bibliographie

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 1, archives 2 ) 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.

26 août 2021

Fowlkes A, Gaglani M, Groover K, et al. Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020–August 2021. MMWR Morb Mortal Wkly Rep. ePub: 24 August 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm?s_cid=mm7034e4_x

Dans cette cohorte de 4217 travailleurs de première ligne (principalement des travailleurs de la santé), l'efficacité du vaccin (EV) est passée de 91 % à 66 % lorsque le variant SARS-CoV-2 Delta est devenu prédominant. Cependant, cette tendance doit être interprétée avec prudence (augmentation du temps écoulé depuis la vaccination, faibles effectifs).

In this cohort of 4217 frontline workers (mainly HCW), the vaccine effectiveness (VE) declined from 91% to 66% when the SARS-CoV-2 Delta variant became predominant. However, this trend should be interpreted with caution (increasing time since vaccination, low numbers).

Behrens GM, Cossmann A, Stankov MV, et al. SARS-CoV-2 delta variant neutralisation after heterologous ChAdOx1-S/BNT162b2 vaccination. Lancet August 17, 2021. https://doi.org/10.1016/S0140-6736(21)01891-2

D'après les auteurs, l'inhibition du variant Delta est robuste avec une séquence AstraZeneca - Pfizer. 

Robust inhibition of variants including Delta by the switch vaccination of AZ then Pfizer/BNT.

Griffin JB, Haddix M, Danza P, et al. SARS-CoV-2 Infections and Hospitalizations Among Persons Aged ≥16 Years, by Vaccination Status — Los Angeles County, California, May 1–July 25, 2021. MMWR Morb Mortal Wkly Rep. ePub: 24 August 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e5.htm?s_cid=mm7034e5_w

Du 1er mai au 25 juillet 2021, parmi 43 127 infections au SRAS-CoV-2 chez les résidents du comté de Los Angeles, 25,3 % étaient des personnes entièrement vaccinées, 3,3 % étaient des personnes partiellement vaccinées et 71,4 % étaient des personnes non vaccinées. Le 25 juillet, les taux d'infection et d'hospitalisation chez les personnes non vaccinées étaient respectivement de 4,9 et 29,2 fois supérieurs à ceux des personnes complètement vaccinées. Il est à noter qu'en juillet, lorsque le Delta était prédominant, les valeurs seuils du Ct étaient similaires pour les personnes non vaccinées et vaccinées.

From May 1–July 25, 2021, among 43,127 SARS-CoV-2 infections in residents of Los Angeles County, 25.3% were in fully vaccinated persons, 3.3% were in partially vaccinated persons, and 71.4% were in unvaccinated persons. On July 25, infection and hospitalization rates among unvaccinated persons were 4.9 and 29.2 times, respectively, those of fully vaccinated persons. Of note, in July, when Delta was predominant, cycle threshold values were similar for unvaccinated and vaccinated persons.

Ong SW, Chiew CJ, Ang LW, et al. Clinical and virological features of SARS-CoV-2 variants of concern: a retrospective cohort study comparing B.1.1.7 (Alpha), B.1.315 (Beta), and B.1.617.2 (Delta). Clin Inf Dis August 23, 2021; ciab721, https://doi.org/10.1093/cid/ciab721

Cohorte rétrospective de Singapour, indiquant une tendance vers une sévérité accrue associée à B.1.617.2 (Delta). L'association de B.1.617.2 avec une valeur seuil de Ct inférieure et une excrétion virale plus longue fournit un mécanisme potentiel pour une transmissibilité accrue. Les 18 patients vaccinés avec Delta avaient tous une maladie bénigne et aucun n'a développé de pneumonie.

Retrospective cohort from Singapore, indicating a signal toward increased severity associated with B.1.617.2 (Delta). The association of B.1.617.2 with lower cycle threshold value and longer viral shedding provides a potential mechanism for increased transmissibility. All of 18 vaccinated patients with Delta had mild disease and none developed pneumonia.

25 août 2021

Wan EY, Chui CD, Lai FT, et al. Bell’s palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study. Lancet Inf Dis August 16, 2021. DOI: https://doi.org/10.1016/S1473-3099(21)00451-5

Paralysies faciales suite à la vaccination avec un vaccin à ARNm (BNT162b2-Pfizer) et un inactivé (CoronaVac) anti-SARS-CoV-2 : une série de cas et une étude cas-témoins appariée.

4,8 cas supplémentaires (par rapport à son incidence habituelle) de cet événement indésirable généralement résolutif pour 100 000 personnes vaccinées avec CoronaVac et 2,0 cas pour 100 000 personnes vaccinées avec BNT162b2 (Pfizer).

An additional 4.8 cases of this generally self-limiting adverse event per 100,000 people vaccinated with CoronaVac and 2.0 cases per 100,000 people vaccinated with BNT162b2.

Ehrmann S, Li J, Ibarra-Estrada M, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Resp Med, August 20, 2021. https://doi.org/10.1016/S2213-2600(21)00356-8

Ce méta-essai collaboratif de six essais de supériorité contrôlés randomisés en ouvert montre que le positionnement à plat ventre des patients éveillés atteints d'insuffisance respiratoire hypoxémique due à COVID-19 réduit le besoin d'intubation sans aucun préjudice. 14 patients éveillés traités en position à plat ventre évitent une intubation.

This collaborative meta-trial of six randomized controlled open label superiority trials shows that awake prone positioning of patients with hypoxemic respiratory failure due to COVID-19 reduces the need for intubation with no signs of harm. 14 patients treated with awake prone positioning avoids one intubation.

24 août 2021

Moritz S, Gottschick C, Horn J, et al. The risk of indoor sports and culture events for the transmission of COVID-19. Nat Commun August 2021, 12, 5096. https://www.nature.com/articles/s41467-021-25317-9

Les auteurs ont dirigé un concert pop « expérimental » (la musique était mainstream) le 22 août 2020, avec un total de 1212 personnes à la Leipzig Arena, en Allemagne. Ils concluent qu'avec un système de ventilation efficace, les événements de rassemblement de masse à l'intérieur avec des pratiques d'hygiène appropriées ont un effet très faible, voire inexistant, sur la propagation de l'épidémie. Si vous êtes intéressé par le système de ventilation dans l'arène : l'air d'admission est soufflé latéralement sur les côtés est et ouest par des buses à jet. https://static-content.springer.com/esm/art%3A10.1038%2Fs41467-021-25317-9/MediaObjects/41467_2021_25317_MOESM7_ESM.mp4

The authors conducted an “experimental” pop concert (music was mainstream) on August 22nd 2020, with a total of 1212 individuals in the Leipzig Arena, Germany. They conclude that with an effective ventilation system, indoor mass gathering events with suitable hygiene practices have a very small, if any, effect on epidemic spread. If you are interested in the ventilation system in the arena: the inlet air is blown in laterally on the east- and west side by jet nozzles. https://static-content.springer.com/esm/art%3A10.1038%2Fs41467-021-25317-9/MediaObjects/41467_2021_25317_MOESM7_ESM.mp4

23 août 2021

Eliakim-Raz N, Massarweh A, Stemmer A, Stemmer SM. Durability of Response to SARS-CoV-2 BNT162b2 Vaccination in Patients on Active Anticancer Treatment. JAMA Oncol. 2021 Aug 11:e214390. PubMed: https://pubmed.gov/34379092. Full text: https://doi.org/10.1001/jamaoncol.2021.4390

La réponse en anticorps IgG anti-spike (anti-S) au vaccin BioNTech/Pfizer chez 95 patients atteints de tumeurs solides sous traitement anticancéreux actif après une médiane de 4 mois à compter de la deuxième vaccination. Quatre-vingt-trois patients (87 %) étaient séropositifs pour les anticorps IgG anti-S. Les niveaux de titre médians chez les patients atteints de cancer étaient significativement inférieurs à ceux du groupe témoin. Il y avait un intervalle de 3,6 fois dans les valeurs de titre médian entre les types de tumeurs et un intervalle plus large (8,8 fois) entre les types de traitement. La seule variable significativement associée à des titres d'IgG inférieurs était le traitement par chimiothérapie plus immunothérapie et immunothérapie plus thérapie biologique.

Anti-spike (anti-S) IgG antibody response to the BioNTech/Pfizer vaccine in 95 patients with solid tumors on active anti-cancer treatment after a median of 4 months from the second vaccination. Eighty-three patients (87%) were seropositive for anti-S IgG antibodies. The median titer levels in patients with cancer was significantly lower than those in the control group. There was a 3.6-fold range in median titer values across tumor types and a wider range (8.8-fold) across treatment types. The only variable significantly associated with lower IgG titers was treatment with chemotherapy plus immunotherapy and immunotherapy plus biological therapy.

Bartels J, Fairfield C, Chen IC, Neu D. Laboratory Study of Physical Barrier Efficiency for Worker Protection against SARS-CoV-2 while Standing or Sitting. medRxiv 2021, posted 29 July. Full text: https://doi.org/10.1101/2021.07.26.21261146

Les masques sont plus efficaces que les barrières en plexiglas. Les auteurs constatent une réduction de plus de 70 % de l'exposition aux aérosols provenant de toux simulées, mais les barrières de plexiglas augmentent l'exposition aux autres personnes à proximité et peuvent entraver une ventilation adéquate. Les barrières en plexiglas détournent les aérosols, les masques les éliminent.

Masks are better than plexiglass barriers. The authors find a more than 70% reduction in exposure to aerosols from simulated coughs, but barriers increase exposure to other people nearby and may impede proper ventilation. Plexiglass barriers divert aerosols, masks remove them.

Brink J, Cullen P, Beek K, Peters SAE. Intimate Partner Violence during the Covid-19 pandemic in Western and Southern European countries. Eur J Public Health. 2021 Aug 18:ckab093. PubMed: https://pubmed.gov/34406373. Full text: https://doi.org/10.1093/eurpub/ckab093

« Six pays ont enregistré une augmentation des signalements de violence domestique (Autriche, Belgique, France, Irlande, Espagne et Royaume-Uni), deux pays une baisse (Italie et Portugal), deux pays n'ont montré aucun changement (Pays-Bas et Suisse) et un le pays n'a pas fourni de données comparatives (Allemagne).

“Six countries showed an increase in domestic violence reports (Austria, Belgium, France, Ireland, Spain, and the UK), two countries a drop (Italy and Portugal), two countries showed no change (the Netherlands and Switzerland), and one country did not provide comparative data (Germany).”

22 août 2021

Resende PC, Naveca FG, Lins RD, et al. The Ongoing Evolution of Variants of Concern and Interest of SARS-CoV-2 in Brazil Revealed by Convergent Indels in the Amino (N)-Terminal Domain of the Spike Protein. Virus Evolution 2021, published 14 August. Full text: https://doi.org/10.1093/ve/veab069

Brésil : de nouveaux variants à prévoir, possiblement davantage résistants aux anticorps neutralisants.

The authors identified that SARS-CoV-2 lineages circulating in Brazil independently acquired convergent deletions and insertions in the amino (N)-terminal domain (NTD) of the S protein. They anticipate that ongoing widespread transmission of SARS-CoV-2 will generate new viral lineages that might be more resistant to antibody neutralization.

 Korley FK, Durkalski-Mauldin V, Yeatts SD, et al. Early Convalescent Plasma for High-Risk Outpatients with Covid-19. N Engl J Med. 2021 Aug 18. PubMed: https://pubmed.gov/34407339. Full text: https://doi.org/10.1056/NEJMoa2103784

Plasma de convalescent : un chapitre à clore ?

Time to close the chapter on convalescent plasma? In this randomized, multicenter, single-blind trial (257 in the convalescent plasma group and 254 in the placebo group), the administration of COVID-19 convalescent plasma to high-risk outpatients within 1 week after the onset of symptoms of COVID-19 did not prevent disease progression

21 août 2021

Chinn J, Sedighim S, Kirby KA, et al. Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic. JAMA Netw Open. 2021 Aug 2;4(8):e2120456. PubMed: https://pubmed.gov/34379123. Full text: https://doi.org/10.1001/jamanetworkopen.2021.20456

Bon, mieux vaut ne pas associer covid-19 et grossesse.

Women with COVID-19 giving birth had increased mortality, need for intubation and ventilation, and intensive care unit admission. This is the result of a cohort study examining 869,079 adult women, including 18,715 women with COVID-19, during 12 months up to February 2021.

20 août 2021

Morris J. Israeli data: How can efficacy vs. severe disease be strong when 60% of hospitalized are vaccinated? Covid-19 Data Science 2021, posted 17 August. Full text: https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated

Israël : «Il est important d'utiliser les taux d'infection et de maladie (pour 100 000, par exemple) et non les nombres bruts pour comparer les groupes non vaccinés et vaccinés afin d'évaluer la proportion de vaccinés. L'utilisation de comptes bruts exagère l'efficacité du vaccin lorsque la proportion de vaccins est faible et atténue l'efficacité du vaccin lorsque, comme en Israël, les proportions de vaccins sont élevées. Voir tableau ci-dessous (cliquer dessus pour l'agrandir)

“It is important to use infection and disease rates (per 100k, e.g.) and not raw counts to compare unvaccinated and vaccinated groups to adjust for the proportion vaccinated. Use of raw counts exaggerates the vaccine efficacy when vaccinated proportion is low and attenuates the vaccine efficacy when, like in Israel, vaccines proportions are high.”

Tan CW, Chia WN, Young BE, et al. Pan-Sarbecovirus Neutralizing Antibodies in BNT162b2-Immunized SARS-CoV-1 Survivors. N Engl J Med. 2021 Aug 18. PubMed: https://pubmed.gov/34407341. Full text: https://doi.org/10.1056/NEJMoa2108453

Si vous aviez survécu au SRAS-CoV-1 en 2002-2004, le vaccin BioNTech/Pfizer vous donnerait aujourd'hui de puissants anticorps neutralisants "pan-sarbecovirus" croisés. Cette étude (n = 8) est une autre preuve de concept qu'un vaccin pan-coronavirus est possible. Un tel vaccin pourrait couvrir non seulement le SRAS-CoV-2 et ses variantes actuelles et futures, mais également d'autres coronavirus connus pour provoquer des maladies humaines graves.

If you had survived SARS-CoV-1 in 2002-2004, the BioNTech/Pfizer vaccine would today give you potent cross-clade pan-sarbecovirus neutralizing antibodies. This study (n = 8) is another proof of concept that a pan-coronavirus vaccine is possible. Such a vaccine might cover not only SARS-CoV-2 and its current and future variants but also other coronaviruses with known potential to cause severe human diseases.

Mallapaty S. Delta’s rise is fuelled by rampant spread from people who feel fine. Nature 2021, published 19 August. Full text: https://www.nature.com/articles/d41586-021-02259-2

« Les personnes infectées par la variante Delta ne présentent généralement des symptômes de COVID-19 que deux jours après avoir commencé à excréter le coronavirus. »

Ce qui signifie deux jours dangereux de diffuision avant suspicion.

“People infected with the Delta variant generally do not have COVID-19 symptoms until two days after they start shedding the coronavirus.”

Paul LA, Daneman N, Schwartz KL, et al. Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection. JAMA Pediatr. 2021 Aug 16. PubMed: https://pubmed.gov/34398179. Full text: https://doi.org/10.1001/jamapediatrics.2021.2770

Dans cette étude ontarienne (Canada) de 6 280 familles ayant des cas index pédiatriques, 1 717 (27,3 %) ont subi une transmission secondaire.

«Les jeunes enfants peuvent avoir un risque plus élevé de transmettre le SRAS-CoV-2 à celle et celui qui prennent soin de lui ainsi qu'aux frères et sœurs de la famille que les enfants plus âgés. Dans cette étude de cohorte de 6280 familles avec des cas index pédiatriques, les probabilités ajustées de transmission dans les familles par les enfants âgés de 0 à 3 ans étaient de 1,43 par rapport aux enfants âgés de 14 à 17 ans.

In this Ontario study of 6280 households with pediatric index cases, 1717 households (27.3%) experienced secondary transmission.

“Younger children may have greater risk of transmitting SARS-CoV-2 to caregivers and siblings in the household than older children. In this cohort study of 6280 households with pediatric index cases, the adjusted odds of household transmission by children aged 0 to 3 years was 1.43 compared with children aged 14 to 17 years.”

