revue de la littérature scientifique, je repère surtout les publications qui me semblent dignes d’intérêt depuis le 18 mars 2021 (voir aussi les archives) dans le listing quotidien de Kamps et Hoffmann : https://covidreference.com/top10

Remarques en français en caractères bleus.

A noter que les mises à jour de cette page ne feront pas systématiquement l'objet d'un avis de publication par courriel comme les autres articles.

9 juillet 2021

Edara VV, Pinksy BA, Suthar MS, et al. Infection and Vaccine-Induced Neutralizing-Antibody Responses to the SARS-CoV-2 B.1.617 Variants. NEJM July 7, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2107799?query=featured_home

Moindre réponse par anticorps neutralisants contre les variants indiens Kappa et Delta. Ainsi, l'immunisation par infection oui par vaccination est moindre contre le Kappa (6,8 fois moins) que contre le Delta (2,9 fois moins). Toutefois, la majorité des sérums de convalescents (19 sur 24 pour le Kappa et 23 sur 24 pour le Delta) ainsi que la totalité du sérum des vaccinés montraient une activité neutralisante détectable.

Good news: protective immunity conferred by the mRNA vaccines is most likely retained against the B.1.617.1 and B.1.617.2 variants. Although the B.1.617.1 variant was 6.8 times (B.1.617.2 variant: 2.9 times) less susceptible to neutralization by serum from recovered or vaccinated persons, the majority of the convalescent serum samples (19/24) against B.1.617.1 (23/24 against B.1.617.2) and all serum samples from vaccinated persons still had detectable neutralizing activity.

Gargano JW, Wallace M, Hadler SC, et al. Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices — United States, June 2021. MMWR Morb Mortal Wkly Rep. ePub: 6 July 2021. DOI: https://www.cdc.gov/mmwr/volumes/70/wr/mm7027e2.htm?s_cid=mm7027e2_w

Myocardites après vaccin à ARNm : même chez les hommes jeunes, le rapport bénéfice-risque est en faveur de al vaccination. 

D'un coté, par million de vaccins ARNm  administrés avec deux doses à des hommes âgés de 12 à 29 ans, 11 000 cas de COVID-19, 560 hospitalisations, 138 admissions en soins intensifs et six décès dus à la COVID-19 pourraient être évités.

De l'autre, 39 à 47 cas attendus de myocardite après vaccination COVID-19.

The Committee concluded that the benefits of COVID-19 vaccination to individual persons and at the population level clearly outweighed the risks of myocarditis after vaccination. Even in young men: per million second doses of mRNA COVID-19 vaccine administered to males aged 12–29 years, 11,000 COVID-19 cases, 560 hospitalizations, 138 ICU admissions, and six deaths due to COVID-19 could be prevented, compared with 39–47 expected myocarditis cases after COVID-19 vaccination.

Patriquin CJ, Laroche V, Selby R, et al. Therapeutic Plasma Exchange in Vaccine-Induced Immune Thrombotic Thrombocytopenia. NEJM July 7, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2109465?query=featured_home

Trois cas de VITT réfractaires au Canada : deux guérisons après échange plasmatique.

Three cases from Canada, indicating that therapeutic plasma exchange may be effective for the treatment of refractory VITT. Two recovered despite their severe presentation.

8 juillet 2021

Golan Y, Prahl M, Cassidy A, et al. Evaluation of Messenger RNA From COVID-19 BTN162b2 and mRNA-1273 Vaccines in Human Milk. JAMA Pediatr July 6, 2021. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2781679?resultClick=1

Pas de présence d'ARNm provenant des vaccins Pfizer et Moderna dans 13 échantillons de lait de 7 femmes allaitantes.

Vaccine-associated mRNA was not detected in 13 milk samples collected 4 to 48 hours after vaccination from 7 breastfeeding individuals.

Melo AK, Milby KM, Caparroz AL, et al. Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis. PLOS ONE, June 29, 2021. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253894

Les marqueurs de l'orage cytokinique indiquent la sévérité de l'inflammation et sont un indice de pronostic mauvais : interleukine 6 et ferritinémie.

According to this review, elevated levels of interleukin-6 and hyperferritinemia should be considered red flags of systemic inflammation and poor prognosis in COVID-19.

7 juillet 2021

Seeßle J, Waterboer T, Hippchen T, et al. Persistent symptoms in adult patients one year after COVID-19: a prospective cohort study. Clinical Infectious Diseases July 5, 2021, ciab611, https://doi.org/10.1093/cid/ciab611

Long Covid : réduction des possibilités d'efforts physiques et fatigue pour plus de la moitié des patients. Les femmes présentent davantage de troubles cognitifs que les hommes. 

Is autoimmunity a cofactor in aetiology of long COVID? Of 96 patients who were included at 5 months after acute COVID-19 in this prospective, non-interventional study, only 23% were completely free of symptoms at 12 months. The most frequent symptoms were reduced exercise capacity (56%) and fatigue (53%). Females showed significantly more neurocognitive symptoms than males. ANA titres were ≥1:160 in 44% of patients at 12 months, and neurocognitive symptom frequency was significantly higher in the group with an ANA titre ≥1:160 compared to <1:160.

Lustig Y, Zuckerman N, Nemet I, et al. Neutralising capacity against Delta (B.1.617.2) and other variants of concern following Comirnaty (BNT162b2, BioNTech/Pfizer) vaccination in health care workers, Israel. Euro Surveill Jul 1, 2021;26(26):pii=2100557. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.26.2100557

Pfizer : capacité de neutralisation diminuée contre le delta en Israël mais réponse significative toutefois.

This study has used micro-neutralisation assays with sera obtained after BNT162b2 (BioNTech/Pfizer) vaccination in 36 healthcare workers. It is shown that, despite a somewhat reduced neutralisation capacity, mRNA vaccination induces a substantial antibody response also for the Delta VOC.

Sangli S, Virani A, Cheronis N, et al. Thrombosis With Thrombocytopenia After the Messenger RNA–1273 Vaccine. Annals Int Med, June 29, 2021. https://www.acpjournals.org/doi/10.7326/L21-0244

Thrombocytopénie induite par le vaccin chez un homme de 65 ans après Moderna. Ce cas indique que ce syndrome n'est pas exclusif aux vaccins à adénovirus.

A 65-year old man with vaccine-induced thrombosis with thrombocytopenia (VITT), developing a few days after administration of the mRNA-1273 vaccine from Moderna. Most of his clotting and other relevant work-up were consistent with the syndrome. This report complicates hypotheses that implicate adenoviral vectors as the sole cause of VITT or TTS.

6 juillet 2021

Leach DA, Mohr A, Giotis ES, et al. The antiandrogen enzalutamide downregulates TMPRSS2 and reduces cellular entry of SARS-CoV-2 in human lung cells. Nat Commun Jul 1, 2021, 12, 4068. https://www.nature.com/articles/s41467-021-24342-y

Espoir du côté d'un anti-androgène par protection des cellules pulmonaires ? Au moins chez la souris...

Treatment with the anti-androgen enzalutamide—a well-tolerated drug widely used in advanced prostate cancer—reduces TMPRSS2 levels in human lung cells and in mouse lungs. Anti-androgens significantly reduced SARS-CoV-2 entry and infection in lung cells.

5 juillet 2021

Lindsley WG, Derk RC, Coyle JP, et al. Efficacy of Portable Air Cleaners and Masking for Reducing Indoor Exposure to Simulated Exhaled SARS-CoV-2 Aerosols — United States, 2021. MMWR Morb Mortal Wkly Rep. ePub: 2 July 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7027e1.htm?s_cid=mm7027e1_w

Efficacité partielle de purificateurs d'air, à compléter avec le masque pour réduire l'exposition de 90 %.

A simulated infected meeting participant who was exhaling aerosols was placed in a room with two simulated uninfected participants and a simulated uninfected speaker. Using two high efficiency particulate air (HEPA) cleaners close to the aerosol source reduced the aerosol exposure of the uninfected participants and speaker by up to 65%. A combination of HEPA air cleaners and universal masking reduced exposure by up to 90%.

Lemey P, Ruktanonchai N, Hong SL, et al. Untangling introductions and persistence in COVID-19 resurgence in Europe. Nature June 30, 2021. https://www.nature.com/articles/s41586-021-03754-2

En Europe, dans beaucoup de pays, c'est le nouveau variant qui prévaut depuis le 15 juin 2021.

The authors estimate that in many countries over half of the lineages circulating in late summer 2020 resulted from new variant introductions since June 15th.

4 juillet 2021

Thompson MG, Burgess JL, Naleway AL, et al. Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines. NEJM June 30, 2021. https://www.nejm.org/doi/full/10.1056/NEJMoa2107058?query=featured_home

Prévention et atténuation de la covid par vaccins à ARNm : confirmation d'efficacité chez des travailleurs de première ligne dont des soignants.

This prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers shows that mRNA vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination.

Roman YM, Burela PA, Pasupuleti V, et al. Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials. Clinical Infectious Diseases June 28, 2021, ciab591, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab591/6310839

Ivermectine : confirmation d'inefficacité.

In comparison to standard of care or placebo, ivermectin did not reduce all-cause mortality, length of stay or viral clearance in this review of 10 RCTs in COVID-19 patients with mostly mild disease. Ivermectin is not a viable option for treating COVID-19 patients.