19 août 2021

Morris J. Israeli data: How can efficacy vs. severe disease be strong when 60% of hospitalized are vaccinated? Covid-19 Data Science 2021, posted 17 August. Full text: https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated

“It is important to use infection and disease rates (per 100k, e.g.) and not raw counts to compare unvaccinated and vaccinated groups to adjust for the proportion vaccinated. Use of raw counts exaggerates the vaccine efficacy when vaccinated proportion is low and attenuates the vaccine efficacy when, like in Israel, vaccines proportions are high.”

France 20210817. Triage in Guadeloupe. La Voix du Nord 2021, published 17 August. Full text: https://www.lavoixdunord.fr/1057833/article/2021-08-17/guadeloupe-le-tri-des-patients-covid-en-reanimation-se-fait-desormais-partir-de

Triage dans un territoire français d'outre-mer. Des articles de presse français indiquent qu'à l'hôpital de Pointe-à-Pitre en Guadeloupe, "les patients de plus de 50 ans et ceux de moins de 50 ans ayant au moins un facteur de comorbidité ne sont plus intubés". Vooir taux d'incidence ci-dessous.

Triage in a French overseas territory. French press reports indicate that at the Pointe-à-Pitre hospital in Guadeloupe, “patients over 50 and those below having at least one comorbid factor are no longer intubated.”

Nanduri S, Pilishvili T, Derado G, et al. Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant — National Healthcare Safety Network, March 1–August 1, 2021. MMWR Morb Mortal Wkly Rep. ePub: 18 August 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7034e3

USA : « Deux doses de vaccins à ARNm étaient efficaces à 74,7% contre l'infection chez les résidents des maisons de retraite au début du programme de vaccination (mars-mai 2021). De juin à juillet 2021, lorsque la circulation des variantes B.1.617.2 (Delta) prédomina, l'efficacité diminua considérablement pour atteindre 53,1 %. »

“Two doses of mRNA vaccines were 74.7% effective against infection among nursing home residents early in the vaccination program (March–May 2021). During June–July 2021, when B.1.617.2 (Delta) variant circulation predominated, effectiveness declined significantly to 53.1%.”

Schmitz AJ, Turner JS, Liu Z, et al. A vaccine-induced public antibody protects against SARS-CoV-2 and emerging variants. Immunity 2021, published 16 August. Full text: https://doi.org/10.1016/j.immuni.2021.08.013

Les auteurs décrivent un anticorps, surnommé 2C08 (un anticorps monoclonal induit par le vaccin SARS-CoV-2 cloné à partir d'une cellule B du centre germinatif isolée d'un ganglion lymphatique axillaire prélevé sur un adulte en bonne santé après avoir reçu sa deuxième dose d'un vaccin à base d'ARNm) qui neutralise puissamment les souches Delta, Gamma et Alpha et réduit la charge virale pulmonaire et la morbidité chez les hamsters atteints de Delta et Gamma. L'analyse clonale a identifié des clonotypes publics de type 2C08 parmi les cellules B répondant à l'infection ou à la vaccination par le SRAS-CoV-2 chez 41 des 181 individus. En somme : les vaccins contre le SRAS-CoV-2 atténuent la résistance aux variants préoccupants. Dites à vos amis de se faire vacciner.

The authors describe an antibody, dubbed 2C08 (a SARS-CoV-2 vaccine-induced mAb cloned from a germinal center B cell isolated from a draining axillary lymph node sampled from a healthy adult after receiving their second dose of an mRNA-based vaccine) which potently neutralizes the Delta, Gamma and Alpha strains and reduces lung viral load and morbidity in hamsters challenged with Delta and Gamma. Clonal analysis identified 2C08-like public clonotypes among B cells responding to SARS-CoV-2 infection or vaccination in 41 out of 181 individuals. Ergo: SARS-CoV-2 vaccines mitigate resistance by circulating variants of concern. Tell your friends to get vaccinated.

Rizk JG, Gupta A, Sardar P, et al. Clinical Characteristics and Pharmacological Management of COVID-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia With Cerebral Venous Sinus Thrombosis: A Review. JAMA Cardiol. 2021 Aug 10. PubMed: https://pubmed.gov/34374713. Full text: https://doi.org/10.1001/jamacardio.2021.3444

Les recommandations de cette revue : le traitement de la thrombopénie thrombotique immunitaire induite par le vaccin (VITT) doit consister en une anticoagulation thérapeutique principalement avec des substances non-hépariniques et de l'immunoglobine intraveineuse à haute dose (IVIG). Dans les cas graves, l'échange plasmatique doit être utilisé pour éliminer les auto-anticorps. Les transfusions de plaquettes de routine, l'aspirine et la warfarine doivent être évitées en raison du risque d'aggravation de la thrombose et d'amplification du risque de saignement.

The recommendations of this review: treatment of vaccine-induced immune thrombotic thrombocytopenia (VITT) should consist of therapeutic anti-coagulation mostly with non-heparin products and high-dose intravenous immunoglobin (IVIG). In severe cases, plasma exchange should be used for clearing autoantibodies. Routine platelet transfusions, aspirin, and warfarin should be avoided because of the possibility of worsening thrombosis and magnifying risk of bleeding.

Dionne A, Sperotto F, Chamberlain S, et al. Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children. JAMA Cardiol. 2021 Aug 10:e213471. PubMed: https://pubmed.gov/34374740. Full text: https://doi.org/10.1001/jamacardio.2021.3471

 Quinze patients (14 patients de sexe masculin [93 %] ; âge médian, 15 ans [extrêmes, 12-18 ans]) ont été hospitalisés pour prise en charge d'une myocardite après avoir reçu le vaccin BNT162b2 (Pfizer). Les symptômes ont débuté  1 à 6 jours après l’injection du vaccin et cinsistaient dans des douleurs thoraciques chez 15 patients (100 %), de la fièvre chez 10 patients (67 %), des myalgies chez 8 patients (53 %) et des céphalées chez 6 patients (40%). Les taux de troponine étaient élevés chez tous les patients à l'admission (médiane, 0,25 ng/mL [0,08-3,15 ng/mL]) et a culminé 0,1 à 2,3 jours après l'admission. A l’examen échocardiographique, une diminution de la fraction d'éjection (FE) ventriculaire gauche (VG) a été constatée chez 3 patients (20 %) et une déformation globale longitudinale ou circonférentielle anormale était présente chez 5 patients (33%). Aucun patient n'avait d'épanchement péricardique. IRM : les résultats de l'imagerie par résonance étaient en faveur d’une myocardite chez 13 patients (87 %). Aucun patient requis une admission en unité de soins intensifs et la durée médiane du séjour à l'hôpital a été de 2 jours (1-5). Au suivi, 1 à 13 jours après la sortie de l'hôpital, 11 patients (73 %) ont présentaient une résolution des symptômes. Un patient (7 %) présentait une fonction systolique VG basse limite persistante à l'échocardiogramme (FE 54 %). Les taux de troponine sont restés légèrement élevés chez 3 patients (20 %). Un patient (7 %) a présenté une tachycardie ventriculaire non soutenue sur l’enregistrement ambulatoire.

A case series of 15 children who were hospitalized with myocarditis after receiving the BioNTech/Pfizer vaccine.

18 août 2021

Liu Y, Liu J, Bryan AJ, et al. Delta spike P681R mutation enhances SARS-CoV-2 fitness over Alpha variant. bioRxiv 2021, posted 12 August. Full text: https://doi.org/10.1101/2021.08.12.456173

La mutation P681R sur la protéine Spike du Delta pourrait être une mutation clé dans l'amélioration de la réplication du variant Delta via un clivage S1/S2 accru. Les auteurs suggèrent que les mutations Spike qui affectent potentiellement l'efficacité du clivage de la furine devraient être étroitement observées pour la surveillance future des variantes.

The Delta spike mutation P681R could be a key mutation in enhancing Delta variant replication via increased S1/S2 cleavage. The authors suggest that Spike mutations that potentially affect furin cleavage efficiency should be closely monitored for future variant surveillance.

Wadman M. A grim warning from Israel: Vaccination blunts, but does not defeat Delta. Science 2021, published 16 August. Full text: https://www.sciencemag.org/news/2021/08/grim-warning-israel-vaccination-blunts-does-not-defeat-delta

Un avertissement inquiétant nous vient d'Israël : la vaccination émousse, mais n'élimine pas le Delta. « Israël, qui a précédé le monde dans le lancement des vaccinations et dans la collecte de données, est confronté à une vague de cas de COVID-19 qui, selon les autorités, poussera les hôpitaux au bord du gouffre. Près de 60 % des patients gravement malades sont complètement vaccinés.

“Israel, which has led the world in launching vaccinations and in data gathering, is confronting a surge of COVID-19 cases that officials expect to push hospitals to the brink. Nearly 60% of gravely ill patients are fully vaccinated.”

Lloyd-Sherlock P, Lasco G, McKee M, Perianayagam A, Sempé L. Does vaccine ageism amount to gerontocide? Lancet. 2021 Aug 11:S0140-6736(21)01689-5. PubMed: https://pubmed.gov/34390657. Full text: https://doi.org/10.1016/S0140-6736(21)01689-5

L'âgisme vaccinal équivaut-il à un gérontocide ? 

«En Inde, plus de personnes de moins de 45 ans sont vaccinées que celles de 60 ans ou plus, même si environ la moitié de ces 60 ans ou plus n'ont pas encore reçu ne serait-ce qu'une seule dose. Contrairement au triage basé sur l'âge pour les soins aigus liés au COVID-19, cette politique de vaccination ne sauvera pas de vies : elle contribuera à des milliers, voire des millions de décès évitables. Aux Philippines, où seulement 8,5% des personnes de 60 ans ou plus avaient été complètement vaccinées au 29 juin 2021, l'accent de la vaccination s'est maintenant déplacé vers les jeunes adultes dits en âge de travailler.

“In India, more people younger than 45 years are being vaccinated than those 60 years or older, even though about half of those 60 years or older are yet to receive even a single dose. Unlike age-based triage for acute COVID-19 care, this vaccination policy will not save lives: it will contribute to thousands, potentially millions of avertable deaths. In the Philippines, where only 8·5% of people 60 years or older had been fully vaccinated as of June 29, 2021, the focus of vaccination has now shifted to younger so-called working age adults.”

Subbaraman N. How do vaccinated people spread Delta? What the science says. Nature 2021, published 12 August. Full text: https://www.nature.com/articles/d41586-021-02187-1

Le delta semble être plus susceptible que d'autres variants de se propager via des personnes vaccinées. Bien que les personnes vaccinées soient probablement contagieuses pendant une période plus courte, elles doivent prendre des précautions, en particulier en intérieur. 

The Delta seems to be more likely than other variants to spread via vaccinated people. Although vaccinated people are probably infectious for a shorter period, they need to take precautions, especially in indoor settings. If you cannot avoid crowded indoor settings, see here: CDC 20210406. Improve How Your Mask Protects You. Centers for Disease Control 2021 (updated 6 April, accessed 15 August). Full text: https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html

Liu T, Wu D, Yan W, et al. Twelve-month systemic consequences of COVID-19 in patients discharged from hospital: a prospective cohort study in Wuhan, China. Clin Infect Dis. 2021 Aug 14:ciab703. PubMed: https://pubmed.gov/34390330. Full text: https://doi.org/10.1093/cid/ciab703

La vie des survivants de la COVID-19 n'est pas facile, comme le montre ce suivi de 12 mois de 594 survivants du COVID-19 sortis de l'hôpital Tongji à Wuhan du 10 février au 30 avril 2020. Après 3, 6 et 12 mois, 257 (51,2%), 169 (40,0%) et 138 (28,4%) patients présentaient au moins un symptôme. Environ 5 % des patients présentaient une altération de la fonction pulmonaire à 12 mois. Des anomalies à l'électrocardiogramme sont présentes chez 256 (51,0 %) patientes  3 mois après la sortie, incluant arythmie, changement ST-T et bloc de conduction, qui ont augmenté à 258 (61,1 %) cas lors de la visite à 6 mois et se sont maintenues à une fréquence élevée, (242 ; 49,8 %) étant retrouvées lors de la visite à 12 mois. Une incidence accrue d'anomalies des fonctions hépatique et rénale a également été observée. Les patients ont un âge médian de 63 ans, ont été sévèrement ou gravement malades à l'origine (88,1 %), dont 36,1 % avaient des antécédents de tabagisme, et au moins une comorbidité préexistante était fréquente.

The lives of COVID-19 survivors is not easy, as shown by this 12-month follow up of 594 COVID-19 survivors discharged from Tongji Hospital in Wuhan from February 10 to April 30, 2020. After 3, 6 and 12 months, 257 (51.2%), 169 (40.0%) and 138 (28.4%) patients had at least one symptom. About 5% of patients had restrictions in pulmonary function at 12 months. Electrocardiogram abnormalities occurred in 256 (51.0%) patients at 3 months post-discharge, including arrhythmia, ST-T change and conduction block, which increased to 258 (61.1%) cases at the 6-month visit and were maintained at a high frequency (242; 49.8%) at the 12-month visit. An increased incidence of abnormal liver and renal function was also found. Patients had a median age of 63, had been severe or critically ill originally (88.1%), 36.1% of whom had a history of smoking, and having at least one pre-existing co-morbidity was common.

17 août 2021

Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and Pericarditis After Vaccination for COVID-19. JAMA. 2021 Aug 4. PubMed: https://pubmed.gov/34347001. Full text: https://doi.org/10.1001/jama.2021.13443

Parmi 2 000 287 personnes ayant reçu au moins 1 vaccination COVID-19 (BioNTech/Pfizer : 52,6 %, Moderna : 44,1 %, Johnson & Johnson : 3,1 %), 20 personnes ont présenté une myocardite liée au vaccin (1 pour 100 000) et 37 une péricardite (1,8 pour 100 000). La myocardite est survenue en moyenne 3,5 jours après la vaccination. Quinze individus (75 %) étaient des hommes. Quatre personnes (20 %) ont développé des symptômes après la première vaccination et 16 (80 %) après la seconde. Dix-neuf patients (95%) ont été admis à l'hôpital. Tous sont sortis après une médiane de 2 jours. Il n'y a eu ni réadmission ni décès. Vous trouverez plus de détails sur la péricardite dans l'article intégral dont je fournis ici l'adresse du fait de son importance dans le débat actuel autour de la dangerosité des vaccinations.

https://cloud.leviia.com/s/2Q4r5NR5zqonxWD

Among 2,000,287 individuals receiving at least 1 COVID-19 vaccination (BioNTech/Pfizer: 52.6%, Moderna: 44.1%, Johnson & Johnson: 3.1%), 20 individuals had vaccine-related myocarditis (1 per 100,000) and 37 had pericarditis (1.8 per 100,000). Myocarditis occurred a median of 3.5 days after vaccination. Fifteen individuals (75%) were male. Four persons (20%) developed symptoms after the first vaccination and 16 (80%) after the second one. Nineteen patients (95%) were admitted to the hospital. All were discharged after a median of 2 days. There were no readmissions or deaths. Find more details about pericarditis in the article.

FDA 20210812. Coronavirus (COVID-19) Update: FDA Authorizes Additional Vaccine Dose for Certain Immunocompromised Individuals. FDA 2021, published 12 August. Full text: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-vaccine-dose-certain-immunocompromised

La FDA autorise une troisième dose de rappel chez les personnes ayant subi une transplantation d'organe solide ou celles qui ont un niveau équivalent d'immunodépression. Le communiqué de presse du 12 juillet 2021 indique également que « les patients doivent être conseillés de maintenir des mesures barrières pour aider à prévenir la COVID-19. De plus, les personnes en contact étroit avec des personnes immunodéprimées devraient se faire vacciner, en fonction de leur état de santé, pour offrir une protection accrue à leurs proches. »

The FDA allows a third booster dose in individuals with solid organ transplant or those who have an equivalent level of immunocompromise. The news release also states that “patients should be counseled to maintain physical precautions to help prevent COVID-19. In addition, close contacts of immunocompromised persons should get vaccinated, as appropriate for their health status, to provide increased protection to their loved ones.”

Read JM, Green CA, Harrison EM, et al. Hospital-acquired SARS-CoV-2 infection in the UK’s first COVID-19 pandemic wave. Lancet 20212, published 12 August. Full text: https://doi.org/10.1016/S0140-6736(21)01786-4

Jusqu'à fin juillet 2020, 6,8% des patients atteints de COVID-19 dans 314 hôpitaux britanniques pourraient avoir été infectés après une admission en hospitalisation, avec un pic de 8,2% à la mi-mai. Les auteurs concluent: « Comme le SRAS-CoV-2 est susceptible de persister en tant que virus endémique ou saisonnier dans les années à venir, il est essentiel d'utiliser les leçons apprises jusqu'à présent dans la pandémie pour minimiser le fardeau des infections nosocomiales. »

Until the end of July 2020, 6.8% of patients with COVID-19 in 314 UK hospitals may have been infected after hospital admission, with a peak of 8.2% in mid-May. The authors conclusion, “As SARS-CoV-2 is likely to persist as an endemic or seasonal virus in coming years, it is critical to use the lessons learned so far in the pandemic to minimise the burden of hospital-acquired infections.”

16 août 2021

Hillus D, Schwarz T, Tober-Lau P, et al. Safety, reactogenicity, and immunogenicity of homologous and heterologous prime-boost immunisation with ChAdOx1 nCoV-19 and BNT162b2: a prospective cohort study. Lancet Respir Dis 2021, published 12 August. Full text: https://doi.org/10.1016/S2213-2600(21)00357-X

Une nouvelle étude prospective de vaccins comparant « AstraZeneca (AZ) + BioNTech/Pfizer (BP) » avec 2 fois AZ et 2 fois BP. Les auteurs montrent que l'administration d'AZ d'abord et de BP ensuite a provoqué une réponse immunitaire plus forte que deux doses de l'un ou l'autre des vaccins. Ces données pourraient-elles stimuler une renaissance du vaccin AstraZeneca ? Pas certain. La différence pourrait s'expliquer par l'intervalle d'immunisation plus long (et peut-être plus efficace) d'AZ+BP par rapport à l'intervalle typique de 3 semaines des deux injections de BP.

A new prospective vaccine mixing study comparing “AstraZeneca (AZ) + BioNTech/Pfizer (BP)” with 2 x AZ and 2 x BP. The authors show “AZ first, BP second” elicited a stronger immune response than two doses of either vaccine. Could these data spur a renaissance for the AstraZeneca vaccine? Not sure. The difference might be explained by the longer (and possibly more effective) immunization interval of AZ+BP compared to the typical 3-week interval of the two BP injections.

OHA 20210805. COVID-19 Monthly Report | Oregon’s Weekly Surveillance Summary. Oregon Health Authority 2021, published 5 August. Full text: https://www.oregon.gov/oha/covid19/Documents/DataReports/Breakthrough-Report-08-2021.pdf

En Oregon (États-Unis), le début de la 4e vague de la pandémie est celui de non vaccinés. En juillet 2021, 81 % des 12 514 cas de COVID-19 concernaient des personnes non vaccinées, tout comme 82 % des décès liés au COVID-19. Conclusion : « Bien que le nombre de cas de COVID-19 malgré la vaccination augmente, ils sont très faibles par rapport aux plus de 2,3 millions de personnes qui ont effectué leur vaccination complète contre le COVID-19. » Voir courbes ci-dessous.

In Oregon (US), the beginning of the 4^th wave of the pandemic is that it is a wave of the unvaccinated. In July 2021, 81% of 12,514 COVID-19 cases were among unvaccinated people, as were 82% of COVID-19-related deaths. Conclusion: “Although the number of vaccine breakthrough cases is increasing, they are very small when compared to the more than 2.3 million people who have completed their COVID-19 vaccination.”

Leatherby L. See How Vaccines Can Make the Difference in Delta Variant’s Impact. The New York Times 2021, published 12 August. Infographic: https://www.nytimes.com/interactive/2021/08/12/science/covid-delta-breakthrough.html

À mesure que le nombre de personnes vaccinées augmente, le nombre de cas de covid malgré vaccination augmentera également. Cela ne veut pas dire que nos vaccins sont inefficaces. En modélisant les épidémies de COVID induites par Delta dans deux communautés, l'une avec un taux de vaccination élevé et l'autre avec un faible taux, les niveaux de maladie grave et de décès étaient très différents.

As the number of vaccinated people increases, so will the number of breakthrough cases. This doesn’t mean that our vaccines are ineffective. See this very instructional infographic which modeled Delta-driven COVID outbreaks in two communities, one with a high vaccination rate and another with a low rate. Their levels of serious illness and death were starkly different.

15 août 2021

Rozier G. Guadeloupe. CovidTracker 2021, update 13 August. Web page: https://covidtracker.fr/dashboard-departements/?dep=971

La Guadeloupe - et dans une moindre mesure l'île sœur La Martinique - sont une image révélatrice du variant Delta entrant dans une population où moins de 20% ont reçu leur première injection de vaccin COVID-19. Pour la semaine du 4 au 10 août, l'incidence cumulée chez les jeunes adultes de 20 à 29 ans était de… 4248 ! Pour la Guadeloupe et la Martinique, les spécialistes du tourisme prévoient une baisse de la fréquentation à la prochaine haute saison (décembre 2021 – avril 2021).

Voir ci-dessous le tableau indiquant le nombre de cas en fonction de la date et de l'âge.

Guadeloupe – and to a lesser extent the sister island Martinique (see Google Maps) – are a telling picture of the Delta variant entering a population where less than 20% had their first COVID-19 vaccine shot. For the week 4-10 August, the cumulative incidence in young adults aged 20 to 29 years was… 4248! For Guadeloupe and Martinique, tourism specialists predict a decline in visitor numbers in the next high season (December 2021 – April 2021).

Yong E. How the Pandemic Now Ends. The Atlantic 2021, published 12 August. Full text: https://www.theatlantic.com/health/archive/2021/08/delta-has-changed-pandemic-endgame/619726/

 Voici donc le dilemme actuel de la pandémie : les vaccins restent le meilleur moyen pour les individus de se protéger, mais les sociétés ne peuvent pas envisager les vaccins comme leur seule défense. Et pour l'instant, les zones non vaccinées sont encore assez grandes pour supporter les surtensions Delta, qui peuvent submerger les hôpitaux, fermer les écoles et créer plus de chances que des variantes encore pires émergent. 

Just one of several excellent citations: “Here, then, is the current pandemic dilemma: Vaccines remain the best way for individuals to protect themselves, but societies cannot treat vaccines as their only defense. And for now, unvaccinated pockets are still large enough to sustain Delta surges, which can overwhelm hospitals, shut down schools, and create more chances for even worse variants to emerge.”

Sah P, Fitzpatrick MC, Zimmer CF, et al. Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. Proc Natl Acad Sci U S A. 2021 Aug 24;118(34):e2109229118. PubMed: https://pubmed.gov/34376550. Full text: https://doi.org/10.1073/pnas.2109229118

Revue systématique et méta-analyse de plus de 350 articles. Les auteurs estiment que plus d'un tiers des infections sont véritablement asymptomatiques, avec un plus grand pourcentage chez les enfants (46,7%) par rapport aux personnes âgées (19,7%) et de même  chez les personnes sans pathologie médicale sous-jacente par rapport à celles qui avaient des comorbidités.

Systematic review and meta-analysis of over 350 papers. The authors estimate that more than one-third of infections are truly asymptomatic, with greater asymptomaticity in children (46.7%) compared with the elderly (19.7%), and greater asymptomaticity among people with no underlying medical conditions compared with those who had comorbidities.

14 août 2021

Pavord S, Scully M, Hunt BJ, et al. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis. N Engl J Med. 2021 Aug 11. PubMed: https://pubmed.gov/34379914. Full text: https://doi.org/10.1056/NEJMoa2109908

La mortalité associée à la thrombopénie et à la thrombose immunitaires induites par le vaccin (VITT) au Royaume -Uni (AstraZeneca, vaccin à adénovirus) était la plus élevée chez les patients présentant une faible numération plaquettaire et une hémorragie intracrânienne. Une étude prospective sur170 cas prouvés et de 50 cas probables de VITT au Royaume-Uni, du 22 mars au 6 juin 2021. La mortalité globale était de 22%, mais de 73% chez les patients avec une numération plaquettaire < 30 000 et une hémorragie intracrânienne.

The mortality associated with vaccine-induced immune thrombocytopenia and thrombosis (VITT) was highest among patients with a low platelet count and intracranial hemorrhage. A prospective study of 170 definite and 50 probable cases of VITT (UK, 22 March – 6 June 2021). The overall mortality was 22%, but 73% among patients with platelet counts < 30,000 and intracranial hemorrhage.

Baraniuk C. Covid-19: How effective are vaccines against the delta variant? BMJ. 2021 Aug 9;374:n1960. PubMed: https://pubmed.gov/34373255. Full text: https://doi.org/10.1136/bmj.n1960

49% des personnes au Royaume-Uni décédées d'une infection par le variante SARS-CoV-2 Delta jusqu'au 19 juillet 2021 avaient reçu deux doses de vaccin. Pfizer travaille sur une version mise à jour de son vaccin, ciblant spécifiquement le variant delta (phrase extraite du texte complet).

49% of people in the UK who died from infection with the SARS-CoV-2 Delta variant up until 19 July had had two vaccine doses – the author is confident about the protection offered by current vaccines. (He’s probably right!)

Malard F, Gaugler B, Gozlan J, et al. Weak immunogenicity of SARS-CoV-2 vaccine in patients with hematologic malignancies. Blood Cancer J. 11, 142 (2021). https://doi.org/10.1038/s41408-021-00534-z

Chez les patients atteints d'hémopathies malignes, la vaccination avec deux doses du vaccin BioNTech/Pfizer se traduit par une augmentation significative de la réponse humorale, permettant à près de la moitié des patients d'obtenir une protection immunitaire contre la COVID-19 (étude rétrospective, n = 237). L'utilisation d'un traitement ciblant les lymphocytes B au cours des 12 mois précédant la vaccination et un faible taux de lymphocytes B CD19+ prédisaient l'échec de l'obtention d'une protection immunitaire.

In patients with hematological malignancies, vaccination with two doses of the BioNTech/Pfizer vaccine translates into a significant increase in humoral response, allowing almost half of the patients to achieve immune protection against COVID-19 (retrospective study, n = 237). The use of B cell targeting treatment within the previous 12 months before vaccination, and a low CD19⁺ B cell level predicted failure in achieving immune protection.

Pegu A, O’Connell S, Schmidt SD, et al. Durability of mRNA-1273-induced antibodies against SARS-CoV-2 variants. Science 2021, published 12 PubMed: https://pubmed.gov/34031659. Full text: https://doi.org/10.1126/science.abj4176

La plupart des personnes vaccinées avec le vaccin Moderna ont conservé des anticorps  fonctionnels contre les variants du SRAS-CoV-2 pendant 6 mois, notamment Alpha, Beta, Gamma, B.1.429 (Californie) et B.1.526 (New York). Les réponses neutralisantes étaient rares après une seule dose de Moderna, mais au pic de la réponse à la deuxième dose, tous les individus avaient des réponses robustes à toutes les variants. L'étude comprenait les résultats de 8 volontaires dans chacun des trois groupes d'âge : 18-55, 55-70 et 71+ ans.

Most individuals vaccinated with the Moderna vaccine maintained binding and functional antibodies against SARS-CoV-2 variants for 6 months, including Alpha, Beta, Gamma, B.1.429, and B.1.526. Neutralizing responses were rare after a single Moderna dose, but at the peak of response to the second dose, all individuals had robust responses to all variants. The study included the results from 8 volunteers in each of three age groups: 18-55, 55-70, and 71+ years of age.

Ali K, Berman G, Zhou H, et al. Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents. N Engl J Med. 2021 Aug 11. PubMed: https://pubmed.gov/34379915. Full text: https://doi.org/10.1056/NEJMoa2109522

Rien de vraiment nouveau : le vaccin Moderna avait un profil d'innocuité acceptable chez les adolescents, la réponse immunitaire étant similaire à celle des jeunes adultes et le vaccin ayant empêché la survenue de la  COVID-19. Fait intéressant, dans le groupe placebo, après les première et deuxième injections, les participants à l'étude ont ressenti une douleur au site d'injection (chez 34,8 % et 30,3 %, respectivement), des céphalées (chez 38,5 % et 30,2 %, respectivement) et de la fatigue (chez 36,6 % et 28,9 %, respectivement). Il est intéressant de constater à quel point la simple idée de recevoir un vaccin qui pourrait vous donner des maux de tête ou de la fatigue donne… une fatigue des maux de tête. 

Nothing truly new: the Moderna vaccine had an acceptable safety profile in adolescents, the immune response was similar to that in young adults, and the vaccine prevented COVID-19. Interestingly, in the placebo group, after the first and second injections, study participants experienced injection-site pain (in 34.8% and 30.3%, respectively), headache (in 38.5% and 30.2%, respectively), and fatigue (in 36.6% and 28.9%, respectively). It’s fascinating how just the thought of getting a vaccine that might give you headache or fatigue is sufficient to give you… headache fatigue. In this trial, about half of all mild adverse events were probably the product of human imagination.

13 août 2021

Jeffey N. Among older Israelis, serious COVID rate six times as high if unvaccinated. The Times of Israel 2021, published 10 August. Full text: https://www.timesofisrael.com/among-older-israelis-serious-covid-rate-six-times-higher-if-unvaccinated/

Dans la nouvelle vague épidémique en Israël, le nombre de cas graves de COVID-19 est beaucoup plus élevé chez les personnes vaccinées, jeunes et moins jeunes.

In the new epidemic wave in Israel, the number of severe COVID-19 cases is far higher among vaccinated people, both old and young.

Van Vinh Chau N, Ngoc NM. Transmission of SARS-CoV-2 Delta Variant Among Vaccinated Healthcare Workers, Vietnam. Lancet Preprints 2021, posted 10 August.

Dans cette étude portant sur 62 professionnels de la santé, les infections avec le variant Delta étaient associées à des charges virales élevées (251 fois plus élevées que chez les personnes infectées par des souches historiques), à une positivité PCR prolongée (8 à 33 jours ; médiane : 21) et à de faibles niveaux d'anticorps neutralisants induits par le vaccin. Les auteurs concluent que les mesures de distanciation physique seront essentielles pour réduire la transmission de la variante Delta.

In this study of 62 healthcare workers, breakthrough infections with the Delta variant were associated with high viral loads (251 times higher than in people infected with historical strains), prolonged PCR positivity (8–33 days; median: 21), and low levels of vaccine-induced neutralizing antibodies. The authors conclude that physical distancing measures will be critical to reduce the transmission of the Delta variant.

12 août 2021

Puranik A, Lenehan PJ, Silvert E, et al. Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence. medRxiv 2021, posted 9 August. Full text: https://doi.org/10.1101/2021.08.06.21261707

Les données du Mayo Clinic Health System de janvier à juillet 2021 révèlent que les vaccins à ARNm produits par BioNTech/Pfizer et Moderna sont très efficaces contre l'infection par le SARS-CoV-2 (BioNTech/Pfizer : 76% ; Moderna : 86%) et les hospitalisations associées (85 % vs 91,6 %). Surprise en juillet : alors que l'efficacité du vaccin contre l'hospitalisation est restée élevée (75 % contre 81 %), l'efficacité contre l'infection a été plus faible pour les deux vaccins (42 % contre 76 %), avec une réduction plus prononcée pour le vaccin BioNTech/Pfizer. A prendre avec un grain de sel. (Vaccin BioNTech/Pfizer administré plus tôt que le vaccin Moderna ?) Notez qu'il s'agit d'un document pré-imprimé qui n'a pas encore été examiné.

Data from the Mayo Clinic Health System from January to July 2021 find that the mRNA vaccines produced by BioNTech/Pfizer and Moderna are highly effective against SARS-CoV-2 infection (BioNTech/Pfizer: 76%; Moderna: 86%) and COVID-19 associated hospitalization (85% vs. 91.6%). Surprise in July: while vaccine effectiveness against hospitalization remained high (75% vs 81%), effectiveness against infection was lower for both vaccines (42% vs 76%), with a more pronounced reduction for the BioNTech/Pfizer vaccine. To be taken with a grain of salt. (BioNTech/Pfizer vaccine administered earlier than the Moderna vaccine?) Note that this is a pre-print paper that has not yet been reviewed.