3 juillet 2021

Lee SA, Park R, Yang JH. et al. Increased risk of acute kidney injury in coronavirus disease patients with renin–angiotensin–aldosterone-system blockade use: a systematic review and meta-analysis. Sci Rep Jun 30, 2021, 11, 13588. https://www.nature.com/articles/s41598-021-92323-8

Augmentation du risque d'atteinte rénale en cas de covid chez des personnes prenant des inhibiteurs de l’enzyme de conversion (IEC) ou des antagonistes des récepteurs AT1 (ARA). Le risque relatif est de 2,45 pour les IEC et de 2,32 pour les AT1. Toutefois, un lien de causalité ne peut pas être établi et donc les recommandations ne doivent pas être modifiées (maintien du blocage du SRA en ttemsp de apndémie)

This meta-analysis of published retrospective and prospective cohort studies observed that the exposure to RAAS blockade was associated with a higher risk of incident acute kidney injury in patients with laboratory-confirmed or clinically diagnosed COVID-19. Odds ratio were 2.45 for ACEI use and 2.32 for ARB use. However, a causal relationship cannot be ascribed to the RAAS blockade and practice changing recommendations cannot be made on the basis of these data.

2 juillet 2021

Hoffmann M, Hofmann-Winkler H, Krüger N, et al. SARS-CoV-2 variant B.1.617 is resistant to Bamlanivimab and evades antibodies induced by infection and vaccination. Cell Reports June 28, 2021. https://www.cell.com/cell-reports/fulltext/S2211-1247(21)00828-7

Le variant delta possède deux mutations dans le RBD qui interagissent avec le récepteur ACE2 et constitue la principale cible des anticorps neutralisants. La spike protein  du delta peut faciliter son entrée dans les cellules pulmonaires avec une efficacité légèrement augmentée et son entrée peut être bloquée par l'ACE2 soluble et le camostat. Le delta échappe aux anticorps induits par la vaccination et par l'infection mais moins que ne le fait le sud-africain.

The spike protein of B.1.617 (delta) harbors two mutations in the receptor-binding domain, which interacts with the ACE2 receptor and constitutes the main target of neutralizing antibodies. The B.1.617 spike protein can facilitate entry into lung cells with slightly increased efficiency and shows that entry can be blocked by soluble ACE2 and camostat. B.1.617 also evades antibodies induced by infection or vaccination, although less so than the B.1.351 variant.

Jung JH, Rha MS, Sa M, et al. SARS-CoV-2-specific T cell memory is sustained in COVID-19 convalescent patients for 10 months with successful development of stem cell-like memory T cells. Nat Commun June 30, 2021, 12, 4043. https://www.nature.com/articles/s41467-021-24377-1

Une immunité cellulaire présente dix mois après l'infection.

In the present study, it is demonstrated that SARS-CoV-2-specific memory T cell responses were maintained in COVID-19 convalescent patients 10 months post-infection regardless of disease severity. Notably, SARS-CoV-2-specific stem cell-like memory T (TSCM) cells were successfully developed, indicating that T cell memory may be long-lasting in COVID-19 convalescent patients.

Castro MC, Gurzenda S, Turra CM, et al. Reduction in life expectancy in Brazil after COVID-19. Nat Med June 29, 2021. https://www.nature.com/articles/s41591-021-01437-z

Espérance de vie à la naissance : réduite de 1,3 ans au Brésil, un niveau de mortalité jamais vu depuis 2014. L'espérance de vie au temps de la covid est équivalent à celui d'il y a 20 ans ou plus dans certains états.

The authors estimate a decline in 2020 life expectancy from birth of 1.3 years, a mortality level not seen since 2014. Life expectancy in the presence of COVID-19 was equivalent to levels observed in Brazil as far back as 20 or more years in some states.

1er juillet 2021

Kim HW, Jenista ER, Wendell DC, et al. Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination. JAMA Cardiol June 29, 2021. https://jamanetwork.com/journals/jamacardiology/fullarticle/2781602?resultClick=1

7 patients présentent une myocardite post-vaccinale à ARNm dont 4 dans les 5 jours qui suivent l'injection entre le 1er février et le 30 avril 2021 : 3 hommes jeunes et une femme de 70 ans.

Texte complet : https://cloud.leviia.com/s/zqd2DYLJtBCYBQ3

In this study of 7 patients with acute myocarditis, 4 occurred within 5 days of COVID-19 vaccination between February 1 and April 30, 2021. Fortunately, the hospital courses of the 4 patients with myocarditis following COVID-19 vaccination were uneventful.

Montgomery J, Ryan M, Engler R, et al. Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military. JAMA Cardiol, June 29, 2021; doi: https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601?resultClick=1

23 hommes de 20 à 51 ans : douleurs thoraciques dans les 4 jours suivant un vaccin à ARNm. Huit présentent une IRM évocatrice de myocardite. Dans le même temps, plus de 2,8 millions de doses de ces vaccins ont été injectées. Pour 16 patients, la résolution des symptômes s'est réalisée en une semaine. Les sept autres font l'objet d'une surveillance à l'heure de la publication de ce texte dans le JAMA. On trouvera le texte complet en lien ici : 

https://cloud.leviia.com/s/nJoQkDBFJm9s23E

A total of 23 male patients (20-51 years) presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. Eight patients had cMRI findings consistent with myocarditis. More than 2.8 million doses of mRNA COVID-19 vaccine were administered in this period.

Van Oekelen O, Gleason CR, Agte S, et al. Highly variable SARS-CoV-2 spike antibody responses to two doses of COVID-19 RNA vaccination in patients with multiple myeloma. Cancer Cell June 28, 2021. https://www.cell.com/cancer-cell/fulltext/S1535-6108(21)00336-6

Myélome : pas d'immunisation malgré humorale malgré deux doses de vaccin à ARNm.

Of note, 15.8% of myeloma patients (41/260) failed to develop any SARS-CoV-2 spike-binding IgG antibodies despite having received both doses of mRNA vaccines.

Lustig Y, Nemet I, Kliker L, et al. Neutralizing Response against Variants after SARS-CoV-2 Infection and One Dose of BNT162b2. N Engl J Med June 24, 2021; 384:2453-2454.  https://www.nejm.org/doi/full/10.1056/NEJMc2104036?query=featured_home

Vaccination : activité neutralisante augmentée par une dose de Pfizer chez des personnes préalablement infectées par le SARS-CoV-2. Ceci contre les variants : anglais, sud-africain et brésilien.

In this study, one dose of the BNT162b2 vaccine increases neutralizing activity against the B.1.1.7, B.1.351, and P.1 variants in six persons previously infected with SARS-CoV-2. This highlights the importance of vaccination even in previously infected patients, given the added benefit of an increased antibody response to the variants tested.

Collier DA, Ferreira IA, Kotagiri P, et al. Age-related immune response heterogeneity to SARS-CoV-2 vaccine BNT162b2. Nature June 30, 2021. https://www.nature.com/articles/s41586-021-03739-1

Immunité humorale diminuée après 80 ans chez des vaccinés par Pfizer. Pas d'activité neutralisante pour le variant brésilien et le variant anglais après la première dose dans cette population.

This study analyzed immune responses following vaccination with the mRNA vaccine BNT162b22 in elderly participants and younger health care workers. Serum neutralization and binding IgG/IgA after the first vaccine dose diminished with increasing age, with a marked drop in participants over 80 years old. Of note, a greater proportion of individuals in the over 80 age group lost all neutralizing activity to P.1 and B.1.1.7 following the first dose compared to the wild type.

Harris RJ, Hall JA, Zaidi A, et al. Effect of Vaccination on Household Transmission of SARS-CoV-2 in England. NEJM June 23, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2107717?query=featured_home

Transmission domestique diminuée de 40 à 50 % chez des personnes vaccinées depuis au moins 21 jours avant d'être testées positives.

Overall, the likelihood of household transmission was approximately 40 to 50% lower in households of index patients who had been vaccinated 21 days or more before testing positive than in households of unvaccinated index patients; the findings were similar for the two vaccines from Pfizer/BioNTech and AstraZeneca.

Pawlowski C, Lenehan P, Puranik A, et al. FDA-authorized mRNA COVID-19 vaccines are effective per real-world evidence synthesized across a multi-state health system. Med June 28, 2021. https://www.cell.com/med/fulltext/S2666-6340(21)00238-5

Prévention de l'hospitalisation de 88,8% et 86% pour le Pfizer et le Moderna.

This retrospective analysis of 136,532 individuals in the Mayo Clinic health system shows comparable real-world vaccine effectiveness in preventing SARS-CoV-2 infection for BNT162b2 (BioNTech/Pfizer, 86.1%) and mRNA-1273 (Moderna, 93.3%). BNT162b2 and mRNA-1273 were 88.8% and 86.0% effective in preventing COVID-19 associated hospitalization.

30 juin 2021

Jalkanen P, Kolehmainen P, Häkkinen HK, et al. COVID-19 mRNA vaccine induced antibody responses against three SARS-CoV-2 variants. Nat Commun June 28, 2021, 12, 3991. https://www.nature.com/articles/s41467-021-24285-4

Vaccins à ARN chez des soignants en Finlande : moindre efficacité sur le variant sud-africain mais suffisante pour indiquer un certain degré de protection.

After the second dose, the sera of BNT162b2-vaccinated health care workers (n = 180) from Finland effectively neutralized the SARS-CoV-2 variant with the D614G substitution and the B.1.1.7 variant, whereas the neutralization of the B.1.351 variant was five-fold reduced. However, 92% of the seronegative vaccinees had a neutralization titre of >20 for the B.1.351 variant indicating some protection.

29 juin 2021

Hall S. COVID vaccines and breastfeeding: what the data say. Nature NEWS June 23, 2021. https://www.nature.com/articles/d41586-021-01680-x

Etat de la science : les vaccins ne passent pas dans le lait maternel mais des anticorps y sont retrouvés, faisant naitre l'espoir d'un certain degré de protection des nourrissons.