Rocklöv J, Liu Y. The reproductive number of the Delta variant of SARS-CoV-2 is far higher compared to the ancestral SARS-CoV-2 virus. J Travel Med 2021, published 9 August. Full text: https://doi.org/10.1093/jtm/taab124

Ne jetez pas vos masques, même si vous êtes vacciné. Ici, les auteurs résument 5 études qui estiment le nombre reproducteur de base pour le variant Delta allant de 3,2 à 8, avec une moyenne de 5,08. C'est presque le double du R0 de la souche historique qui est de 2,79. La vaccination à elle seule pourrait ne pas suffire jusqu'en 2022.

Don’t throw your masks away, even if you are vaccinated. Here, the authors summarize 5 studies that estimate the basic reproductive number for the Delta variant ranging from 3.2 to 8, with a mean of 5.08. This is almost double the R₀ of the historical strain which is 2.79. Vaccination alone may not be sufficient until well into 2022.

11 août 2021

Moline HL, Whitaker M, Deng L, et al. Effectiveness of COVID-19 Vaccines in Preventing Hospitalization Among Adults Aged ≥65 Years — COVID-NET, 13 States, February–April 2021. MMWR Morb Mortal Wkly Rep. ePub: 6 August 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7032e3

Chez les adultes 65 ans, l'efficacité de la vaccination complète pour prévenir l'hospitalisation était de 96 % pour les vaccins BioNTech/Pfizer et Moderna (exception : 91 % pour le vaccin BioNTech/Pfizer chez les 75 ans et plus) et de 84 % pour le vaccin Janssen. Noter que ces données datent de "l'ère pré-Delta".

Among adults aged ≥ 65, the effectiveness of full vaccination for preventing hospitalization was 96% for the BioNTech/Pfizer and Moderna vaccines (exception: 91% for the BioNTech/Pfizer vaccine in age ≥ 75 years) and 84% for the Janssen vaccine. Note that these data are from the pre-Delta era.

Nirenberg E. Myocarditis and COVID-19 mRNA vaccines. Deplatformdisease.com 2021, published 10 July. https://www.deplatformdisease.com/blog/myocarditis-and-covid-19-mrna-vaccines?format=amp

Ce n'est pas un article scientifique, mais ça vaut le coup d'être lu. L'auteur mentionne que par rapport à la myocardite induite par le vaccin à ARNm, laisser les enfants sans protection ou incomplètement protégés contre COVID-19 fait courir actuellement le plus grand risque.

Not a scientific paper, but worth reading. The author mentions that compared to mRNA vaccine-induced myocarditis, leaving children unprotected or incompletely protected from COVID-19 is currently the bigger risk.

Pepe S, Gregory AT, Denniss AR. Myocarditis, Pericarditis and Cardiomyopathy After COVID-19 Vaccination. Heart Lung Circ. 2021 Jul 30:S1443-9506(21)01156-2. PubMed: https://pubmed.gov/34340927. Full text: https://doi.org/10.1016/j.hlc.2021.07.011

Parmi 2 000 287 personnes ayant reçu au moins une dose de vaccin, 20 ont présenté une myocardite liée au vaccin (1,0/100 000 ; âge médian : 36) et 37 avaient une péricardite (1,8/100 000 ; âge médian : 59). La myocardite est survenue en médiane 3,5 jours après la vaccination, la péricardite s'est développée après une médiane de 20 jours. Tous les patients sont sortis après un délai médian de 1 à 2 jours. Aucun décès.

Among 2,000,287 individuals receiving at least one dose of vaccine, 20 had vaccine-related myocarditis (1.0/100,000; median age: 36) and 37 had pericarditis (1.8/100,000; median age: 59). Myocarditis occurred a median of 3.5 days after vaccination, pericarditis developed after a median of 20 days. All patients were discharged after a median of 1 to 2 days. No one died.

Kidman R. Use HIV’s lessons to help children orphaned by COVID-19. Nature 2021, published 9 August. Full text: https://www.nature.com/articles/d41586-021-02155-9

« Les jeunes qui ont perdu leurs parents à cause de la pandémie ont besoin d'un soutien urgent et d'un suivi à long terme pour éviter la cascade d'adversité qui peut s'ensuivre. Des décennies de recherche sur l'épidémie d'HIV fournissent une base solide."

“Young people who have lost parents to the pandemic need urgent support and long-term study to avert the cascade of adversity that can follow. Decades of research into the HIV epidemic provide(s) a solid foundation.”

10 août 2021

Perkins G, Bronwen CJ, Connolly BA, et al. An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19. medRxiv 2021, posted 4 August. Full text: https://doi.org/10.1101/2021.08.02.21261379

Sur 13 mois, 1272 participants ont été randomisés pour recevoir une ventilation en pression positive continue (CPAP ; n = 380, 29,9 %), une oxygénation nasale à haut débit (HFNO ; n = 417, 32,8 %) et une oxygénothérapie conventionnelle (n = 475, 37,3 % ). Ni CPAP ni HFNO, comparés à l'oxygénothérapie conventionnelle, n'ont réduit la mortalité.

Dans un commentaire d'Elisabeth Mahase (Covid-19 : la CPAP réduit le besoin de ventilation mécanique invasive chez les patients nécessitant de l'oxygène, selon une étude. BMJ. 4 août 2021 ; 374 : n1950. PubMed : https://pubmed.gov/34353810. Texte intégral : https://doi.org/10.1136/bmj.n1950), le chercheur en chef de l'étude, Danny McAuley, est cité, déclarant que la « CPAP réduit la pression sur le besoin de ventilation mécanique invasive et la pression sur les lits des unités de soins intensifs. L'HFNO utilise une grande quantité d'oxygène et peut causer des problèmes avec une ressource limitée, et nous avons constaté qu'elle ne produit rien de plus que la thérapie conventionnelle.

Over 13 months, 1272 participants were randomized to continuous positive airway pressure (CPAP; n = 380, 29.9%), high-flow nasal oxygenation (HFNO; n = 417, 32.8%) and conventional oxygen therapy (n = 475, 37.3%). Neither CPAP nor HFNO, when compared with conventional oxygen therapy, reduced mortality at any point. In a comment by Elisabeth Mahase (Covid-19: CPAP reduces need for invasive mechanical ventilation in patients requiring oxygen, study finds. BMJ. 2021 Aug 4;374:n1950. PubMed: https://pubmed.gov/34353810. Full text: https://doi.org/10.1136/bmj.n1950), the study’s chief investigator Danny McAuley is cited, saying that “CPAP reduces the pressure on the need for invasive mechanical ventilation and the pressure on intensive care unit beds. HFNO uses a large amount of oxygen and can cause issues with limited oxygen therapy, and we’ve found that it doesn’t really add anything above conventional therapy.”

Bitan DT, Kridin K, Cohen AD, Weinstein O. COVID-19 hospitalisation, mortality, vaccination, and postvaccination trends among people with schizophrenia in Israel: a longitudinal cohort study. Lancet Psychiatry 2021, published 5 August. Full text: https://doi.org/10.1016/S2215-0366(21)00256-X

Une étude de cohorte longitudinale avec une estimation sur un an des différences d'hospitalisation et de mortalité chez 25 539 patients atteints de schizophrénie et 25 539 témoins. Les personnes atteintes de schizophrénie ont montré un risque plus élevé d'hospitalisation pour COVID-19 (rapport de risque [HR] 4,81) et de mortalité (HR 2,52) et ont montré une baisse plus marquée de la survie au fil du temps. Le diabète, l'hypertension, l'obésité et les cardiopathies ischémiques étaient des prédicteurs significatifs des taux de vaccination chez les patients atteints de schizophrénie, mais pas chez les témoins. Voir aussi le commentaire de De Picker LJ. Combler les lacunes en matière de mortalité, de vaccination et de preuves liées au COVID-19 pour les personnes atteintes de maladie mentale grave. Lancet Psychiatry 2021, publié le 5 août. Texte intégral : https://doi.org/10.1016/S2215-0366(21)00291-1

A longitudinal cohort study with a year-long estimation of differences in hospitalization and mortality among 25,539 patients with schizophrenia and 25,539 controls. People with schizophrenia showed a higher risk for COVID-19 hospitalization (hazard ratio [HR] 4.81) and mortality (HR 2.52) and showed a sharper decline in survival as time progressed. Diabetes, hypertension, obesity, and ischemic heart disease were significant predictors of vaccination rates among patients with schizophrenia but not among controls. See also the comment by De Picker LJ. Closing COVID-19 mortality, vaccination, and evidence gaps for those with severe mental illness. Lancet Psychiatry 2021, published 5 August. Full text: https://doi.org/10.1016/S2215-0366(21)00291-1

Chauhan K, Soni D, Sarkar D, et al. Mucormycosis after COVID-19 in a patient with diabetes. Lancet 2021, published 4 August. Full text: https://doi.org/10.1016/S0140-6736(21)01641-X

Dix jours après un traitement incluant oxygénothérapie, des antibiotiques intraveineux et des corticostéroïdes en raison d'une pneumonie modérément sévère causée par le SRAS-CoV-2, ce patient se présente avec une tache noirâtre - s'étendant juste en dessous de son œil gauche jusqu'au côté gauche de sa face au niveau de sa bouche—qui était apparue 2 jours plus tôt. Les auteurs expliquent que la « COVID-19 suivie d'une mucormycose entraîne un taux de mortalité très élevé nécessitant une détection rapide, un traitement antifongique et un débridement chirurgical agressif qui restent des facteurs clés dans la thérapeutique ». Voir aussi la vidéo ci-dessous.

Ten days after starting a treatment with supplemental oxygen, intravenous antibiotics, and corticosteroids due to a moderately severe pneumonia caused by SARS-CoV-2, this patient presents with a blackish patch—extending from just below his left eye to the left side of his face to the level of his mouth—that had developed 2 days earlier. The authors explain that “COVID-19 followed by mucormycosis carries a very high mortality rate and timely detection, antifungal therapy, and aggressive surgical debridement remain key factors in the management.” See also the video at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01641-X/fulltext#sec1

9 août 2021

Perry RJ, Tamborska A, Bhagteshwar S, et al. Cerebral venous thrombosis after vaccination against COVID-19 in the UK: a multicentre cohort study. Lancet 2021, published 6 August. Full text: https://doi.org/10.1016/S0140-6736(21)01608-1

Une analyse de 95 patients de plus de 40 hôpitaux à travers le Royaume-Uni. Soixante-dix patients avaient une thrombopénie thrombotique immunitaire induite par le vaccin (VITT) et 25 n'en avaient pas. Les patients atteints de thrombose veineuse cérébrale associée au VITT avaient plus de veines intracrâniennes thrombosées que les patients non-VITT ; ils avaient aussi plus fréquemment une thrombose extracrânienne. Le décès ou la dépendance sont survenus chez 47 % des patients atteints de thrombose veineuse cérébrale associée au VITT. Les anticoagulants non hépariniques et le traitement par immunoglobulines pourraient améliorer les résultats du VITT.

An analysis of 95 patients from more than 40 hospitals across the UK. Seventy patients had vaccine-induced immune thrombotic thrombocytopenia (VITT) and 25 did not. Patients with VITT-associated cerebral venous thrombosis had more intracranial veins thrombosed than non-VITT patients; they also more frequently had extracranial thrombosis. Death or dependency occurred in 47% of patients with VITT-associated cerebral venous thrombosis. Non-heparin anticoagulants and immunoglobulin treatment might improve VITT outcome.

Cavanaugh AM, Spicer KB, Thoroughman D, Glick C, Winter K. Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination — Kentucky, May–June 2021. MMWR Morb Mortal Wkly Rep. ePub: 6 August 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7032e1

La réponse immunologique provoquée par les vaccins pourrait être meilleure que la réponse provoquée par l'infection naturelle par le SRAS-CoV-2. Chez les résidents du Kentucky infectés par COVID en 2020, ceux qui n'étaient pas vaccinés avaient un risque de réinfection 2,34 fois plus élevé que ceux qui étaient complètement vaccinés.

The immunological response elicited by vaccines might be better than the response elicited by natural SARS-CoV-2 infection. In Kentucky residents infected by COVID in 2020, those who were not vaccinated had a 2.34 times higher risk of reinfection than those who were fully vaccinated.

Sansone A, Mollaioli D, Ciocca G, et al. “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID-19. Andrology. 2021 Jul;9(4):1053-1059. PubMed: https://pubmed.gov/33742540. Full text: https://onlinelibrary.wiley.com/doi/10.1111/andr.13003 | See also the informal discussion at https://theconversation.com/covid-19-could-cause-male-infertility-and-sexual-dysfunction-but-vaccines-do-not-164139

La dysfonction érectile (DE) pourrait être une complication à court ou à long terme de la COVID-19. Dans cette analyse de 100 personnes (25 COVID‐positives et 75 COVID‐négatives), la prévalence de la dysfonction érectile était significativement plus élevée dans le groupe COVID+ (28 % contre 9,33 % ; p = 0,027).

De là à affirmer que les hommes qui défilent en ce moment seront impuissants, il y a un pas que la rigueur scientifique m'empêche de franchir. 😏

Erectile dysfunction (ED) could be a short‐ or long‐term complication of COVID‐19.  In this analysis of 100 people (25 COVID‐positive and 75 COVID‐negative), the prevalence of ED was significantly higher in the COVID+ group (28% vs. 9.33%; p = 0.027).

8 août 2021

Public Health England 202100806. SARS-CoV-2 variants of concern and variants under investigation in England | Technical briefing 20. UK Government 2021, 6 August. https://www.gov.uk/government/publications/investigation-of-novel-sars-cov-2-variant-variant-of-concern-20201201 | PDF: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1009243/Technical_Briefing_20.pdf

Pour les infections à variant Delta, le seuil du cycle de charge virale (Ct) est rapporté comme étant similaire pour les individus non vaccinés (17,8) et ceux avec un calendrier de vaccination complet (18,0). Les auteurs concluent que "des valeurs de Ct similaires (...) suggèrent une faible différence en matière d'infectiosité". Il existe toujours la possibilité que les personnes vaccinées excrètent le virus pendant une période plus courte. La vaccination peut également réduire le risque global d'infection d'un individu. En tout cas, il faut s'attendre à ce que la vaccination réduise la transmission du SRAS-CoV-2, même du variant Delta. Des discussions intéressantes à venir.

Again, for Delta variant infections, the viral load cycle threshold (Ct) is described as being similar for unvaccinated individuals (17.8) and those with a full vaccination schedule (18.0). The authors conclude that “similar Ct values (…) suggest limited difference in infectiousness.” Note that there is still the possibility that vaccinated people shed the virus for a shorter period of time. Vaccination may also reduce an individual’s overall risk of becoming infected. In any case, vaccination should be expected to reduce SARS-CoV-2 transmission, even of the Delta variant. Interesting discussions ahead.

Molteni E, Sudre CH, Canas LS, et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health 2021, published 3 August. https://doi.org/10.1016/S2352-4642(21)00198-X

Dans cette étude britannique concernant plus de 1700 enfants âgés de 5 à 17 ans qui a analysé les données rapportées par un proche adulte via une application mobile, 62% des enfants souffraient de céphalées et 55% d'épuisement. Chez les enfants plus jeunes (5 à 11 ans), la fièvre (44 %), les maux de gorge (36 %) et les gastralgies (28 %) étaient également courants. Parmi les enfants plus âgés, les symptômes comprenaient des maux de gorge (51 %), une anosmie (48 %), de la fièvre (35 %) et une toux persistante (26 %). Les enfants plus jeunes et plus âgés étaient malades pendant une médiane de cinq et sept jours, respectivement. 4,4 % des enfants présentaient des symptômes depuis au moins 28 jours ; ceci était plus fréquent chez les enfants plus âgés que chez les plus jeunes (5,1 % et 3,1 %, respectivement).