Shannon Halls summarizes current knowledge. The vaccines do not pass through breastmilk, but antibodies do — providing hope that breastfed babies might have some level of protection. While reading this article, we have learnt a new word: “milk mysteries”.

28 juin 2021

Woolf SH, Masters RK, Aron LY. Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data. BMJ June 24, 2021; 373 doi: https://doi.org/10.1136/bmj.n1343

Baisse de l'espérance de vie aux USA de 1,87 an entre 2018 et 2020, surtout aux dépens des Noirs et des Hispaniques. Chez les Noirs, retour à l'espérance de vie de 1998. Autres pays à haut revenu global : perte de 0,22 ans.

Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years). Losses were more pronounced among the Hispanic and non-Hispanic Black populations. Life expectancy in Black men reached its lowest level since 1998.

Choe PG, Kang CK, Kim KH, et al. Persistence of Neutralizing Antibody Response up to One Year after Asymptomatic or Symptomatic SARS-CoV-2 infection. The Journal of Infectious Diseases June 24, 2021, jiab339, https://doi.org/10.1093/infdis/jiab339

Chez 16 patients dont 7 asymptomatiques, présence d'anticorps neutralisants jusqu'à 1 an après l'infection.

Of 16 patients (7 asymptomatic), all showed neutralizing antibody response up to 1 year after infection.

Ginther DK, Zambrana C. Association of Mask Mandates and COVID-19 Case Rates, Hospitalizations, and Deaths in Kansas. JAMA Netw Open June 23, 2021; 4(6):e2114514. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781283?resultClick=1

Efficacité du masque : mais faut-il encore la démontrer ?

At the start of the mask mandate, COVID-19 case rates in mask counties were 3 times higher than in no-mask counties (15 versus 5 cases per 100,000). These trends reversed, and by October 26, 2020, cases were 2.1 times higher in no-mask counties (44 versus 21 cases per 100,000). Similar results were found for hospitalizations and deaths.

27 juin 2021

Renaud M, Thibault C, LeNormand F, et al. Clinical Outcomes for Patients With Anosmia 1 Year After COVID-19 Diagnosis. JAMA Netw Open June 24, 2021;4(6):e2115352. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781319?resultClick=1

A 8 mois, l'anosmie n'est pas retrouvée chez 49 de 51 patients. Deux demeurent hyposmiques à 1 an.

At 8 months, objective olfactory assessment confirmed full recovery in 49 of 51 patients (96%). Two patients remained hyposmic at 1 year. Findings suggest that an additional 10% gain in recovery can be expected at 12 months, compared to studies with 6 months of follow-up.

Bliddal S, Banasik K, Pedersen OB, et al. Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients. Sci Rep June 23, 2021, 11, 13153. https://www.nature.com/articles/s41598-021-92045-x

Covid long : fatigue, troubles mnésiques et de la concentration chez 36% de 198 patients symptomatiques dans un suivi de plus de 4 semaines. Facteurs de risque : le genre féminin (44 % vs  24% chez les hommes) et l'IMC.

Among non-hospitalized PCR-confirmed COVID-19 patients, one third were asymptomatic while one third of symptomatic participants had persistent symptoms illustrating the heterogeneity of disease presentation. The most common persistent symptoms were fatigue and memory and concentration difficulties, reported by 36% of 198 symptomatic participants with follow-up > 4 weeks. Risk factors for persistent symptoms included female sex (women 44% vs. men 24%) and BMI.

Pratt J, Lester E, Parker R. Could SARS-CoV-2 cause tauopathy? Lancet Neurology, July, 2021. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00168-X/fulltext

Suivi à long terme pour éventuelle tauopathie après covid.

James Pratt, Evan Lester and Roy Parker believe that follow-up studies of neurological dysfunction in survivors of COVID-19 should be done, particularly in people who showed acute or subacute neurological symptoms. Such studies should continue for at least a decade and focus on young individuals in order to reduce the proportion of participants who develop tauopathies due to age.

Blomberg B, Mohn KG, Brokstad KA, et al. Long COVID in a prospective cohort of home-isolated patients. Nat Med June 22, 2021. https://www.nature.com/articles/s41591-021-01433-3

Long covid en Norvège. Parmi 61 jeunes de 16 à 32 ans, 32 ont des symptômes à 6 mois : perte du goût ou de l'odorat dans 28% des cas, fatigue pour 21 %, dyspnée pour 13 %, concentration mentale altérée pour 13% et problèmes de mémoire dans 11% des cas.

In this study from Norway, 32/61 of home-isolated young adults aged 16–30 years had symptoms at 6 months, including loss of taste and/or smell (28%), fatigue (21%), dyspnea (13%), impaired concentration (13%) and memory problems (11%).

Bugembe DL, Phan MV, Ssewanyana I, et al. Emergence and spread of a SARS-CoV-2 lineage A variant (A.23.1) with altered spike protein in Uganda. Nat Microbiol June 23, 2021. https://www.nature.com/articles/s41564-021-00933-9

Ouganda : un nouveau variant préoccupant ?

A new variant of concern? The authors describe the emergence and spread of a SARS-CoV-2 variant of the A lineage (A.23.1) with multiple protein changes throughout the viral genome. A.23.1 shares many features found in the lineage B VOCs, including alteration of key spike protein regions, especially the ACE 2 binding region, the furin cleavage site and the 613/614 change.

McEwen AE, Cohen S, Bryson-Cahn C, et al. Variants of concern are overrepresented among post-vaccination breakthrough infections of SARS-CoV-2 in Washington State. Clinical Infectious Diseases June 24, 2021, ciab581, https://doi.org/10.1093/cid/ciab581

Deux variants californiens et un anglais : les trois variants sont davantage susceptibles d'apparaitre chez des personnes vaccinées.

Across 20 vaccine breakthrough cases detected, all 20 were due to variants of concern (VOC) and had a low median Ct of 20.2 (IQR=17.1-23.3). Variants B.1.427, B.1.429, and B.1.1.7 were 3.38-fold, 1.51-fold, and 1.29-fold more common in breakthrough cases compared to controls.

26 juin 2021

Larson KF, Ammirati E, Adler ED, et al. Myocarditis after BNT162b2 and mRNA-1273 Vaccination. Circulation 16 Jun 2021. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055913

Huit patients hospitalisés pour myocardite 2 à 4 jours après vaccin à ARNm. Tous des hommes en bonne santé entre 21 et 56 ans. Troponine toujours élevée.

Eight patients hospitalized with chest pain who were diagnosed with myocarditis by laboratory and cardiac magnetic resonance imaging within 2-4 days of receiving either the BNT162b2 or mRNA-1273 vaccine. All were otherwise healthy males between the ages of 21 and 56. Troponin values were elevated in all individuals.

Rosner CM, Genovese L, Tehrani BN, et al. Myocarditis Temporally Associated with COVID-19 Vaccination. Circulation 16 Jun 2021. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055891

Myocardite après vaccin : 7 cas, tous des hommes blancs de moins de 40 ans, tous avec douleur thoracique de 3 à 7 jours après vaccination, témoin biologique présent : troponine I. Evolution favorable.

Seven patients hospitalized for acute myocarditis-like illness following COVID-19 vaccination. All were white males < 40 years of age. All patients presented 3-7 days post vaccination with acute onset chest pain and biochemical evidence of myocardial injury, by cardiac troponin I. The clinical course was favorable.

Shemer A, Pras E, Einan-Lifshitz A, et al. Association of COVID-19 Vaccination and Facial Nerve Palsy – A Case-Control Study. JAMA Otolaryngol Head Neck Surg June 24, 2021. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2781367?resultClick=1

Seulement 37 patients vs contrôles. Mais pas de lien établi entre Pfizer et paralysie faciale.

In this case-control study of 37 patients with acute-onset facial nerve palsy and a matched control group, no increased risk of facial nerve palsy was observed after vaccination with the Pfizer-BioNTech BNT162b2 COVID-19 vaccine.

Mazzola A, Todesco E, Drouin S, et al. Poor Antibody Response after Two Doses of SARS-CoV-2 vaccine in Transplant Recipients. Clinical Infectious Diseases June 24, 2021, ciab580, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab580/6309017

Faible efficacité du Pfizer chez des receveurs d'organe solide. Meilleure réponse avec trois doses. Voir publication suivante.

A low anti-spike antibody response of 28.6% was observed 28 days after BNT162b2 vaccine second dose among 133 solid organ transplant recipients.

Kamar N, Abravanel F, Marion O, et al. Three Doses of an mRNA Covid-19 Vaccine in Solid-Organ Transplant Recipients. N Engl J Med Jun 23, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2108861
Is a third jab the solution? Among the 59 solid organ transplant recipients who had been seronegative before the third dose of the BioNTech vaccine, 26 (44%) were seropositive 4 weeks after the third dose.

Yu J, Tostanoski LH, Mercado NB, et al. Protective efficacy of Ad26.COV2.S against SARS-CoV-2 B.1.351 in macaques. Nature June 23, 2021. https://www.nature.com/articles/s41586-021-03732-8

Publication favorable au Janssen, réputé efficace sur le variant sud-africain. L'explication pourrait venir d'une réponse croisée entre immunité humorale et cellulaire contre les varaints préoccupants chez... les macaques

This study may provide an explanation of why the Johnson & Johnson vaccine worked well in South Africa. In rhesus macaques, Ad26.COV2.S induced cross-reactive antibody and T cell responses against SARS-CoV-2 variants of concern, including the B.1.351 variant.

25 juin 2021

Shroti M, Krutikov M, Palmer T, et al. Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study. Lancet Inf Dis June 23, 2021. https://doi.org/10.1016/S1473-3099(21)00289-9

10 412 résidents de soins de longue durée en Angleterre : diminution à 0,44 des infections à PCR positives à J28 - J34 de la première injection d'AstraZeneca ou de Pfizer et à 0,38 à J35 - J48.