In this study of more than 1700 children age 5-17 that analyzed data reported by an adult proxy via a mobile application, 62% of children suffered from headaches and 55% from exhaustion. Among the younger children (5 to 11 years old), fever (44%), sore throat (36%) and stomach pain (28%) were also common. Among the older children, other symptoms included sore throat (51%), anosmia (48%), fever (35%) and persistent cough (26%). Younger and older children were sick for a median of five and seven days, respectively. 4.4% of the children had symptoms for at least 28 days; this was more commonly in older than younger children (5.1% and 3.1%, respectively).

7 août 2021

Israel A, Merzon E, Schäffer AA, et al. Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection in a large cohort. medRxiv 2021, posted 5 August. Full text: https://doi.org/10.1101/2021.08.03.21261496

Une étude rétrospective d'Israël décrivant 33 993 adultes entièrement vaccinés a tenté de répondre à l'une des plus grandes questions de nos jours : le temps écoulé depuis la deuxième injection du vaccin BioNTech/Pfizer est-il significativement associé à un risque d'infection post-vaccinale à la COVID-19 ? Oui c'est le cas. Ceux qui ont reçu leur deuxième dose de vaccin au moins 146 jours avant un nouveau test RT-PCR (groupe 1) présentaient un risque d'infection plus élevé que ceux qui ont reçu leur vaccin moins de 146 jours avant (groupe 2). Les chiffres absolus sont un peu moins effrayants : parmi les personnes de plus de 60 ans, 182/7021 (2,6%) ont été testés positifs dans le groupe 1 et 19/2164 (0,9%) dans le groupe 2.

A retrospective study from Israel describing 33,993 fully vaccinated adults tried to answer one of the bigger questions these days: is the amount of time since the second injection of the BioNTech/Pfizer vaccine significantly associated with a risk of post-vaccination COVID-19 infection? Yes, it is. Those who received their second dose of vaccine at least 146 days before a new RT-PCR test (Group 1) had a higher risk of infection that those who received their vaccine less than 146 days before (Group 2). The absolute numbers are somewhat less scary: among people older than 60, 182/7021 (2.6%) tested positive in Group 1 and 19/2164 (0.9%) in Group 2.

Elliott P, Haw D, Wang H, et al. REACT-1 round 13 final report: exponential growth, high prevalence of SARS-CoV-2 and vaccine effectiveness associated with Delta variant in England during May to July 2021. Imperial College London 2021, published 4 August. https://spiral.imperial.ac.uk/handle/10044/1/90800

Angleterre. D'abord la bonne nouvelle : les personnes entièrement vaccinées ont une charge virale plus faible (Ct médiane : 27,6) que les personnes non vaccinées ou partiellement vaccinées (23,1), de sorte que les vaccins sont susceptibles de réduire le potentiel de transmission du variant Delta. Maintenant, la mauvaise nouvelle : entre le 24 juin et le 12 juillet 2021, avec le variant Delta déjà fermement installé au Royaume-Uni, 44% des infections se sont produites chez des individus entièrement vaccinés. Les auteurs estiment l'efficacité du vaccin contre l'infection à 49 %. Le sexe, l'origine ethnique, la taille du ménage et les niveaux économiques locaux ont également contribué conjointement au risque d'une prévalence plus élevée. Les auteurs prévoient qu'une mixité sociale accrue au cours de l'automne en présence du variant Delta pourrait entraîner une nouvelle vague de pandémie, même avec des niveaux élevés de vaccination.

First, the good news: fully vaccinated people have lower viral loads (median Ct: 27.6) than unvaccinated or partially vaccinated people (23.1), so vaccines are likely to decrease the potential for the transmission of the Delta variant. Now, the bad news: between 24 June and 12 July 2021, with the Delta variant already firmly established in the UK, 44% of infections occurred in fully vaccinated individuals. The authors estimate vaccine effectiveness against infection to be 49%. Sex, ethnicity, household size and local levels of economy also jointly contributed to the risk of higher prevalence. The authors anticipate that increased mixing during the autumn in the presence of the Delta variant may lead to a new wave of the pandemic, even at high levels of vaccination. [Note that men had higher odds of infection than women, a finding not seen in a previous analysis (20 May and 7 June). The reason? Increased social mixing during England’s progression in the Euro 2020 football competition during June and July 2021…]

Hakimian S, Raines D, Reed G, et al. Assessment of Video Capsule Endoscopy in the Management of Acute Gastrointestinal Bleeding During the COVID-19 Pandemic. JAMA Netw Open. 2021 Jul 1;4(7):e2118796. PubMed: https://pubmed.gov/34328500. Full text: https://doi.org/10.1001/jamanetworkopen.2021.18796

Les auteurs suggèrent que l'endoscopie par capsule vidéo peut constituer une alternative sûre à l'évaluation endoscopique standard des saignements gastro-intestinaux, car elle réduit le nombre de procédures invasives, le personnel impliqué et l'utilisation d'équipements de protection individuelle.

The authors suggest that “video capsule endoscopy can serve as a safe alternative to the standard endoscopic evaluation of gastrointestinal bleeding because it reduces the number of invasive procedures, personnel involved, and use of personal protective equipment.”

Corey L, Beyrer C, Cohen MS, Michael NL, Bedford T, Rolland M. SARS-CoV-2 Variants in Patients with Immunosuppression. N Engl J Med. 2021 Aug 5;385(6):562-566. PubMed: https://pubmed.gov/34347959. Full text: https://doi.org/10.1056/NEJMsb2104756

L'évolution du virus chez les patients immunodéprimés est-elle un facteur important dans l'émergence de variants préoccupants du SRAS-CoV-2 ? 

Is viral evolution in immunocompromised patients an important factor in the emergence of SARS-CoV-2 variants of concern? Read this nice summary of our current knowledge.

6 août 2021

Kimura I, Kosugi Y, Wu J, et al. SARS-CoV-2 Lambda variant exhibits higher infectivity and immune resistance. bioRxiv 2021, posted 28 July. Full-text: https://doi.org/10.1101/2021.07.28.454085

Après le Delta, le Lambda ? Déjà au Pérou, au Chili, en Argentine et en Equateur. Il possède des mutations qui confèrent une résistance à la vaccination.

More about the Lambda variant (also known as the C.37 lineage which is now spreading in South American countries such as Peru, Chile, Argentina, and Ecuador).
The authors describe three mutations or variants, the RSYLTPGD246-253N, L452Q and F490S mutations, which respectively confer resistance to vaccine-induced antiviral immunity. Additionally, the T76I and L452Q mutations contribute to enhanced viral infectivity.

Dermatoses dont zona après vaccination anti-covid-19 dont vaccins à ARNm :

REMAP-CAP, et al. Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19. N Engl J Med 2021, published 4 July. Full text: https://doi.org/10.1056/NEJMoa2103417

Pas de bénéfice d'une HBPM ou de l'HNF en routine contre la covid en situation critique.

No benefit for critically ill patients with COVID-19 from routine therapeutic-dose anticoagulation with unfractionated or low-molecular-weight heparin. See also the comment by ten Cate H. Surviving Covid-19 with Heparin? N Engl J Med 2021, published 4 July. Full text: https://doi.org/10.1056/NEJMe2111151

5 août 2021

Hause AM, Gee J, Baggs J, et al. COVID-19 Vaccine Safety in Adolescents Aged 12–17 Years — United States, December 14, 2020–July 16, 2021. MMWR Morb Mortal Wkly Rep. ePub: 30 July 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7031e1

Au 16 juillet 2021, près de 9 millions d'adolescents américains âgés de 12 à 17 ans avaient reçu le vaccin BioNTech/Pfizer. La pharmacovigilance américaine a reçu 9 246 signalements, dont 90,7 % concernaient des événements indésirables non graves tandis que 9,3 % concernaient des événements indésirables graves, dont environ 400 cas de myocardite (4,3 % ; environ 1 pour 25 000 vaccinés ; voir également https://www.cdc.gov/mmwr/volumes/70/wr/mm7027e2.htm). Les réactions systémiques étaient plus fréquentes après la deuxième dose.

As of July 16, 2021, almost 9 million US adolescents aged 12–17 years had received the BioNTech/Pfizer vaccine. The Vaccine Adverse Event Reporting System (VAERS) received 9246 reports, 90.7% of which were for non-serious adverse events while 9.3% were for serious adverse events, including around 400 cases of myocarditis (4.3%; about 1:25,000 vaccinees; see also https://www.cdc.gov/mmwr/volumes/70/wr/mm7027e2.htm). Systemic reactions were more common after the second dose.

Xydakis MS, Albers MW, Holbrook EH, et al. Post-viral effects of COVID-19 in the olfactory system and their implications. Lancet Neurol. 2021 Jul 30:S1474-4422(21)00182-4. PubMed: https://pubmed.gov/34339626. Full text: https://doi.org/10.1016/S1474-4422(21)00182-4

Pourquoi perdons-nous notre odorat avec la COVID-19 ? Et quelles pourraient en être les conséquences ? Les auteurs proposent que, « chez les personnes qui se sont remises de la COVID-19, un déficit olfactif chronique, recrudescent ou permanent pourrait être l'indice d’une probabilité accrue de séquelles neurologiques ou de troubles neurodégénératifs à long terme ». Voir aussi le commentaire de Doty RL. Les mécanismes de perte d'odeur après infection par le SRAS-CoV-2. Lancet Neurol. 30 juillet 2021 : S1474-4422(21)00202-7. PubMed : https://pubmed.gov/34339627. Texte intégral : https://doi.org/10.1016/S1474-4422(21)00202-7

Why do we lose our smell with COVID-19? And what might be the consequences? The authors postulate that, “in people who have recovered from COVID-19, a chronic, recrudescent, or permanent olfactory deficit could be prognostic for an increased likelihood of neurological sequelae or neurodegenerative disorders in the long term.” See also the comment by Doty RL. The mechanisms of smell loss after SARS-CoV-2 infection. Lancet Neurol. 2021 Jul 30:S1474-4422(21)00202-7. PubMed: https://pubmed.gov/34339627. Full text: https://doi.org/10.1016/S1474-4422(21)00202-7

4 août 2021

Chia PY, Ong S, Chiew CJ, et al. Virological and serological kinetics of SARS-CoV-2 Delta variant vaccine-breakthrough infections: a multi-center cohort study. medRxiv 2021, posted 31 July. Full text: https://doi.org/10.1101/2021.07.28.21261295

A singapour, covid malgré Pfizer ou Moderna : déclin plus rapide de la charge virale, moindres besoins en oxygène.

Singapore, 218 patients admitted to hospital with Delta (B.1.617.2) SARS-CoV-2 infection. Vaccination (mostly with the BioNTech/Pfizer or Moderna vaccines) was associated with a faster decline in RNA viral load. The odds of severe COVID-19 requiring oxygen supplementation was significantly lower following vaccination (adjusted odds ratio 0.07, p = 0.001). PCR cycle threshold (Ct) values were similar between vaccinated and unvaccinated groups at diagnosis, but viral loads decreased faster in vaccinated individuals.

3 août 2021

DREES 20210729. Entrées hospitalières et décès de patients Covid-19 selon le statut vaccinal et la présence de la mutation L452R. DREES 2021 (Direction de la recherche, des études, de l’évaluation et des statistiques), published 29 July. Full text : https://solidarites-sante.gouv.fr/IMG/pdf/2021-07-23_-_sivic-sidep-vacsi_premiers_resultats_-_drees-2.pdf

En France, entre le 31 mai et le 11 juillet 2021, les personnes non vaccinées représentaient environ 85 % des patients COVID-19 hospitalisés, aussi bien en unité de soins intensifs que hors unité de soins intensifs. Les patients complètement vaccinés ne représentaient que 7 % des admissions.

In France, between 31 May and 11 July 2021, unvaccinated people represented around 85% of COVID-19 patients hospitalized, both in ICU units and non-ICU units. Fully vaccinated patients made up only 7% of admissions.

Texte complet :

Merrill ED, Kashem SW, Amerson EH, et al. Association of Facial Pustular Neutrophilic Eruption With Messenger RNA-1273 SARS-CoV-2 Vaccine. JAMA Dermatol. 2021 Jul 28. PubMed: https://pubmed.gov/34319363. Full text: https://doi.org/10.1001/jamadermatol.2021.2474

Les auteurs rapportent une éruption faciale qui s'est développée dans les 24 heures après avoir reçu le vaccin Moderna chez 2 patients sans antécédents d'allergies connues, de rosacée, d'application de substances faciales/dentaires ou d'infection antérieure par le SRAS-CoV-2.

The authors report a facial eruption that developed within 24 hours after receiving the Moderna vaccine in 2 patients without a history of known allergies, rosacea, facial/dental fillers, or prior SARS-CoV-2 infection.

Sikkens JJ, Buis DTP, Peters EJG, et al. Serologic Surveillance and Phylogenetic Analysis of SARS-CoV-2 Infection Among Hospital Health Care Workers. JAMA Netw Open. 2021 Jul 1;4(7):e2118554. PubMed: https://pubmed.gov/34319354. Full text: https://doi.org/10.1001/jamanetworkopen.2021.18554

Dans cette étude de cohorte portant sur 801 employés hospitaliers (HCW), le risque d'être infecté par le SRAS-CoV-2 était presque 4 fois plus élevé chez les HCW dans les services COVID-19 que chez les HCW ne prenant pas en charge des patients. Il n'y avait aucune preuve de transmission de patient à HCW, mais plusieurs occurrences de transmission d'HCW à HCW. 

In this cohort study of 801 hospital health care workers (HCWs), the risk of getting infected with SARS-CoV-2 was nearly 4-fold higher among HCWs on COVID-19 wards compared with HCWs not in patient care. There was no evidence for patient-to-HCW transmission but several occurrences of HCW-to-HCW transmission.

2 août 2021

Butler CC, Yu LM, Dorward J, et al. Doxycycline for community treatment of suspected COVID-19 in people at high risk of adverse outcomes in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet Resp Med 2021, published 27 July. Full text: https://doi.org/10.1016/S2213-2600(21)00310-6

Doxycycline : éviter.

Don’t use doxycycline as a routine treatment for COVID-19! In patients with suspected COVID-19 who were at high risk of adverse outcomes, treatment with doxycycline was not associated with clinically meaningful reductions in time to recovery, hospital admissions or deaths related to COVID-19.

Araujo-Silva CA, Marcos AAA, Marinho PM, et al. Presumed SARS-CoV-2 Viral Particles in the Human Retina of Patients With COVID-19. JAMA Ophthalmol. 2021 Jul 29. PubMed: https://pubmed.gov/34323931. Full text: https://doi.org/10.1001/jamaophthalmol.2021.2795

Même la rétine peut être concernée.

Post-mortem analysis of enucleated eyes of three patients with confirmed COVID-19 infection revealed presumed S and N COVID-19 proteins within endothelial cells close to the capillary flame and cells of the inner and the outer nuclear layers. This finding may explain some of the infection’s ocular clinical manifestations.

Fallah M. Remember Ebola: stop mass death in Africa. Nature. 2021 Jul;595(7869):627. PubMed: https://pubmed.gov/34316054. Full text: https://doi.org/10.1038/d41586-021-01964-2

Le risque d'une nouvelle culpabilité collective devant l'Histoire. « Les pays riches accumulent des vaccins, laissant les doses expirer tandis que les personnes non vaccinées qui veulent se faire vacciner meurent. »

“Rich countries are hoarding vaccines, allowing doses to expire while unvaccinated people who want to be immunized die.”

1er août 2021

Schooley RT. Introduction to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) Supplement, Clinical Infectious Diseases, Volume 73, Issue Supplement_2, 1 August 2021, Page S119, https://doi.org/10.1093/cid/ciab524

Huit manuscrits sur le fondement scientifique des interventions non biologiques. Entre autres sujets : 1) l'importance des aérosols et de l'excrétion virale pré-symptomatique ; 2) l'impact de la distanciation et du masque sur la prévention de la transmission virale ; 3) la surestimation initiale du rôle des vecteurs passifs (matériaux) et des gouttelettes dans la transmission virale.

Eight manuscripts about the scientific underpinning of non-biological interventions. Among other topics: 1) the importance of aerosols and pre-symptomatic shedding; 2) the impact of distancing and masking on preventing ongoing viral transmission; 3) initial overestimation of the role of fomites and of droplets in viral transmission.