Among 10,412 care home residents aged 65 years and older, adjusted hazard ratios (HRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days after the first vaccine dose to 0.44 (95% CI 0.24–0.81) at 28–34 days and 0.38 (0.19–0.77) at 35–48 days. Similar effect sizes were seen for ChAdOx1 and BNT162b2 vaccines at 35–48 days.

Hyams C, Marlow R, Maseko Z. Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 COVID-19 vaccination at preventing hospitalisations in people aged at least 80 years: a test-negative, case-control study. Lancet Inf Dis June 23, 2021. https://doi.org/10.1016/S1473-3099(21)00330-3

Prévention des hospitalisations chez les plus de 80 ans : une dose d'AstraZeneca ou de Pfizer diminue le risque de 80,4%.

Same direction. One dose of either BNT162b2 or ChAdOx1 nCoV-19 resulted in substantial risk reductions of COVID-19-related hospitalisation in people aged at least 80 years. The adjusted vaccine effectiveness was 80.4% (95% CI 36.4–94.5).

24 juin 2021

Lepak AJ, Taylor LN, Stone CA, et al. Association of Changes in Seasonal Respiratory Virus Activity and Ambulatory Antibiotic Prescriptions With the COVID-19 Pandemic. JAMA Intern Med June 21, 2021. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781312

Moindre détection des virus respiratoires habituels dans le Wisconsin en période de covid-19 et diminution de 79% de la prescripton d'antibiotiques.

This study from Wisconsin, US demonstrated a marked decrease in respiratory virus detection, with a concomitant 79% decline in ambulatory antibiotic prescribing rates for respiratory tract infections, during the COVID-19 pandemic.

Duffy E, Thomas M, Hills T, Ritchie S. The impacts of New Zealand’s COVID-19 epidemic response on community antibiotic use and hospitalisation for pneumonia, peritonsillar abscess and rheumatic fever. Lancet Regional Health July 01, 2021. https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(21)00071-7/fulltext

Moindre prescription d'antibiotiques, en Nouvelle-Zélande aussi.

Same findings from New Zealand. Antibiotic dispensing rates fell by 36%, suggesting that countries with high rates of antibiotic use could significantly reduce their use without an increase in morbidity.

Steenblock C, Richter S, Berger I. et al. Viral infiltration of pancreatic islets in patients with COVID-19. Nat Commun June 21, 2021, 12, 3534. https://www.nature.com/articles/s41467-021-23886-3

Infiltration virale du pancréas retrouvée à l'autopsie sans physiopathologie complétemtn descriptible.

Using human islets and autopsy tissue from patients that died of COVID-19, this study provides clear proof that beta cells are permissive to infection with SARS-CoV-2. The mechanism of virus entry is not completely clear at this point as ACE2 is only expressed in beta cells in a subset of patients. Therefore, other receptors/factors may be involved in facilitating uptake of SARS-CoV-2 into beta-cells. SARS-CoV-2 may induce a local inflammation and may be associated with necroptotic cell death in islets, but the current study cannot answer in detail the mechanism that may lead to islet impairment and metabolic dysregulation.

Matheney M, Maleque N, Channell N, et al. Severe Exacerbations of Systemic Capillary Leak Syndrome After COVID-19 Vaccination: A Case Series. Ann Int Med June 15, 2021. https://doi.org/10.7326/L21-0250

Trois cas de syndrome d'hyperperméabilité capillaire après AstraZeneca, Pfizer et Moderna. Les auteurs recommandent l'utilisation d'immunoglobulines intraveineuses.

Three patients who had severe flares of SCLS immediately after receiving standard doses of the COVID-19 vaccines (AstraZeneca, BioNTech and Moderna). The authors recommend that patients with a diagnosis or suspected diagnosis of SCLS should receive IVIG prophylaxis before vaccination.

Bøhler AD, Strøm ME, Sandvig KU et al. Acute macular neuroretinopathy following COVID-19 vaccination. Eye June 21, 2021. https://www.nature.com/articles/s41433-021-01610-1

Un cas de rétinopathie maculaire après AstraZeneca.

A patient who developed an acute paracentral scotoma after having received the AstraZeneca vaccine: the signs and symptoms were consistent with acute macular neuroretinopathy (AMN).

Kwon S, Joshi AD, Lo CH. et al. Association of social distancing and face mask use with risk of COVID-19. Nat Commun Jun 21, 2021, 12, 3737. https://www.nature.com/articles/s41467-021-24115-7

Diminution du risque de transmission : 31% avec la distanciation, 62% avec le masque, même chez des personnes avec mauvaise distanciation sociale.

Individuals living in communities with the greatest social distancing had a 31% lower risk of predicted COVID-19 compared with those living in communities with poor social distancing. Self-reported ‘always’ use of face mask was associated with a 62% reduced risk of predicted COVID-19 even among individuals living in a community with poor social distancing.

23 juin 2021

Whaley CM, Cantor J, Pera M, et al. Assessing the Association Between Social Gatherings and COVID-19 Risk Using Birthdays. JAMA Intern Med June 21, 2021. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781306?resultClick=1

Anniversaires à domicile aux USA : 8,6 de diagnostics supplémentaires pour 10 000 personnes si anniversaire dans les quinze jours qui précédent.

Yes, there is an association between household birthdays, which likely correspond to informal social gatherings, and COVID-19. Among the 2.9 million households in the study, in the top 10% of counties in COVID-19 prevalence, households with a birthday in the 2 weeks prior had 8.6 more diagnoses per 10,000 individuals compared with households without a birthday in the 2 weeks prior. The relative increase was 31% of county-level prevalence and was even larger in magnitude in households that had a recent child’s (vs adult’s) birthday.

Kentish-Barnes N, Cohen-Solal Z, Morin L, et al. Lived Experiences of Family Members of Patients With Severe COVID-19 Who Died in Intensive Care Units in France. JAMA Netw Open June 21, 2021; 4(6):e2113355. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781115?resultClick=1

France : confirmation de l'importance prioritaire de la présence de la famille en soins intensifs. 

This study reports how bereaved family members’ experiences of care, death, and mourning were disrupted during the first wave of the COVID-19 pandemic, both during hospitalization in the ICU and after the patient’s death. The main finding is “what family-centered research has taught us in the last 20 years: the presence of family members in ICUs should remain a priority”.

22 juin 2021

Braunstein SL, Slutsker JS, Lazar R, et al. Epidemiology of reported HIV and other sexually transmitted infections during the COVID-19 pandemic, New York City. J Inf Dis Jun 16, 2021, jiab319, https://doi.org/10.1093/infdis/jiab319.

MST et confinement dans la ville de New York : des effets positifs qui doivent interroger els sociologues.

During NYC lockdown, the volume of positive HIV/STI tests, and diagnoses of HIV, chlamydia, gonorrhea, and syphilis declined substantially, reaching a nadir in April before rebounding.

21 juin 2021

De Paula Eduardo F, Corrêa L, Heller D, et al. Salivary SARS-CoV-2 load reduction with mouthwash use: a randomized pilot clinical trial. Heliyon June 17, 2021. https://doi.org/10.1016/j.heliyon.2021.e07346

Des lavages de bouche à l'étude pour diminuer la charge virale salivaire.

Mouthwash with cetylpyridinium chloride + Zinc and chlorhexidine gluconate resulted in significant reductions of the SARS-CoV-2 viral load in saliva up to 60 mins after rinsing, while hydrogen peroxide mouthwash resulted in a significant reduction up to 30 mins after rinsing.

Son BF, Murray N, Friedman K, et al. Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes. NEJM June 16, 2021. https://www.nejm.org/doi/full/10.1056/NEJMoa2102605?query=featured_home

Syndrome inflammatoire multisystémique chez l'enfant : diminution des atteintes cardiaques avec un traitement  initial associant immunoglobulines IV et corticoïdes.

This may be the case here. Surveillance data on 518 inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 US hospitals. In the propensity-score–matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%).

20 juin 2021

Hunter RF, Garcia L, de Sa TH et al. Effect of COVID-19 response policies on walking behavior in US cities. Nat Commun 12 June 15, 2021, 3652. https://www.nature.com/articles/s41467-021-23937-9

L'analyse des podomètres de nos smartphones : réduction de la marche "utilitaire" dans les métropoles aux USA à la faveur de la covid-19.

Analyzing mobility data from mobile devices and area-level data to study the walking patterns of 1.62 million anonymous users in 10 metropolitan areas in the US, this study reveals dramatic declines in walking, particularly utilitarian walking, while recreational walking has recovered and even surpassed pre-pandemic levels.

Bi Q, Lessler J, Eckerle I, et al. Insights into household transmission of SARS-CoV-2 from a population-based serological survey. Nat Commun June 15, 2021, 12, 3643. https://doi.org/10.1038/s41467-021-23733-5

Suisse : la transmission domestique trois fois plus fréquente que la transmission à l'extérieur lors de la première vague chez des personnes de plus de 5 ans d'âge.

This was a cross-sectional, household-based population serosurvey of 4534 people ≥ 5 years from 2267 households enrolled April-June 2020 in Geneva, Switzerland. The risk of infection from exposure to a single infected household member aged ≥ 5 years (17.3%, 13.7-21.7) was more than three-times that of extra-household exposures over the first pandemic wave (5.1%, 4.5-5.8). Young children had a lower risk of infection from household members.

Campbell F, Archer B, Laurenson-Schafer H, et al. Increased transmissibility and global spread of SARS-CoV-2 variants of concern as at June 2021. Eurosurveillance June 2021; 26(24):pii=2100509. https://doi.org/10.2807/1560-7917.ES.2021.26.24.2100509

C'est le variant indien qui pose problème par ses capacités de diffusion. Il devrait supplanter tous les autres.

This analysis of the effective reproduction number and global spread of SARS-CoV-2 variants with data available by 3 June 2021 suggest that B.1.617.2 is expected to rapidly out-compete other variants and become the dominant circulating lineage over the coming months.

19 juin 2021

Liu C, Ginn HM, Dehnirattisai W, et al. Reduced neutralization of SARS-CoV-2 B.1.617 by vaccine and convalescent serum. Cell June 16, 2021. https://doi.org/10.1016/j.cell.2021.06.020

Mieux vaut ne pas avoir été infecté par le variant brésilien pour être protégé du variant indien.

The ability of monoclonal antibodies, convalescent and vaccine sera to neutralize B.1.617.1 and B.1.617.2 is reduced when compared with ancestral Wuhan strains but there is no evidence of widespread antibody escape as seen with B.1.351. However, B.1.351 and P.1 sera showed markedly more reduction in neutralization of B.1.617.2 suggesting that individuals previously infected by these variants may be more susceptible to re-infection by B.1.617.2.

18 juin 2021

Gupta K, O’Brian WJ, Bellino P, et al. Incidence of SARS-CoV-2 Infection in Health Care Workers After a Single Dose of mRNA-1273 Vaccine. JAMA Netw Open June 16, 2021;4(6):e2116416. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781173?resultClick=1

Efficacité du Moderna dès la première dose chez des soignants : 95% du jour 15 au jour 42.

This study demonstrated an association between receipt of the mRNA-1273 vaccine and a reduction in SARS-CoV-2 infection in HCWs beginning 8 days after dose 1. Vaccine clinical effectiveness was 50.3% for the entire 42-day period of follow-up, 77.5% for days 8 through 42, and 95.0% for days 15 through 42.

Samarakoon U, Alvarez-Arango S, Blumenthal KG. Delayed Large Local Reactions to mRNA Covid-19 Vaccines in Blacks, Indigenous Persons, and People of Color. NEJM June 9, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2108620?query=featured_home

Réactions locales étendues apparaissant de manière retardée, à 8 jours en moyenne (plus ou moins 2 jours) après vaccin à ARNm

Photos of eight large local reactions are shown. The mean time from vaccination until the onset of the reaction was 8 ± 2 days (range, 4 to 14).

Une fake news stérile : la vaccination à ARNm ne modifie pas la composition du sperme chez 45 volontaires.

Source :

Gonzalez DC, Nassau DE, Khodamoradi K, et al. Sperm Parameters Before and After COVID-19 mRNA Vaccination. JAMA. Published online June 17, 2021. doi:10.1001/jama.2021.9976

17 juin 2021

Nyberg TR, Twohig KA, Harris RJ, et al. Risk of hospital admission for patients with SARS-CoV-2 variant B.1.1.7: cohort analysis. BMJ 2021 June 15, 2021; 373. https://www.bmj.com/content/373/bmj.n1412

Admission en hôpital après variant anglais : tout-de-même une fois et demi plus fréquente qu'avec la souche initiale.

This retrospective analysis identified through community testing in England indicated that the risk of hospital admission within 14 days after a positive test was 1.52 (1.47 to 1.57) times higher for patients infected with the B.1.1.7 variant compared with those infected with wild-type variants, after adjustment for age, sex, deprivation, ethnicity, region, and week of diagnosis.

Xin H, Wong JY, Murphy C, et al. The incubation period distribution of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Clin Inf Dis June 12, ciab501, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab501/6297425

Une période moyenne d'incubation un peu plus longue que prévue initialement : 6,3 jours (de 1.8 à 11.9 jours).

Mean, median and 95th percentile for incubation period are 6.3 days (range: 1.8 to 11.9 days), 5.4 days (range: 2.0 to 17.9 days) and 13.1 days (range: 3.2 to 17.8 days), respectively.

16 juin 2021

Kustin T, Harel N, Finkel U, et al. Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2-mRNA-vaccinated individuals. Nat Med June 14, 2021. https://www.nature.com/articles/s41591-021-01413-7

Le vaccin à ARNm BNT162b2 (Pfizer) est très efficace contre le SRAS-CoV-2. Cependant, il existe une crainte que les variants préoccupants (VOC : variants of concern) puissent échapper à la protection vaccinale, en raison des preuves d'une neutralisation réduite des VOC B.1.1.7 (anglais) et B.1.351 (sud-africain) par les sérums vaccinaux dans les analyses de laboratoire. Nous avons effectué une étude de cohorte appariée pour examiner la distribution des VOC dans les infections de vaccinés par ARNm BNT162b2 aux Clalit Health Services (Israël) en utilisant le séquençage génomique viral, et avons émis l'hypothèse que si l'efficacité du vaccin contre un VOC est réduite, sa proportion parmi les cas incidents serait plus élevée que chez les témoins non vaccinés. En analysant 813 séquences de génome viral à partir d'écouvillons nasopharyngés, nous avons montré que les vaccinés testés positifs au moins 7 jours après la deuxième dose étaient infectés de manière disproportionnée par le B.1.351 par rapport aux témoins. Ceux qui ont été testés positifs entre 2 semaines après la première dose et 6 jours après la deuxième dose ont été infectés de manière disproportionnée par le B.1.1.7. Ces résultats suggèrent une efficacité réduite du vaccin contre les deux VOC dans des fenêtres de temps particulières. Nos résultats soulignent l'importance de suivre rigoureusement les variants viraux et d'augmenter le nombre des vaccinations pour empêcher la propagation des VOC.

Analyzing 813 viral genome sequences, the authors showed that vaccinees who tested positive at least 7 days after the second dose were disproportionally infected with B.1.351, compared with controls. Those who tested positive between 2 weeks after the first dose and 6 days after the second dose were disproportionally infected by B.1.1.7.

Bauer A, Schreinlechner M Sappler N, et al. Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial. Lancet Resp Med June 11, 2021. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00214-9/fulltext

Une étude qui plaiderait pour une interruption des IEC lors d'une Covid-19 mais une  méthodologie contestée (voir citation suivante).

In this open label RCT (ACEI-COVID) performed at 35 centers in Austria and Germany, 204 patients (median age 75 years) were randomly assigned to discontinue or continue RAS inhibitors. Of note, discontinuation had no significant effect on the maximum severity of COVID-19 but led to a faster and better recovery. At 30 days, 11 (11%) in the discontinuation group and 23 (23%) in the continuation group had signs of organ dysfunction (SOFA score ≥ 1) or were dead (p = 0·017).

Kerneis M, Montalescot G. RAS inhibition and COVID-19: more questions than answers? Lancet Resp Med June 11, 2021. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00233-2/fulltext

Comment on ACEI-COVID. See title. Mathieu Kerneis and Gilles Montalescot argue that the study should be interpreted with great caution, considering that it derives from secondary analyses of a study that did not meet its primary endpoint.

15 juin 2021

Vaughn VM, Yost M, Abshire C, et al. Trends in Venous Thromboembolism Anticoagulation in Patients Hospitalized With COVID-19. JAMA Netw Open June 11, 2021;4(6):e2111788. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780927?resultClick=1

Chez 1351 patients hospitalisés pour Covid-19 aux USA, l'anticoagulation à doses prophylactiques a réduit la mortalité à 60 jours.

In this cohort study of 1351 patients hospitalized with COVID-19 in which 1127 patients received anti-coagulation, prophylactic anti-coagulation remained associated with lower mortality at 60 days.

Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35).

14 juin 2021

Vitamine D et covid grave : des facteurs génétiques

The Vitamin D–COVID Question: Is the Answer in Our Genes?
Source : https://tinyurl.com/uee3mad7

Source : https://tinyurl.com/uee3mad7

Després JP. Severe COVID-19 outcomes — the role of physical activity. Nature Reviews Endocrinology 10 June 2021. https://www.nature.com/articles/s41574-021-00521-1

Covid graves : pas seulement l'obésité mais aussi les comportements sédentaires et le manque d'activité physique. Il est vrai que ceux-ci vont souvent avec celle-là.

It’s not only obesity: according to this nice review, current sedentary behaviors and lack of physical activity are also contributing to morbidity and mortality associated with COVID-19.

13 juin 2021

Simpson CR, Shi T, Vasileiou E et al. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Med June 9, 2021. https://www.nature.com/articles/s41591-021-01408-4

Entre le 8 décembre 2020 et le 14 avril 2021, 1,71 million de personnes en Écosse ont été vaccinées avec le vaccin AstraZeneca et 0,82 million de personnes ont été vaccinées avec le vaccin Pfizer. La première dose de vaccin AstraZeneca s'est avérée être associée à une légère augmentation des risques de thrombocytopénie induite par le vaccin, avec des preuves suggérant un risque accru d'événements thromboemboliques et hémorragiques artériels. Il n'y avait pas de risque global accru de ces événements indésirables chez les personnes recevant le vaccin Pfizer.

Between 8 December 2020 and 14 April 2021, 1.71 million people from Scotland were vaccinated with the ChAdOx1 vaccine, and 0.82 million people were vaccinated with the BNT162b2 vaccine. First dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. There was no overall increased risk in these adverse events in individuals receiving BNT162b2.

Bourguignon A, Arnold DM, Warkentin TE, et al. Adjunct Immune Globulin for Vaccine-Induced Thrombotic Thrombocytopenia. NEJM June 9, 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa2107051?query=featured_home

Cofirmation du rôle bénéfique des immunoglobulines en cas de thrombocytopénie thrombotique induite par le vaccin AstraZeneca.