Krantz MS, Kwah JH, Stone CA Jr, et al. Safety Evaluation of the Second Dose of Messenger RNA COVID-19 Vaccines in Patients With Immediate Reactions to the First Dose. JAMA Intern Med. 2021 Jul 26. PubMed: https://pubmed.gov/34309623. Full text: https://doi.org/10.1001/jamainternmed.2021.3779

Les 159 patients ayant eu une réaction allergique immédiate à la première dose du vaccin Pfizer/BioNTech ou Moderna, dont 19 personnes souffrant d'anaphylaxie à la première dose, ont toléré la deuxième dose. Une prémédication antihistaminique avait été administrée à 47 patients [30%] avant la deuxième dose. Trente-deux patients (20 %) ont signalé des symptômes immédiats et potentiellement allergiques associés à la deuxième dose qui étaient spontanément résolutifs, légers et/ou résolus avec les antihistaminiques seuls.

All 159 patients with an immediate allergic reaction to the first dose of the Pfizer/BioNTech or Moderna vaccine, including 19 individuals with first-dose anaphylaxis, tolerated the second dose. (Antihistamine pre-medication had been given to 47 patients [30%] before the second dose). Thirty-two patients (20%) reported immediate and potentially allergic symptoms that were associated with the second dose that were self-limiting, mild, and/or resolved with antihistamines alone.

Chowell G, Dahal S, Bono R, et al. Harnessing testing strategies and public health measures to avert COVID-19 outbreaks during ocean cruises. Sci Rep 11, 15482 (2021). Full text: https://doi.org/10.1038/s41598-021-95032-4

Vive les vacances en croisière ! Un bateau de croisière n'est pas un bon endroit où se trouver pendant une pandémie avec agent pathogène respiratoire telle que la covid-19. Cette étude révèle que les tests PCR à l'embarquement et les tests quotidiens de toutes les personnes à bord, ainsi qu'une distanciation sociale accrue, pourraient être en mesure de réduire la probabilité de propagation de la maladie.

Au niveau personnel, il pourrait y avoir une stratégie encore plus prometteuse : éviter les bateaux de croisière jusqu'à ce que la pandémie soit sous contrôle.

A cruise ship is not a good place to be during a pandemic of a respiratory pathogen. This study finds that PCR testing at embarkation and daily testing of all individuals aboard, together with increased social distancing, might be able to reduce the probability of onboard COVID-19 community spread. At the personal level, there might be an even more promising strategy: avoid cruise ships until the pandemic is under control.

31 juillet 2021

Brown CM, Vostok J, Johnson H, et al. Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021. MMWR Morb Mortal Wkly Rep. ePub: 30 July 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7031e2

Mauvaise nouvelle. Grand rassemblement dans le Massachusetts en juillet 2021 avec vaccinés et non-vaccinés : le Delta ne discrimine pas les deux populations.

Bad news from Barnstable County, Massachusetts. In July 2021, following multiple summer events and large public gatherings, 469 COVID-19 cases were identified among Massachusetts residents who had traveled to the town during July 3–17. Intriguingly, 346 (74%) occurred in fully vaccinated persons. Even more intriguingly: cycle threshold values were similar among specimens from patients who were fully vaccinated and those who were not. The driving force behind the outbreak: the Delta variant.

Wu S, Huang J, Zhang Z, et al. Safety, tolerability, and immunogenicity of an aerosolised adenovirus type-5 vector-based COVID-19 vaccine (Ad5-nCoV) in adults: preliminary report of an open-label and randomised phase 1 clinical trial. Lancet Resp Med 2021, published 26 July. Full text: https://doi.org/10.1016/S1473-3099(21)00396-0

En attente du vaccin intranasal : un vaccin aérosolisé à adénovirus produit une réponse  similaire à une injection de vaccin IM. La dose administrée est pourtant de 1/5ème à 2/5ème de celle de la voie IM.

Two doses of an aerosolized adenovirus type-5 vector-based COVID-19 vaccine – equivalent to a fifth or two-fifths of an intramuscular dose – were well-tolerated and did not produce serious side effects in healthy adults. They elicited strong IgG and neutralizing antibody responses similar to one dose of an intramuscular injection.

Katsoularis I, Fonseca-Rodríguez O, Farrington P. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study. Lancet 2021, published 29 July.

Risque accru d'infarctus de myocarde et d'AVC au décours de la covid-19. 

86,742 patients with COVID-19 and 348,481 matched controls. The authors find that COVID-19 is a risk factor for acute myocardial infarction and ischemic stroke and that both conditions are part of the clinical picture of COVID-19. See also a commentary by Mafham M, Baigent C. What is the association of COVID-19 with heart attacks and strokes? Lancet 2021, published 29 July. Full text: https://doi.org/10.1016/S0140-6736(21)01071-0

Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management. BMJ. 2021 Jul 26;374:n1648. PubMed: https://pubmed.gov/34312178. Full-text: https://doi.org/10.1136/bmj.n1648

Covid long : le jour d'après. Fatigue, dyspnée, anomalies cardiaques, altération cognitive, troubles du sommeil. Une revue des facteurs de risque et des options thérapeutiques possibles.

The day after COVID-19: fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, etc. A state-of-the-art review of long COVID, discussing risk factors and possible therapeutic options.

30 juillet 2021

CDC 20210727. When You’ve Been Fully Vaccinated | How to Protect Yourself and Others. CDC 2021, published 27 July. Full text: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html

Le Delta change les règles du jeu. Les nouvelles directives de port de masque du CDC  : « Pour maximiser la protection contre le variant Delta et éviter éventuellement de le propager à d'autres, portez un masque à l'intérieur en public si vous vous trouvez dans une zone de transmission importante ou élevée. »

Delta is changing the rules of the game. The new CDC mask-wearing guidelines for the smarter part of the population: “To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.”

Bergwerk M, Gonen T, Lustig Y, et al. Covid-19 Breakthrough Infections in Vaccinated Health Care Workers. N Engl J Med. 2021 Jul 28. PubMed: https://pubmed.gov/34320281. Full-text: https://doi.org/10.1056/NEJMoa2109072

Long COVID malgré la vaccination chez des soignants vaccinés ? La plupart des infections à covid-19 au cours de la période de quatre mois suivant la deuxième dose de vaccin (39/1497, 0,4 %) étaient légères ou asymptomatiques ; cependant, 7 patients (19%) ont présenté des symptômes persistants (> 6 semaines), notamment des céphalées, des myalgies, une agueusie, une anosmie ainsi que de la fatigue, ce qui indique qu'un long COVID peut survenir chez les personnes ayant souffert d'infection aiguë après vaccination. A noter que l'étude a été effectuée dans la période pré-Delta (du 20 janvier au 28 avril 2021; 85 % des échantillons ont objectivé la souche Alpha [B.1.1.7]). Attendons-nous à ce que les données soient moins favorables dans le contexte où le Delta (B.1.617.2) devient la souche dominante. Il peut être judicieux de suivre les nouvelles directives du CDC et de porter des masques à l'intérieur dans les situations à risque.

Long COVID after breakthrough infections? Most breakthrough infections during the 4-month period after the second vaccine dose (39/1497, 0.4%) were mild or asymptomatic; however, 7 patients (19%) had persistent symptoms (> 6 weeks), including headaches, muscle pain, loss of taste and smell and fatigue), indicating that Long COVID may occur among people who experience breakthrough infections. Note that the study is from the pre-Delta world (20 January through 28 April; 85% of the samples yielded the Alpha strain [B.1.1.7]). Expect the data to be less favorable in settings where Delta (B.1.617.2) is the dominant strain. It may be wise to follow the new CDC guidelines and wear masks indoors in risky situations (see the next paragraph, “Prevention”).

Scudellari M. How the coronavirus infects cells — and why Delta is so dangerous. Nature 2021, published 28 July. Full text: https://www.nature.com/articles/d41586-021-02039-y

Comment le virus infecte les cellules et pourquoi le Delta est si dangereux. Wendy Barclay, Imperial College de Londres : « Deux variants de coronavirus, l'Alpha et le Delta, ont altéré les sites de clivage de la furine. Dans la variante Alpha, l'acide aminé proline initial est changé en histidine (P681H); dans la variante Delta, il est remplacé par une arginine (P681R). Les deux changements rendent la séquence moins acide, et plus la chaîne d'acides aminés est alcaline, plus la furine la reconnaît et la coupe efficacement.

Wendy Barclay, Imperial College London: “Two coronavirus variants, Alpha and Delta, have altered furin cleavage sites. In the Alpha variant, the initial proline amino acid is changed to a histidine (P681H); in the Delta variant, it is changed to an arginine (P681R). Both changes make the sequence less acidic, and the more basic the string of amino acids, the more effectively furin recognizes and cuts it.”

Thomas SJ, Moreira ED, Kitchin N, et al. Six Month Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine. medRxiv 2021, posted 28 July. Full text: https://www.medrxiv.org/content/10.1101/2021.07.28.21261159v1

Protection pas le Pfizer : au moins six mois.

Six-month efficacy data from the Pfizer/BioNTech vaccine trial: 1) Efficacy declining from 96% at 2 months to 85% at 4-6 months for infection, for an average decline of ~6% every two months; 2) Protection against severe illness was 97% through at least 6 months.

Guimarães PO, Quirk D, Furtado RH, et al. Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med. 2021 Jul 29;385(5):406-415. PubMed: https://pubmed.gov/34133856. Full-text: https://doi.org/10.1056/NEJMoa2101643

 Le tofacitinib est un inhibiteur sélectif de la Janus kinase (Jak) ; administré par voie orale, qui bloque les voies de transduction intracellulaire après qu'une cytokine s'est liée à son récepteur (en conséquence, aucune réponse cellulaire n'est déclenchée et la production de cytokines est indirectement supprimée). Parmi les patients hospitalisés pour une pneumonie au COVID-19, le tofacitinib a entraîné un risque plus faible de décès ou d'insuffisance respiratoire jusqu'au jour 28 que le placebo. L'incidence cumulée de décès ou d'insuffisance respiratoire était de 18,1 % versus 29,0 % dans le groupe placebo (risque relatif 0,63 ; IC à 95 % : 0,41 à 0,97 ; p = 0,04).

Now in NEJM’s print edition. Our previous comment on the online publication (16 June): tofacitinib (Wikipedia) is an orally administered selective inhibitor of Janus kinase (Jak), that blocks intracellular transduction pathways after a cytokine is bound to its receptor (as a consequence, no cellular response is triggered, and cytokine production is indirectly suppressed). Among patients hospitalized with COVID-19 pneumonia, tofacitinib led to a lower risk of death or respiratory failure through day 28 than did placebo. The cumulative incidence of death or respiratory failure was 18.1% versus 29.0% in the placebo group (risk ratio, 0.63; 95% CI: 0.41 to 0.97; p = 0.04).

29 juillet 2021

Schrock JM, Ryan DT, Saber R, et al. Cohabitation With a Known Coronavirus Disease 2019 Case Is Associated With Greater Antibody Concentration and Symptom Severity in a Community-Based Sample of Seropositive Adults. Open Forum Infectious Diseases, Volume 8, Issue 7, 24 July 2021. Full text: https://doi.org/10.1093/ofid/ofab244

Les personnes  séropositives au SARS-CoV-2 qui vivaient avec un cas connu de COVID-19 présentaient une plus grande sévérité des symptômes et des niveaux d'IgG anti-SRAS-CoV-2 RBD plus élevés que les personnes séropositives qui ne vivaient pas avec un cas connu de COVID-19. Ces résultats appellent à des recherches supplémentaires pour savoir si l'intensité ou la durée de l'exposition virale explique la relation entre l'exposition à domicile, la gravité des symptômes et les concentrations d'anticorps.

The authors find that those who lived with a known COVID-19 case exhibited greater symptom severity compared to those who did not live with a known COVID-19 case. Does the duration of viral exposure explain this relation between household exposure and symptom severity?

28 juillet 2021

Paetzold J, Krammer F, van Laer D, et al. The effects of rapid mass vaccination against SARS-CoV-2 and its Variants-of-Concern: Evidence from an early VoCs hotspot. Research Square 2021, posted 24 July. Full text: https://doi.org/10.21203/rs.3.rs-741944/v1

Suite à une importante épidémie des variants Beta (B.1.351, « Afrique du Sud » et Alpha (B.1.1.7/E484K, « Angleterre ») dans le district de Schwaz, en Autriche, plus de 70 % de la population adulte du district a reçu sa première dose de vaccin Pfizer/BioNTech dans les 6 jours (11 et 16 mars). Résultat : une réduction de 60 % des nouvelles infections au SRAS-CoV-2 par rapport aux personnes résidant juste à proximité du district vacciné.

Following a large outbreak of the Beta (B.1.351, “South Africa”) and Alpha variants (B.1.1.7/E484K, “England”) in the district of Schwaz, Austria, more than 70% of the adult population of the district received their first Pfizer/BioNTech vaccine dose within 6 days (11 and 16 March). Result: a 60% reduction in new SARS-CoV-2 infections relative to people residing just outside of the vaccinated district.

27 juillet 2021

Public Health England 20210723. SARS-CoV-2 variants of concern and variants under investigation in England | Technical briefing 19. Public Health England 2021, published 23 July. Full text: https://www.gov.uk/government/publications/investigation-of-novel-sars-cov-2-variant-variant-of-concern-20201201

Le risque de réinfection avec le variant Delta peut être 1,46 fois plus élevé qu'avec le variante Alpha. Fait intéressant, le risque de réinfection n'était pas élevé si la primo-infection était < 180 jours, mais était plus élevé pour ceux qui avaient une infection antérieure ≥ 180 jours plus tôt (risque relatif = 2,37).

The risk of reinfection with the Delta variant may be 1.46 times higher than with the Alpha variant. Interestingly, the risk of reinfection was not elevated if the primary infection was < 180 days, but was higher for those with a prior infection ≥ 180 days earlier (adjusted odds ratio = 2.37).

Recalde M, Pistillo A, Fernandez-Bertolin S, et al. Body mass index and risk of COVID-19 diagnosis, hospitalisation, and death: a cohort study of 2 524 926 Catalans. J Clin Endocrinol Metab. 2021 Jul 23:dgab546. PubMed: https://pubmed.gov/34297116. Full-text: https://doi.org/10.1210/clinem/dgab546

Dans cette étude réalisée en Espagne dans une cohorte de 2 524 926 catalans, un indice de masse corporelle (IMC) de 31 kg/m2 était associé à un risque plus élevé de diagnostic (risque relatif 1,22) et d'hospitalisation (1,88) par rapport aux personnes ayant un IMC de 22 kg/m2. Il y avait un risque accru de décès plus prononcé pour les IMC 40 kg/m2. L'augmentation du risque de survenue de COVID-19 a été particulièrement prononcée chez les patients les plus jeunes.

In this study from Spain, a body mass index (BMI) of 31kg/m² was associated with a higher risk for diagnosis (hazard ratio, 1.22) and hospitalization (1.88) compared to people with a BMI of 22kg/m². There was also a more pronounced increasing risk of death for BMIs ≥ 40kg/m². The increase in risk for COVID-19 outcomes was particularly pronounced among younger patients.

26 juillet 2021

Robinson KA, Maimone S, Gococo-Benore DA, Li Z, Advani PP, Chumsri S. Incidence of Axillary Adenopathy in Breast Imaging After COVID-19 Vaccination. JAMA Oncol. 2021 Jul 22. PubMed: https://pubmed.gov/34292295. Full-text: https://doi.org/10.1001/jamaoncol.2021.3127

Adénopathie axillaire après vaccination contre le SARS-CoV-2 : plus fréquente. Donc imagerie mammaire à repousser 4 à 6 semaines après cette deuxième injection.

In this retrospective analysis (n = 750), 23 (3%) patients had axillary adenopathy on mammography. This incidence is higher than axillary adenopathy in otherwise normal mammography (0.02% – 0.04%). The incidence of adenopathy decreased over time with no adenopathy seen in patients who received the vaccine more than 28 days previously. When possible, consider scheduling screening breast imaging 4 to 6 weeks after the second COVID-19 vaccination dose (National Comprehensive Cancer Network, 15 June 2021, Recommendations of the NCCN COVID-19 Vaccination Advisory: https://www.nccn.org/docs/default-source/covid-19/2021_covid-19_vaccination_guidance_v3-0.pdf

25 juillet 2021

Else H. COVID and mass sport events: early studies yield limited insights. Nature 2021, published 22 July. Full text: https://www.nature.com/articles/d41586-021-02016-5

Grands rassemblements : éviter.