Three older patients with vaccine-induced immune thrombotic thrombocytopenia (VITT), occurring after the AstraZenec vaccine. Of note, all had one or more arterial thrombotic events. After the initiation of high-dose intravenous immune globulin treatment, reduced antibody-induced platelet activation in serum was seen in all three patients.

Liu J, Liu Y, Xia H, et al. BNT162b2-elicited neutralization of B.1.617 and other SARS-CoV-2 variants. Nature June 10, 2021. https://www.nature.com/articles/s41586-021-03693-y

Action du Pfizer jugée satisfaisante sur tous les variants bien que moindre sur le B.1.617.1 indien.

Good news. A total of 20 human sera, drawn 2 or 4 weeks after two doses of BNT162b2, neutralized engineered SARS-CoV-2 with different spike proteins of the delta variants (from India). B.1.617.1 was the least neutralized, probably due to the presence of both L452R and E484Q substitutions at the receptor binding site. Nevertheless, all variants were neutralized by all tested sera at titers ≥ 40

Milman O, Yelin I, Aharony N et al. Community-level evidence for SARS-CoV-2 vaccine protection of unvaccinated individuals. Nat Med June 10, 2021. https://doi.org/10.1038/s41591-021-01407-5

Protection croisée en Israël : pour chaque 20% de personnes vaccinées, diminution de moitié des tests positifs chez les non vaccinés.

Vaccination provides cross-protection to unvaccinated individuals in the community: this groundbreaking study from Israel shows that on average, for each 20 percentage points of individuals who are vaccinated in a given population, the positive test fraction for the unvaccinated population decreased approximately twofold.

12 juin 2021

Payne AB, Gilari Z, Godfred-Cato S, et al. Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2. JAMA Netw Open June 10, 2021;4(6):e2116420. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780861?resultClick=1

Incidence du syndrome inflammatoire multisystémique chez les enfants aux USA : 5,1 pour un millon et par mois alors que 316 par million d'infections au SARS-CoV-2 chez les personnes de moins de 21 ans.

MIS-C incidence was 5.1 persons per 1,000,000 person-months and 316 persons per 1,000,000 SARS-CoV-2 infections in persons younger than 21 years.

Discepolo V, Catzola A, Pierri L, et al. Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic. JAMA Netw Open June 10, 2021;4(6):e2111369. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780866?resultClick=1

Lésions des orteils évocatrices d'engelures chez l'adolescent : penser à la Covid.

This case series of 17 adolescents found that chilblain-like lesions of the toes emerged during the COVID-19 pandemic in otherwise healthy adolescents without signs of SARS-CoV-2 infection or other inflammatory, autoimmune, or thrombophilic phenomena.

11 juin 2021

Razani N, Malekinejad M, Rutherford GW. Clarification regarding Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses, a Systematic Review. J Inf Dis June 4, 2021, jiab298, https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab298/6291889

Encore une confirmation. La contamination en extérieur pourrait être de moins de 10% des cas, peut-être moindre que 1% des cas pour la plupart des études.

Update of a previous paper, supporting the initial conclusion that the risk of SARS-CoV-2 transmission is much lower outdoors than indoors. The proportion of infections happening outdoors is likely much lower than 10%, and most studies suggest that it is likely less than 1%.

Kompaniyets L, Agathus NT, Nelson JM, et al. Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children. JAMA Netw Open June 7, 2021;4(6):e2111182. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780706?resultClick=1

Covid sévère chez l'enfant : des comorbidités dont le diabète de type 1, des pathologies cardiaques et l'obèsité.

This cross-sectional study on 43,465 patients with COVID-19 aged 18 years or younger found a higher risk of severe illness among children with medical complexity and certain underlying conditions, such as type 1 diabetes (strongest risk factor with an adjusted risk ratio of 2.38), cardiac and circulatory congenital anomalies, and obesity.

10 juin 2021

Christie A, Henley SJ, Mattocks L, et al. Decreases in COVID-19 Cases, Emergency Department Visits, Hospital Admissions, and Deaths Among Older Adults Following the Introduction of COVID-19 Vaccine — United States, September 6, 2020–May 1, 2021. MMWR Morb Mortal Wkly Rep. ePub: 8 June 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7023e2.htm?s_cid=mm7023e2_w

Vaccination aux USA : déclin de la mortalité de la Covid-19 depuis le mi-décembre 2020. Entre les deux semaines avant vaccination et la période de deux semaines fin avril, l'amélioration de la situation a été plus importante chez les personnes âgées car davantage vaccinées que chez les jeunes moins protégés.

The ratio for COVID-19 deaths began to decline in mid-December while rate ratios for COVID-19 incidence, ED visits, and hospital admissions began to decline in late December to mid-January. Comparing the 2-week pre-vaccination period with 2 weeks in late April, declines were significantly greater among older adults, who had higher vaccination coverage, than among younger adults, who had lower coverage.

9 juin 2021

Chodick G, Tene K, Patalon T, et al. Assessment of Effectiveness of 1 Dose of BNT162b2 Vaccine for SARS-CoV-2 Infection 13 to 24 Days After Immunization. JAMA Netw Open June 7, 2021; 4(6):e2115985. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780700?resultClick=1

Réduction de 54% environ des infections symptomatiques après une dose Pfizer au bout de 13 à 24 jours en Israël.

In this study of 503,875 individuals from Israel who received 1 dose of the BNT162b2 vaccine, the first dose was associated with an approximately 54% reduction in the risk of symptomatic SARS-CoV-2 infections at 13 to 24 days after immunization compared to 1 to 12 days after vaccination.

8 juin 2021

Havers FP, Whitaker M, Self JL, et al. Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021. MMWR Morb Mortal Wkly Rep. ePub: 4 June 2021 https://www.cdc.gov/mmwr/volumes/70/wr/mm7023e1.htm?s_cid=mm7023e1_w

Adolescents (12 à 17 ans) aux USA : 204 hospitalisés au premier trimestre de 2021, 31,4% admis en soins intensifs, 4,9% nécessitant une ventilation mécanique, aucun décès.

Among 204 adolescents who were likely hospitalized primarily for COVID-19 during January 1–March 31, 2021, 31.4% were admitted to an intensive care unit (ICU), and 4.9% required invasive mechanical ventilation; there were no associated deaths.

Vanker A, McGeer A, O’Byrne G, et al. Adverse Outcomes Associated with SARS-CoV-2 variant B.1.351 Infection in Vaccinated Residents of a Long Term Care Home, Ontario, Canada. Clin Inf Dis, June 6, 2021, ciab523, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab523/6294072

Episode de variant sud-africain dans un établissement de soins de longue durée au Canada. Sur les neuf résidents vaccinés avec le Pfizer, quatre ont développé une hypoxémie. Trois sont décédés.

Another outbreak of B.1.351 (south Africa) in a long term care home (LTCH) in Canada. Of the 9 residents (vaccinated with B162.B2 from BionTech/Pfizer) and infected with B.1.351, 4 developed hypoxemia. Of these, 3 (including both hospitalized patients) died.

De Giorgi V, West KA, Henning AN, et al. Naturally acquired SARS-CoV-2 immunity persists for up to 11 months following infection. J Inf Dis, June 5, 2021, jiab295,  https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab295/6293992

Parmi 228 personnes, 116 ayant présenté la Covid-219 ; chez ces dernières, 91,4% montraient des niveaux détectables d'IgG jusqu'à 11 mois après guérison, 63 % considérés comme neutralisants. 

Of the 116 donors presenting for repeat timepoints, 91.4% of donors had detectable IgG levels up to 11 months post-symptom recovery, while 63% had detectable neutralizing titers. Of note, 25% of donors had neutralizing levels that dropped to an undetectable titer over time.

Sender R, Bar-On YM, Gleizer S, et al. The total number and mass of SARS-CoV-2 virions. PNAS June 3, 2021. https://www.pnas.org/content/118/25/e2024815118

Un poids plume qui pèse lourd : le SARS-CoV-2.

All SARS-CoV-2 virions currently in all human hosts have a mass of between 100 g and 10 kg. Although each infected person carries an estimated 1 billion to 100 billion virions during peak infection, their total mass is no more than 0.1 mg.

7 juin 2021

Goyal A, Reeves DB, Thakkar N, et al. Slight reduction in SARS-CoV-2 exposure viral load due to masking results in a significant reduction in transmission with widespread implementation. Sci Rep 11, 11838 (2021). https://doi.org/10.1038/s41598-021-91338-5

S'il en étati besoisn, encore une étude en faveur de l'efficacité des masques.

This modeling study shows that the use of masks by both a potential transmitter and exposed person substantially reduces the probability of successful transmission, even if masks only lower exposure viral load by ~ 50%. The model also predicts that moderately efficacious masks will lower exposure viral load tenfold among people who get infected despite masking, potentially limiting infection severity.

6 juin 2021

Lash RR, Moonan PK, Byers BL, et al. COVID-19 Case Investigation and Contact Tracing in the US, 2020. JAMA Netw Open June 3, 2021. 2021;4(6):e2115850. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780568?resultClick=1

Bien joli de vouloir contacter et tracer les cas contacts aux USA en 2020. Encore fallait-il que l'on pût joindre les cas contacts en question et que leurs noms fussent connus. Ce ne fut pas le cas deux fois sur trois.

In this cross-sectional study of US local COVID-19 surveillance data, contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because two of three cases were either not reached for interview or named no contacts when interviewed.

Tardif JC, Bouabdallaoui N, L’Allier PL, et al. Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial. Lancet Resp Med May 27, 2021. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00222-8/fulltext

Colchicine et Covid-19 : peut-être des résultats encourageants mais loin d'être confirmés. Sans oublier les effets secondaires. Trop tôt pour conclure et surtout initier cette thérapeutique.

In this large RCT enrolling high-risk patients from six countries (Brazil, Canada, Greece, South Africa, Spain, and the USA) who were not under immediate consideration for hospital admission, colchicine led to a lower rate of the composite of death or hospital admission than placebo. Among 4,159 patients with PCR-confirmed COVID-19, the primary endpoint occurred in 96 (4.6%) of 2,075 patients in the colchicine group and 126 (6,0%) of 2,084 patients in the placebo group (odds ratio 0.75, 0.57–0.99; p=0.042). Diarrhoea was reported by 14% of patients in the colchicine group and 7% in the placebo group. But do the authors trust their own data? They conclude that “replication in other studies… is recommended”.

5 juin 2021

Hag-Ali M, Al Shamsi AS, Boeijen L et al. The detection dogs test is more sensitive than real-time PCR in screening for SARS-CoV-2. Commun Biol June 3, 2021, 4, 686. https://www.nature.com/articles/s42003-021-02232-9

Notre ami le chien meilleur que le RT-PCR à l'aéroport ?  La valeur prédictive positive (VPP) est de 52 %, la valeur prédictive négative (VPN) est de... 99,8%.

La VPP indique la probabilité que la maladie soit réellement présente lorsque le résultat du test est positif.

La valeur VPN est la probabilité que la condition ne soit pas présente lorsque le test est négatif.

Can we use dogs at the airports to identify COVID-19 patients? Upon training explosives detection dogs on sniffing COVID-19 odor in patients’ sweat, those dogs were able to successfully screen out 3249 individuals who tested negative for the SARS-CoV-2, from a cohort of 3290 individuals. The positive predictive value of dog detection was 52% (probability that identified individuals do truly have the disease). The negative predictive value was 99.8%. Almost better than PCR testing.

Cohen MS, Nirula A, Mulligan MJ, et al. Effect of Bamlanivimab vs Placebo on Incidence of COVID-19 Among Residents and Staff of Skilled Nursing and Assisted Living Facilities: A Randomized Clinical Trial. JAMA June 3, 2021. https://jamanetwork.com/journals/jama/fullarticle/2780870?resultClick=1

Un anticorps monoclonal neutralisant, le bamlanivimab est efficace en réduisant l'incidence des cas légers ou graves chez 966 résidents et soignants d'établissements pour personnes âgées aux USA. Etude randomisée en double insu de phase 3, toutefois réalisée avant l'apparition des variants.

Paper of the day. Bamlanivimab (BAM), a neutralizing monoclonal antibody, is effective in reducing the incidence of mild or worse COVID-19 in residents and participants at high risk of severe COVID-19. This large phase 3 RCT included 966 participants who were residents and staff at US skilled nursing facilities with at least one confirmed SARS-CoV-2 index case. The incidence of COVID-19 infection among those treated with a single infusion of BAM was 8.5% vs 15.2% with placebo, with an odds ratio of 0.43 (95% CI, 0.28-0.68, beautiful Figure below!). Moreover, participants who received BAM and acquired SARS-CoV-2 had lower baseline viral loads and shorter time to viral clearance. However, one limitation is that the study was conducted prior to the occurrence of SARS-CoV-2 variants that may have reduced susceptibility to BAM.

Time From Infusion to Development of Mild or Worse COVID-19 With Bamlanivimab vs Placebo Among Resident and Staff Participants

4 juin 2021

Takuva S, Takalani A, Garrett N, et al. Thromboembolic Events in the South African Ad26.COV2.S Vaccine Study. NEJM 3, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2107920?query=featured_home

MTE après Janssen : rares et surtout chez des personnes avec facteurs de risque en Afrique du Sud.

esseInterim safety data from the first 288,368 participants who were vaccinated with Ad26.COV2.S (Johnson & Johnson) in the Sisonke study — an open-label, Phase IIIb implementation study. The rate of adverse events with vaccination is low, and thromboembolic events occur mainly in persons with risk factors for thromboembolism.

3 juin 2021

Patel MD, Rosenstrom E, Ivy JS, et al. Association of Simulated COVID-19 Vaccination and Nonpharmaceutical Interventions With Infections, Hospitalizations, and Mortality. JAMA Netw Open June 1, 2021;4(6):e2110782. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780539

Vaccins moins efficaces et mesures non médicamenteuses : meilleure attitude que vaccination plus efficace sans mesures non médicamenteuses.

Interesting finding: compared with more efficacious vaccines with lower population coverage, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection.

Vogel G, Couzin-Frankel J. Israel reports link between rare cases of heart inflammation and COVID-19 vaccination in young men. Nature NEWS June 1, 2021. https://www.sciencemag.org/news/2021/06/israel-reports-link-between-rare-cases-heart-inflammation-and-covid-19-vaccination

Israël : un sur 3000 à un sur 6000 jeunes hommes de 16 à 24 ans ont présenté une myocardite après Pfizer. La plupart des cas étaient légers et se sont amendés en quelques semaines. Une forte production d'anticorps pourrait être responsable de ces rares cas.

Brief summary of current knowledge: in Israel, between one in 3000 and one in 6000 men ages 16 to 24 who received the BioNTech vaccine developed myocarditis. Most cases were mild and resolved within a few weeks. It is speculated that very high antibody levels generated in young people may also, in rare cases, lead to a sort of immune overreaction that inflames the heart.

2 juin 2021

Arnold DT, Milne A, Samms E, et al. Symptoms After COVID-19 Vaccination in Patients With Persistent Symptoms After Acute Infection: A Case Series. Ann Int Med, 25 May 2021. https://www.acpjournals.org/doi/10.7326/M21-1976

36 patients avec Covid long souffrant d'au moins un symptôme 8 mois après l'épisode aigu. Sont vaccinés par Pfizer ou AstraZeneca. Légère amélioration et pas de diminution de la qualité de vie ou aggravation des symptômes. 

In total, 36 patients who reported at least 1 persistent symptom 8 months after acute infection were vaccinated with Astra Zeneca or the BionTech vaccine. There was some improvement and no decrease in quality of life or worsening of symptoms.

1er juin 2021

Massarweh A, Eliakim-Raz N, Stemmer A, et al. Evaluation of Seropositivity Following BNT162b2 Messenger RNA Vaccination for SARS-CoV-2 in Patients Undergoing Treatment for Cancer.  JAMA Oncol May 28, 2021. https://jamanetwork.com/journals/jamaoncology/fullarticle/2780584?resultClick=1

Moindre immunisation après Pfizer si cancer plus chimiothérapie plus immunothérapie.

In this cohort study of 102 patients with cancer from Israel who were receiving active treatment and 78 healthy controls, 92 patients with cancer (90%) and 100% of the controls were seropositive after the BNT162b2 vaccine (BioNTech/Pfizer). The median IgG titer in the patients with cancer was significantly lower than that in the controls. In a multivariate analysis, the only variable that was significantly associated with lower IgG titers was treatment with chemotherapy plus immunotherapy.

Yazaki S, Yoshida T, Kolima Y, et al. Difference in SARS-CoV-2 Antibody Status Between Patients With Cancer and Health Care Workers During the COVID-19 Pandemic in Japan. JAMA Oncol 28, 2021. https://jamanetwork.com/journals/jamaoncology/fullarticle/2780583?resultClick=1

Comparaison entre 500 patients cancéreux et 1190 soignants. Les anticorps anti-S et anti-N sont diminués en cas de cancer sauf chez les patients recevant une immunothérapie par inhibiteurs de point de contrôle. 

In this cross-sectional study including 500 patients with cancer and 1190 HCWs, the seroprevalence was similar, but the levels of IgG antibodies against nucleocapsid and spike protein were significantly lower in patients than in HCWs. Interestingly, N-IgG and S-IgG levels were significantly higher in patients who received immune checkpoint inhibitors than in those who did not.

31 mai 2021

Loenenbach A, Markus I, Lehfeld AS, et al. SARS-CoV-2 variant B.1.1.7 susceptibility and infectiousness of children and adults deduced from investigations of childcare centre outbreaks, Germany, 2021. Euro Surveill. 2021;26(21):pii=2100433. https://doi.org/10.2807/1560-7917.ES.2021.26.21.2100433

Variant anglais en Allemagne : les enfants de 1 à 6 ans aussi, peut-être autant que les adultes.

This analysis of three simultaneously occurring outbreaks in childcare facilities (a total of 47 infections), suggests that both susceptibility and infectiousness of children aged between 1 to 6 years are substantially higher compared to the pre-B.1.1.7 period, and may be converging with those among adults.

García-García D, Vigo MI, Fonfría ES, et al. Retrospective methodology to estimate daily infections from deaths (REMEDID) in COVID-19: the Spain case study. Sci Rep 11, 11274 (2021). https://www.nature.com/articles/s41598-021-90051-7

Sous-estimation très importante du nombre de cas d'infections à SARS-CoV-2 en Espagne lors de la première vague.

During the first wave, infection numbers were largely underestimated in Spain. The authors propose a retrospective methodology to estimate daily infections from daily deaths because deaths are usually more accurately documented. They estimate that probable daily infections during the first wave were between 35 and 42 times higher than those officially documented on 14 March, when the national government decreed a national lockdown and still 9 times more than those documented by the updated version of the official data.

30 mai 2021

Myocardite après Pfizer

Un cas chez un homme de 39 ans

Adverse reactions to vaccines are usually insignificant, but there have been reports of myopericarditis after vaccination. Recently, several cases have been published of myopericarditis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection., 

We describe the case of a 39-year-old male physician, with a past medical history of asthma, autoimmune hypothyroidism, chronic atrophic gastritis, an isolated episode of atrial fibrillation, and recurrent spontaneous pneumothorax with left apical lobectomy. In recent months, he had undergone several PCR and serology screening tests for SARS-CoV-2 infection, all of which were negative. The patient gave informed consent for the write-up and publication of this clinical case.