Is it safe to attend large gatherings? Maybe not yet.

Mazagatos C, Monge S, Olmedo C, et al. Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents, Spain, weeks 53 2020 to 13 2021. Euro Surveill. 2021 Jun;26(24):2100452. PubMed: https://pubmed.gov/34142647. Full-text: https://doi.org/10.2807/1560-7917.ES.2021.26.24.2100452

Un groupe de résidents âgés (65 ans et plus) en établissement de soins de longue durée en Espagne : efficacité vaccinale partielle (EV) de 50 % avec la première dose du vaccin BioNTech/Pfizer et du vaccin Moderna. Après la deuxième dose, l'EV était de 71% contre l'infection par le SRAS-CoV-2, 88% et 97% contre les hospitalisations et les décès COVID-19, respectivement.

The same message from a group of elderly residents (aged 65 years and older) in long-term care facilities: partial vaccine effectiveness (VE) of 50% with the first dose of the BioNTech/Pfizer and the Moderna vaccine. After the second dose, VE was 71% against SARS-CoV-2 infection, 88% and 97% against COVID-19 hospitalizations and deaths, respectively.

Mateo-Urdiales A, Spila Alegiani S, Fabiani M, et al. Risk of SARS-CoV-2 infection and subsequent hospital admission and death at different time intervals since first dose of COVID-19 vaccine administration, Italy, 27 December 2020 to mid-April 2021. Euro Surveill. 2021 Jun;26(25):2100507. PubMed: https://pubmed.gov/34169819. Full-text: https://doi.org/10.2807/1560-7917.ES.2021.26.25.2100507

Italie comme Israël : protection partielle dès la deuxième semaine après la première injection.

A report on 7,370,008 persons who had received their first dose of vaccine by 4 April 2021 in Italy. As in earlier studies from Israel, a partial protection can be seen as early as two weeks after the first dose.

Pas de modification du sperme retrouvée après deux injections de vaccins à ARNm.

Source :

24 juillet 2021

Wei J, Stoesser N, Matthews PC, et al. Antibody responses to SARS-CoV-2 vaccines in 45,965 adults from the general population of the United Kingdom. Nat Microbiol. 2021 Jul 21. PubMed: https://pubmed.gov/34290390. Full-text: https://doi.org/10.1038/s41564-021-00947-3

Dans cette cohorte britannique de 45 965 adultes, les taux de séroconversion et les taux d'anticorps après une seule dose de vaccin étaient plus faibles chez les personnes âgées, en particulier chez celles âgées de > 60 ans. Les faibles répondeurs étaient plus fréquents chez les personnes prenant des immunosuppresseurs ou des corticostéroïdes, ainsi que chez les patients atteints de polyarthrite rhumatoïde, de pathologie hépatique chronique, de cancer, de diabète de type 2, d'obésité et d'asthme.

In this UK cohort of 45,965 adults, seroconversion rates and antibody levels after a single vaccine dose were lower in older individuals, especially in those aged > 60 years. Low responders were more common among people taking immunosuppressants or corticosteroids, as well as in patients with rheumatoid arthritis, chronic liver disease, cancer, type 2 diabetes, obesity, and asthma.

Ito K, Piantham C, Nishiura H. Predicted dominance of variant Delta of SARS-CoV-2 before Tokyo Olympic Games, Japan, July 2021. Euro Surveill. 2021 Jul;26(27):2100570. PubMed: https://pubmed.gov/34240695. Full-text: https://doi.org/10.2807/1560-7917.ES.2021.26.27.2100570

Les participants aux JO vont-ils ramener le Delta ?

In many countries, the Delta variant (B.1.671.2) has already replaced other variants. The authors show that in Japan, the replacement is likely to happen mostly before the start of the Tokyo Olympic Games on 23 July 2021. A substantial number of international visitors might be exposed and help spread the Delta variant around the world.

23 juillet 2021

Lopez Bernal J, Andrews N, Gower C, et al. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. N Engl J Med. 2021 Jul 21. PubMed: https://pubmed.gov/34289274. Full-text: https://doi.org/10.1056/NEJMoa2108891

L'efficacité après une dose de BioNTech/Pfizer ou d'AstraZeneca était plus faible chez les individus infectés par le variant Delta (B.1.671.2, « indien ») qu'avec le variant Alpha (B.1.1.7, « anglais»): Delta, 30,7% – Alpha, 48,7% (il n'y avait pas de différence entre les deux vaccins). Après deux doses, les différences d'efficacité du vaccin entre les deux variants étaient modestes, mais le vaccin BioNTech/Pfizer était supérieur au vaccin AstraZeneca (BioNTech/Pfizer : Delta, 88,0 % – Alpha, 93,7 % ; AstraZeneca : Delta, 67,0 % ; Alpha , 74,5%.

Effectiveness after one dose of the BioNTech/Pfizer or AstraZeneca was lower among individuals infected with the Delta variant (B.1.671.2, “India”) than with the Alpha variant (B.1.1.7, “England”): Delta, 30.7% – Alpha, 48.7% (there was no difference between the two vaccines). After two doses, differences in vaccine effectiveness with the two variants were modest, but the BioNTech/Pfizer vaccine was superior to the AstraZeneca vaccine (BioNTech/Pfizer: Delta, 88.0% – Alpha, 93.7%; AstraZeneca: Delta, 67.0%; Alpha, 74.5%).

García-Azorín D, Sierra Á, Trigo J, et al. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep. 2021 Jul 19;11(1):14674. PubMed: https://pubmed.gov/34282206. Full-text: https://doi.org/10.1038/s41598-021-94220-6

Les céphalées peuvent être le symptôme révélateur de la COVID-19. Dans cette étude, le délai médian d'apparition des céphalées était dans les 24 h, avec une durée médiane de 7 jours. Chez 13 % des patients, la céphalée persistait après 1 mois. La plupart des patients ont décrit une céphalée bilatérale à prédominance frontale, de qualité oppressante et d'intensité sévère.

Headache may be the presenting symptom of COVID-19. In this study, median headache onset was within 24 h, with a median duration of 7 days. In 13% of patients, the headache persisted after 1 month. Most patients described a bilateral headache with frontal predominance, an oppressive quality, and severe intensity.

Hillis SD, Unwin HJT, Chen Y, et al. Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study. Lancet 2021, published 20 July. Full text: https://doi.org/10.1016/S0140-6736(21)01253-8

Autre conséquence de la covid-19 : plus d'un million de nouveaux orphelins.

From March 1, 2020, to April 30, 2021, more than one million children lost at least one parent or custodial grandparent.

See also the comment by Kentor RA, Thompson AL. Answering the call to support youth orphaned by COVID-19. Lancet 2021, published 20 July. Full text: Lancet 2021, published 20 July. Full text: https://doi.org/10.1016/S0140-6736(21)01253-8

22 juillet 2021

Ledford H. Should children get COVID vaccines? What the science says. Nature 2021, published 20 July. Full text: https://www.nature.com/articles/d41586-021-01898-9

Pendant que l'on débat et se débat en France avec l'obligation vaccinale, d'autres pays se confrontent à la pénurie de vaccins. Se posent alors des questions dans une autre dimension : qui vacciner en premier ? Par exemple des personnes vulnérables ou des adolescents; les rares complications du vaccin Pfizer à type de myocardite et de péricardite chez les adolescents masculins de 12 à 17 ans (67 cas par million de secondes doses) et féminins (9 cas par million de secondes doses) vont elles être dissuasives alors que la covid, bien que peu fréquente, peut entrainer des complications graves chez les sujets de cette tranche d'âge ?

Vaccinating children. Is it necessary? Is it safe? And how will it affect the pandemic?

Mateus J, Dan JM, Zhang Z, et al. Low dose mRNA-1273 COVID-19 vaccine generates durable T cell memory and antibodies enhanced by pre-existing crossreactive T cell memory. medRxiv 2021, posted 5 July. Full text: https://doi.org/10.1101/2021.06.30.21259787

Moderna protecteur au quart de dose ? Et sans effet secondaire ?

At 25 µg (instead of the four-fold higher 100 µg standard dose), the Moderna vaccine mRNA-1273 vaccine induced a durable and functional T cell and antibody response comparable to natural infection. If these preliminary findings are confirmed, the lower dose could accelerate the global immunization campaign (and perhaps help with side effects?).

21 juillet 2021

Brosh-Nissimov T, Orenbuch-Harroch E, Chowers M, et al. BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully-vaccinated hospitalized COVID-19 patients in Israel. Clin Microbiol Infect. 2021 Jul 7:S1198-743X(21)00367-0. PubMed: https://pubmed.gov/34245907. Full-text: https://doi.org/10.1016/j.cmi.2021.06.036

Après Pfizer chez 152 patients israéliens qui ont développé une covid au moins une semaine après la deuxième injection et qui ont été hospitalisés. Parmi eux, leurs comorbidités : HTA pour 71%, diabète pour 48%, insuffisance cardiaque congestive pour 27%, pathologies pulmonaires pour 24%, insuffisance rénale pour 24%, démence chez 19% et cancer pour 24%. 40% étaient immunodéprimés et 22% sont morts (soit 34 patients). 

Retrospective study of 152 individuals who developed COVID-19 more than 7 days after the second BioNTech/Pfizer vaccine dose and required hospitalization. High rate of existing co-morbidities: hypertension (71%), diabetes (48%), congestive heart failure (27%), lung diseases (24%), chronic kidney (24%), dementia (19%) and cancer (24%). Importantly, 60 (40%) patients were immunocompromised. Thirty-four (22%) patients died.

Lucas C, Vogels CBF, Yildirim I, et al. Impact of circulating SARS-CoV-2 variants on mRNA vaccine-induced immunity in uninfected and previously infected individuals. medRxiv 2021, posted 18 July. Full text: https://www.medrxiv.org/content/10.1101/2021.07.14.21260307v1

Meilleure immunité si infection préalable que si vaccination et réduction de la neutralisation pour le Béta, le Gamma suivis par le Delta et l'Alpha.

Analysis of plasma neutralization using 16 SARS-CoV-2 variants. The Beta (B.1.351, ‘South Africa’) and Gamma (P.1, ‘Brazil’) strains, showed the greatest reduction, followed by the Delta (B.1.617.2, ‘India’) and Alfa (B.1.1.7, ‘England’) strains. Plasma from previously infected vaccinated individuals had a better neutralization than plasma from uninfected vaccinated individuals.

Coleman KK, Tay DJW, Tan KS, et al. Viral Load of SARS-CoV-2 in Respiratory Aerosols Emitted by COVID-19 Patients while Breathing, Talking, and Singing. medRxiv 2021, posted 19 July. Full text: https://doi.org/10.1101/2021.07.15.21260561

Bon, on peut s'arrêter de chanter et de parler mais il est encore permis de respirer.

In this study, fine aerosols (≤ 5μm) produced by talking and singing contained more SARS-CoV-2 copies than coarse aerosols. “The largest proportion of SARS-CoV-2 RNA copies was emitted by singing (53%), followed by talking (41%) and breathing (6%).”

20 juillet 2021

Li B, Deng A, Li K, et al. Viral infection and transmission in a large well-traced outbreak caused by the Delta SARS-CoV-2 variant. medRxiv 2021, posted 12 July. Full-text: https://doi.org/10.1101/2021.07.07.21260122

Delta : charge virale 1000 fois plus élevée et réduction de 6 à 4 jours entre le premier cas et le second quand ils présentenet des symptômes.

Explaining the forces behind the Delta wave: 1) 1000 times higher viral load and 2) a reduced serial interval, 4 days instead of 6 (the serial interval is defined as the duration of time between a primary case patient having symptom onset and a secondary case patient having symptom onset).

Dougherty K, Mannell M, Naqvi O, Matson D, Stone J. SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a Gymnastics Facility – Oklahoma, April-May 2021. MMWR Morb Mortal Wkly Rep. 2021 Jul 16;70(28):1004-1007. PubMed: https://pubmed.gov/34264910. Full-text: https://doi.org/10.15585/mmwr.mm7028e2

Delta : évitez la gymnastique encore davantage que... la maison.

In the coming months, avoid gyms. The Delta variant (B.1.617.2, first identified in India) is frighteningly transmissible (see article above) and will lead to increased attack rates, especially in households and in indoor sports settings. In this report, the attack rates at the gymnastics facility and in households were 20% and 53%, respectively.

Guimarães RM, Portela MC, Villela DAM, Matta GC, de Freitas CM. Younger Brazilians hit by COVID-19 – What are the implications? Lancet Regional Health 2021, published 14 July. Full text: https://doi.org/10.1016/j.lana.2021.100014

Chute de 13 ans de l'âge médian des décédés au Brésil depuis le début de 2021.

New variants and incomplete vaccination will lead to increasing numbers of young and middle-aged adults in intensive care units. In the months ahead, how far will the “youthening of the pandemic” go? In Brazil, among patients who died from COVID-19, the median age has dropped 13 years since the beginning of 2021.

19 juillet 2021

Said M, Davis P, Davis P, et al. A Rapid Olfactory Test as a Potential Screening Tool for COVID-19. JAMA Otolaryngol Head Neck Surg July 15, 2021. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2782044?resultClick=1

Un test olfactif pour dépistage : sensibilité de 75% and spécificité de 95.2% en utilisant un test PCR comme référence.

In this pilot study, a novel olfactory test alone had a sensitivity of 75% and specificity of 95.2% in detecting COVID-19 using PCR testing as the gold standard.

Drake TM, Riad AM, Fairfield CJ, et al. Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Lancet July 17, 2021. Volume 398, ISSUE 10296, P223-237, July 17, 2021. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00799-6/fulltext

Des conséquences sévères esn sortie d'hospitalisation, y compris chez des jeunes en bonne santé, les complications neurologiques possédant le pronostic le plus défavorable.

Hospitalization with COVID-19 is associated with high rates of morbidity in adults. In this large prospective cohort study, almost half of the survivors had one or more complications. Rates were high even in young, previously healthy individuals. Acute complications were associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes.

Yoshikawa Y, Kawachi I. Association of Socioeconomic Characteristics With Disparities in COVID-19 Outcomes in Japan. JAMA Netw Open July 14. 2021;4(7):e2117060. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781935?resultClick=1

Inégalités face à la Covid-19 : au Japon aussi. Pas surprenant : revenus faibles, population recevant une assistance publique, un taux de chômage plus élevé, un nombre plus grand de travailleurs de la distribution, des transports et des postes ainsi que de la restauration. Davvantage si nombreux à la maison, tabagisme et obésité.

Disparities in COVID-19 outcomes are not unique to the US and Europe: in this cross-sectional study of the 47 prefectures in Japan, a higher burden of COVID-19 cases and deaths was observed in prefectures with lower household incomes; a higher proportion of the population receiving public assistance; a higher unemployment rate; higher numbers of retail, transportation and postal, and restaurant industry workers; more household crowding; and higher smoking and obesity rates.

Oldenburg CE, Pinsky BA, Brogdon J, et al. Effect of Oral Azithromycin vs Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 Infection – A Randomized Clinical Trial. JAMA July 16, 2021. doi:10.1001/jama.2021.11517

Encore un essai clinique défavorable à l'utilisation d'azithromycine.

In this randomized trial that included 263 outpatients with SARS-CoV-2 infection, treatment with a single oral dose of azithromycin, 1.2 g, vs placebo resulted in self-reported absence of COVID-19 symptoms at day 14 in 50% vs 50%.

18 juillet 2021

Barouch DH, Stephenson KE, Sadoff J, et al. Durable Humoral and Cellular Immune Responses 8 Months after Ad26.COV2.S Vaccination. NEJM July 14, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2108829?query=featured_home

Après Janssen, immunités cellulaire et humorale maintenues avec une décroissance minimale au bout de 8 mois. Développement des anticorps neutralisants y compris contre le Delta.