Lien : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075838/

Myocarditis following COVID-19 vaccination
The coronavirus disease 2019 (COVID-19) vaccination frequently leads to minor side-effects, that may be more intense after the second dose, but more serious side effects have been reported. We report a case of a 24-year-old man who presented to the hospital with acute substernal chest pain, 4 days after his second COVID-19 Moderna vaccination. Laboratory studies revealed elevated troponins and negative viral serologies. Cardiac magnetic resonance imaging (cMRI) demonstrated edema and delayed gadolinium enhancement of the left ventricle in a midmyocardial and epicardial distribution. The patient was diagnosed with myocarditis following Moderna vaccination. Our case report raises concern that myocarditis is a rare side effect of COVID-19 vaccine. Despite our report, it appears that there is a significantly higher risk of cardiac involvement from COVID-19 infection compared to COVID-19 vaccination.
 

Frenck RW, Klein NP, Kitchin N, et al. Safety, Immunogenicity, and Efficacy of the BNT162b2 Covid-19 Vaccine in Adolescents. NEJM May 27, 2021. https://www.nejm.org/doi/full/10.1056/NEJMoa2107456?query=featured_home

Profil favorable du Pfizer chez 1131 adolescents entre 12 et 15 ans.

In 1,131 adolescents (12-to-15-year-old), the BNT162b2 vaccine had a favorable safety profile. The immune response was noninferior to that observed in another cohort of 16-to-25-year-old young adults.

Schulz C, Wylezich C, Wernike K, Gründl M, Dangel A, Baechlein C, et al. Prolonged SARS-CoV-2 RNA shedding from therapy cat after cluster outbreak in retirement home. Emerg Inf Dis May 26, 2021 https://wwwnc.cdc.gov/eid/article/27/7/20-4670_article

Faut-il tester le chat de l'EHPAD ?

Although an infected and asymptomatic therapy cat in a nursing home in Germany showed prolonged shedding of SARS-CoV-2 RNA up to day 21 after the first detection, genome sequencing found no further role of the cat in human infections on site.

Bodilsen J, Nielsen PB, Søgaard M. Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study. BMJ 25 May 2021, 373. https://www.bmj.com/content/373/bmj.n1135

Malades non-covid-19 au Danemark : hospitalisations diminuées de 30% et de 22 % lors des deux confinements nationaux en comparaison avec les années précédentes. Hausse de la mortalité chez les patients hospitalisés avec des pathologies respiratoires, des cancers, des pneumonies et des infections.

Hospital admissions for all major non-COVID-19 disease groups were 30% and 22% lower during the two national lockdowns compared to previous years. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis.

29 mai 2021

Leidi A, Koegler F, Dumont R, et al. Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study. Clin Inf Dis 27 May 2021, ciab495, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab495/6287116

Séropositif à la Covid : 94% de diminution du nombre des tests positifs.

Among 8344 serosurvey participants from Geneva, Switzerland, 498 seropositive individuals were selected and matched with 996 seronegative controls. After a mean follow up of 35 weeks, there was a 94% (95% CI: 86% to 98%, P < 0.001) reduction in the hazard of having a positive SARS-CoV-2 test in seropositive people.

Daniels CJ, Rajpal S, Greenshields JT, et al. Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection. JAMA Cardiol May 27, 2021. https://jamanetwork.com/journals/jamacardiology/fullarticle/2780548?resultClick=1

Myocardites après Covid-19 : plutôt une IRM ?

In this study of aggregate data from 13 Big Ten universities, 1597 athletes who tested positive by PCR underwent comprehensive cardiac evaluation including ECG, echocardiogram, troponin, and CMR imaging. Of these, 2.3% had either clinical or subclinical myocarditis that restricted them from training and competitive play. The authors believe that the role of CMR imaging in routine screening for athletes’ safe return to play should be explored further.

28 mai 2021

Salzman MB, Huang C-W, O’Brien CM, Castillo RD. Multisystem inflammatory syndrome after SARS-CoV-2 infection and COVID-19 vaccination. Emerg Infect Dis May 26, 2021. https://wwwnc.cdc.gov/eid/article/27/7/21-0594_article

Trois cas de syndrome inflammatoire multisystémique chez des adultes de 18, 20 et 40 ans après vaccination par Pfizer précédée dans deux cas d'une Covid-19. Voir aussihttps://wwwnc.cdc.gov/eid/article/27/7/21-0594-t1

Three patients from California are described, who experienced multisystem inflammatory syndrome (MIS) after immunization and severe acute respiratory syndrome coronavirus 2 infection.

27 mai 2021

CDC COVID-19 Vaccine Breakthrough Case Investigations Team. COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021. MMWR Morb Mortal Wkly Rep. ePub: 25 May 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e3.htm?s_cid=mm7021e3_w

Covid-19 malgré la vaccination, données américaines. On sait que les USA ont massivement vacciné avec des vaccins à ARNm. Sur 101 millions de personnes vaccinées au 30 avril 2021, un total de 10 262 infections à SARS-CoV2 s'est tout-de-même produit ; 6446 (63%) sont des femmes, 995 (10%) des patients ont été hospitalisés et 160 (2%) sont morts. Les virus ont été séquencés dans 555 (5%) cas dont 356 (64%) étaient des variants préoccupants. Parmi ces derniers, le variant anglais (199 ; 56%), les variants californiens (88 ; 25%) et (28 ; 8%), le variant brésilien (28 ; 8%) et le sud-africain (13 ; 4%).

As of April 30, 2021, approximately 101 million persons in the US had been fully vaccinated against COVID-19. A total of 10,262 SARS-CoV-2 vaccine breakthrough infections had been reported, among them 6446 (63%) in females. In total, 995 (10%) patients were known to be hospitalized, and 160 (2%) patients died. Sequence data were available from 555 (5%) reported cases, 356 (64%) of which were identified as SARS-CoV-2 variants of concern, including B.1.1.7 (199; 56%), B.1.429 (88; 25%), B.1.427 (28; 8%), P.1 (28; 8%), and B.1.351 (13; 4%).

26 mai 2021

Selon l'OMS, 115 000 soignants ont trouvé la mort dans le monde depuis le début de la pandémie :

Vayne C, Rollin J, Gruel Y, et al. PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia. NEJM May 19. 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2106383?query=featured_coronavirus

Diagnostic des troubles de la coagulation induits pas le vaccin : non-validité des tests rapides de détection des PF4.

It is important to use the right assay in patients with suspected VITT. Rapid immunoassays should be avoided in the detection of PF4-specific antibodies.

Mariette X, Hermine O, Tharaux PL, et al. Effectiveness of Tocilizumab in Patients Hospitalized With COVID-19A Follow-up of the CORIMUNO-TOCI-1 Randomized Clinical Trial. JAMA Network May 24, 2021. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2780021?resultClick=1

Tocilizumab : encore des résultats encourageants sur la mortalité (étude française).

Post hoc analysis of a French RCT, including hospitalized patients who were receiving oxygen but did not require high-flow or mechanical ventilation. Results were stratified by CRP. In patients with CRP levels greater than 15.0 mg/dL, the percentage of patients who received ventilation or those who died was 18% and 57% in the tocilizumab and usual care groups, respectively. Day-90 mortality was 9% and 35% in the tocilizumab and usual care groups, respectively.

25 mai 2021

Hodgson D, Flasche S, Jit M, et al. The potential for vaccination-induced herd immunity against the SARS-CoV-2 B.1.1.7 variant. Euro Surveill May 20, 2021. 26(20):pii=2100428. https://doi.org/10.2807/1560-7917.ES.2021.26.20.2100428

Avec un modèle reposant sur le seul variant anglais, il faudrait, en l'absence d'intervention non-médicamenteuse, une efficacité vaccinale ≥ 80% (tels les vaccins à ARNm)  et vacciner toute la population, y compris les enfants.

This brilliant modeling study suggests that if highly transmissible variants become dominant in areas with low seroprevalence, control of infection by vaccination, in the absence of non-pharmaceutical interventions, may only be achievable with a vaccine effectiveness against infectiousness of ≥ 80% – as suggested by early data for mRNA vaccines – extended to the full population, including children.

24 mai 2021

Formeister EJ, Chien W, Agrawal Y, et al. Preliminary Analysis of Association Between COVID-19 Vaccination and Sudden Hearing Loss Using US Centers for Disease Control and Prevention Vaccine Adverse Events Reporting System Data. JAMA Otolaryngology–Head & Neck Surgery, May 20, 2021. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2780288?resultClick=1

Pas d'association entre perte de l'audition et vaccins à ARNm.

No association exists between mRNA vaccines and sudden hearing loss.

Le Vu, S., Jones, G., Anna, F. et al. Prevalence of SARS-CoV-2 antibodies in France: results from nationwide serological surveillance. Nat Commun May 21, 12, 3025. https://www.nature.com/articles/s41467-021-23233-6

Mortalité de près de 10% des patients de 80 ans et plus en mai 2020 en France.

The first wave in France. Testing 11,000 residual specimens for anti-SARS-CoV-2 IgG and neutralizing antibodies, the authors found nationwide seroprevalence of 0.41% mid-March, 4.14% mid-April and 4.93% mid-May 2020. The authors infer that as of 17 May 2020, only 1 in 24 cumulative infections was reported as a confirmed case. Overall infection fatality rate (IFR) was estimated at 0.84% and increased exponentially with age, peaking in those ≥ 80 years old at 9.70%.

Publié dans Covid-19, bibliographie

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