This small study indicates that the Ad26.COV2.S vaccine (J&J) elicited durable humoral and cellular immune responses with minimal decreases for at least 8 months. Moreover, there was an expansion of neutralizing antibody breadth associated with improved coverage of SARS-CoV-2 variants over time, including increased neutralizing antibody titers against Delta.

Ferreira I, Kemp S, Datir R, et al. SARS-CoV-2 B.1.617 mutations L452 and E484Q are not synergistic for antibody evasion. J Infect Dis July 14, 2021, jiab368. https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab368/6321359

Des modifications de la protéine Spike telles que vues sur le Delta ne diminuent que faiblement l'efficacité du Pfizer.

Spike bearing L452R and E484Q (as seen in Delta) confers modestly reduced sensitivity to BNT162b2 mRNA vaccine-elicited antibodies. The effect is similar in magnitude to the loss of sensitivity conferred by L452R or E484Q alone.

Bennett TD, Moffitt RA, Hajagos JG, et al. Clinical Characterization and Prediction of Clinical Severity of SARS-CoV-2 Infection Among US Adults Using Data From the US National COVID Cohort Collaborative. JAMA Netw Open Jul 13, 2021;4(7):e2116901. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781923?resultClick=1

USA : facteurs indépendants de sévérité. L'âge, le sexe masculin, une affection hépatique, une démence, le fait d'être une personne de peau noire ou d'origine asiatique, l'obésité.

In this cohort study of 174,568 adults with SARS-CoV-2, 32,472 (18.6%) were hospitalized and 6565 (20.2%) got severely ill, and first-day machine learning models accurately predicted clinical severity. Mortality decreased from 16.4% in March to April 2020 to 8.6% in September to October 2020. In a separate multivariate logistic regression model built for inference, age (odds ratio, 1.03 per year), male sex (OR, 1.60), liver disease (OR, 1.20), dementia (OR, 1.26), African-American (OR, 1.12) and Asian (OR, 1.33) race, and obesity (OR, 1.36) were independently associated with higher clinical severity.

17 juillet 2021

Williamson EJ, McDonald HI, Bhaskaran K, et al. Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform. BMJ July 14, 2021; 374. https://www.bmj.com/content/374/bmj.n1592

Trisomie 21 : davantage de Covid-19.

This large population-based cohort study from England indicates that people with learning disability have markedly increased risks of hospital admission and death from covid-19, over and above the risks observed for non-covid causes of death. Down’s syndrome and cerebral palsy were associated with increased hazards for both events; Down’s syndrome to a greater extent.

Williams SV, Vusirikala A, Ladhani SN, et al. An outbreak caused by the SARS-CoV-2 Delta (B.1.617.2) variant in a care home after partial vaccination with a single dose of the COVID-19 vaccine Vaxzevria, London, England, April 2021. Euro Surveill. 2021;26(27):pii=2100626. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.27.2100626

Soignants et patients mal protégés contre le Delta par une seule dose d'AstraZeneca mais hospitalisation peu fréquente et pas de décès.

The Delta attack rate after the first dose of Astra Zeneca’s vaccine was 35.7% (5/14) for staff and 81.3% (13/16) for residents, indicating lower protection in people who had received only one dose of the Vaxzevria vaccine within 3 months. Reassuringly, though, hospitalisation was uncommon and there were no deaths, providing some evidence that a single dose of vaccine may be protective against severe disease following infection with the Delta variant.

Normark J, Vikström L, Gwon YD, et al. Heterologous ChAdOx1 nCoV-19 and mRNA-1273 Vaccination. NEJM July 14, 2021. https://www.nejm.org/doi/full/10.1056/NEJMc2110716?query=featured_home

Meilleure efficacité du MODERNA mais davantage d'effets secondaires que l'AstraZeneca : fièvre, céphalée, frissons, myalgies.

This relatively small cohort suggests that the mRNA-1273 vaccine (MODERNA) boost may provide better protection against the B.1.351 variant than a ChAdOx1 nCoV-19 boost. However, the mRNA-1273 boost led to more frequent reports of fever, headache, chills, and muscle aches than the ChAdOx1 nCoV-19 boost.

Kimihito I, Chayada P, NHiroshi N. Predicted dominance of variant Delta of SARS-CoV-2 before Tokyo Olympic Games, Japan, July 2021. Euro Surveill. 2021;26(27):pii=2100570. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.27.2100570

Moins d'une semaine avant que le Delta ne remplace les autres variants au Japon.

It is just a matter of time for the Delta variant to replace other variants in Japan. This study shows that the replacement is likely to happen mostly before the start of the Tokyo Olympic Games on 23 July 2021.

16 juillet 2021

Rossi AH, Ojeda DS, Varese A, et al. Sputnik V Vaccine Elicits Seroconversion and Neutralizing Capacity to SARS CoV-2 after a Single Dose. Cell Rep Med July 13, 2021. https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(21)00208-1

Sputnik V plus efficace dès la première dose chez des soignants argentins déjà infectés.

Of 227 seronegative healthcare workers in Argentina, 94% developed spike-specific IgG antibodies at day 21 after the first dose. A single Sputnik V dose elicited higher antibody levels and virus neutralizing capacity in 67 previously infected individuals than in naïve ones receiving the full two-dose schedule.

Bui LT, Winters NI, Chung MIm et al. Chronic lung diseases are associated with gene expression programs favoring SARS-CoV-2 entry and severity. Nat Commun Jul 14, 2021, 12, 4314. https://www.nature.com/articles/s41467-021-24467-0

Pathologies respiratoires chroniques : un mécanisme génétique favorisant la sévérité de la covid.

Chronic lung disease AT2 cells express higher levels of genes linked directly to the efficiency of viral replication and the innate immune response.

Mura C, Preissner S, Nahles S, et al. Real-world evidence for improved outcomes with histamine antagonists and aspirin in 22,560 COVID-19 patients. Sig Transduct Target Ther July 14, 2021, 6, 267. https://www.nature.com/articles/s41392-021-00689-y

Association aspirine-famotidine (un anti-H2) : un espoir ?

In this analysis of 22,560 COVID-19 patients taking H1/H2 receptor antagonists, the combination of famotidine and aspirin did exhibit a significant synergistic survival benefit (OR 0.55, CI 0.39–0.78). The RR for death decreased by 32.5%—an immense benefit. The authors anticipate that at least three prospective RCTs that have been underway (NCT04504240, NCT04370262, and NCT04545008) will illuminate famotidine’s potential therapeutic profile.

15 juillet 2021

Barros-Martins J, Hammerschmidt SI, Cossmann A, et al. Immune responses against SARS-CoV-2 variants after heterologous and homologous ChAdOx1 nCoV-19/BNT162b2 vaccination. Nat Med Jul 14, 2021. https://www.nature.com/articles/s41591-021-01449-9

Pfizer vs AstraZeneca. meilleure immunisation par le premier au niveau cellulaire et humoral. Les auteurs déclarent qu'ils n'ont aucun conflit d'intérêt...

ChAdOx1 (Astra Zeneca)-primed immune responses before and 3 weeks after booster with ChAd (n=32) or BioNTech/Pfizer’s BNT162b2 (n=55): Although both vaccines boosted prime-induced immunity, BNT162b2 induced significantly higher frequencies of spike-specific CD4+ and CD8+ T cells and, in particular, high titers of neutralizing antibodies against the B.1.1.7, B.1.351 and P.1 variants.

Goldshtein I, Nevo D, Steinberg DM, et al. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. JAMA Jul 12, 2021; https://jamanetwork.com/journals/jama/fullarticle/2782047?resultClick=1

Efficacité de 78% pendant la grossesse avec Pfizer. Une efficacité atténuée par les autres mesures de prévention mieux suivies pendant la grossesse.

This cohort included 7,530 vaccinated and 7,530 matched unvaccinated women, 46% and 33% in the second and third trimester, respectively. Adjusted hazard ratio for infection of 0.22 (95% CI, 0.11-0.43), corresponding to an estimate of vaccine effectiveness of 78%. The authors argue that benefit from the vaccine may be somewhat attenuated because pregnant women were generally advised to take extra precautions during the pandemic.

14 juillet 2021

Koehler J, Ritzer B, Weidlich S, et al. Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany. Infection July 6, 2021. https://doi.org/10.1007/s15010-021-01657-y

Anticorps monoclonaux : les essais continuent.

Because of an in-house transmission of SARS-CoV-2 infection, 11 patients received monoclonal antibodies shortly after an infection (eight cases received bamlanivimab, three received the combination of casirivimab and imdevimab), and prior to symptoms. Despite many risk factors, none of these 11 patients were admitted to the intensive care unit or died from any causes.

Barizien N, Le Guen M, Russel S, et al. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep July 7, 2021, 11, 14042. https://www.nature.com/articles/s41598-021-93546-5

Dysautonomie : une explication pour la longue covid ?

A small study, indicating that dysautonomia (the failure or the increase of the sympathetic or para-sympathetic components activities in the autonomic nervous system) may explain the persistent symptoms observed in long COVID-19 patients, such as fatigue and hypoxia.

COVID-19 Host Genetics Initiative. Mapping the human genetic architecture of COVID-19. Nature July 8, 2021. https://www.nature.com/articles/s41586-021-03767-x

Nous ne sommes pas tous génétiquement égaux face à la covid-19.

An individual’s genetics can influence their risk of infection and the severity of disease symptoms. This large international study has identified parts of the human genome that can affect the risk of severe COVID-19. Three genome-wide association meta-analyses comprised of up to 49,562 COVID-19 patients from 46 studies identified a total of 13 genome-wide significant loci associated with SARS-CoV-2 infection (n = 4) or severe manifestations of COVID-19 (n = 9). Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases.

13 juillet 2021

Mahil SK, Bechman K, Raharja A, et al. The effect of methotrexate and targeted immunosuppression on humoral and cellular immune responses to the COVID-19 vaccine BNT162b2: a cohort study. Lancet Rheumatology July 08, 2021. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00212-5/fulltext

Immunité cellulaire préservée mais immunité humorale diminuée chez des patients sous méthotrexate.

Seroconversion alone might not adequately reflect vaccine immunogenicity in individuals with immune-mediated inflammatory diseases receiving therapeutic immunosuppression. In 84 patients with psoriasis receiving immunosuppressive drugs, seroconversion rates were lower in patients receiving immunosuppressants (78%), compared to 17 controls (100%), with the lowest rate in those receiving methotrexate (47%). However, cellular responses were preserved in almost all patients.

Hinks TS, Cureton L, Knight R, et al. Azithromycin versus standard care in patients with mild-to-moderate COVID-19 (ATOMIC2): an open-label, randomised trial. Lancet Resp Med July 09, 2021. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00263-0/fulltext

Inefficacité confirmée de l'azithromycine chez des patients souffrant de Covid-19 léger à modéré.

In patients with mild-to-moderate COVID-19, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospital admission or death.

12 juillet 2021

Planas D, Veyer D, Baidaliuk A. et al. Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization. Nature July 8, 2021. https://www.nature.com/articles/s41586-021-03777-9

Le Delta échappe partiellement mais de manière significative aux anticorps monoclonaux neutralisants et aux anticorps polyclonaux provoqués par une infection ou une vaccination antérieure par le SRAS-CoV-2. Les sérums d'individus ayant reçu une dose des vaccins Pfizer ou AstraZeneca ont à peine inhibé le variant delta. L'administration de deux doses a généré une réponse neutralisante chez 95% des individus, avec des titres 3 à 5 fois inférieurs contre le delta que contre l'alpha.

Delta partially but significantly escapes neutralizing mAbs, and polyclonal antibodies elicited by previous SARS-CoV-2 infection or vaccination. Sera from individuals having received one dose of either the Pfizer or AstraZeneca vaccines barely inhibited the delta variant. Administration of two doses generated a neutralizing response in 95% of individuals, with titers 3-to-5-fold lower against delta than alpha.

Abdelnabi R, Foo CS, De Jonghe S, et al. Molnupiravir inhibits the replication of the emerging SARS-CoV-2 variants of concern (VoCs) in a hamster infection model. The Journal of Infectious Diseases Juily 9, 2021, jiab361, https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab361/6318434

Molnupiravir, un espoir contre le delta et l'alpha... chez le hamster.

Molnupiravir, currently in Phase II clinical trials, has worked well in hamsters infected with either Wuhan strain, with the delta or alpha variants.

Dougherty K, Mannell M, Naqvi O, Matson D, Stone J. SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a Gymnastics Facility — Oklahoma, April–May 2021. MMWR Morb Mortal Wkly Rep. ePub: 9 July 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7028e2.htm?s_cid=mm7028e2_w

L'épidémie de delta peut indiquer que le retour au gymnase en 2021 n'est probablement pas la meilleure idée. Du 15 avril au 3 mai 2021, 47 cas de COVID-19 (les 21 cas testés étaient delta) étaient liés à une salle de gymnastique. Les taux globaux de diffusion dans des établissements et des familles étaient de 20 % et 53 %, respectivement. Il est à noter que quatre personnes (9 %) avaient reçu 2 doses de Moderna ou de Pfizer-BioNTech ou une dose unique du vaccin Johnson & Johnson ≥ 14 jours avant un résultat de test positif. Plusieurs facteurs de risque potentiels de transmission ont été identifiés, notamment le fait de ne pas utiliser de masques chez les participants actifs, couplé à une respiration accrue pendant la participation sportive active (en outre, la politique de l'établissement était que toutes les personnes ne participant pas activement portent des masques, mais cette politique n'était pas toujours suivie) ; mauvaise ventilation de l'installation.

This delta outbreak may indicate that return to gym in 2021 is probably not the best idea. During April 15–May 3, 2021, 47 COVID-19 cases (all 21 tested cases were delta) were linked to a gymnastics facility. The overall facility and household attack rates were 20% and 53%, respectively. Of note, four persons (9%) had received 2 doses of either the Moderna or Pfizer-BioNTech or a single dose of the Johnson & Johnson vaccine ≥ 14 days before a positive test result. Several potential risk factors for transmission were identified, including not using masks among active participants, coupled with increased respiration during active sport participation (further, facility policy was that all persons not actively participating wear masks, but this policy was not always followed); poor facility ventilation; staff members training multiple cohorts, etc.

11 juillet 2021

Nehme M, Braillard O, Chappuis F, et al. Prevalence of Symptoms More Than Seven Months After Diagnosis of Symptomatic COVID-19 in an Outpatient Setting. Annals Int Med July 6, 2021. https://www.acpjournals.org/doi/10.7326/M21-0878

Des symptômes persistants après infection par le SRAS-CoV-2 sont courants chez les personnes jeunes et en bonne santé suivies en ambulatoire. Sur les 629 participants qui ont honoré les entretiens de base, 410 ont effectué le suivi 7 à 9 mois après le diagnostic de COVID-19 ; 39,0 % ont signalé des symptômes résiduels. La fatigue (20,7 %) était le symptôme le plus fréquemment signalé, suivi de la perte du goût ou de l'odorat (16,8 %) et de la dyspnée (11,7 %).

Residual symptoms after SARS-CoV-2 infection are common among otherwise young and healthy persons followed in an outpatient setting. Of the 629 participants who completed the baseline interviews, 410 completed follow-up at 7 to 9 months after COVID-19 diagnosis; 39.0% reported residual symptoms. Fatigue (20.7%) was the most common symptom reported, followed by loss of taste or smell (16.8%) and dyspnea (11.7%).

Kadri SS, Sun J, Lawandi A, et al. Association Between Caseload Surge and COVID-19 Survival in 558 U.S. Hospitals, March to August 2020. Ann Int Med July 6, 2021. https://www.acpjournals.org/doi/10.7326/M21-1213

USA : près d'un décès sur quatre dus au COVID-19 était potentiellement attribuable à la charge excessive des hôpitaux mis à rude épreuve par l'augmentation du nombre de cas. Le renforcement des mesures préventives et le soutien aux hôpitaux  permettraient de sauver de nombreuses vies.

Nearly 1 in 4 COVID-19 deaths was potentially attributable to hospitals strained by surging caseload. Bolstering preventive measures and supporting surging hospitals will save many lives.

10 juillet 2021

Tarke A, Sidney J, Methot N, et al. Impact of SARS-CoV-2 variants on the total CD4+ and CD8+ T cell reactivity in infected or vaccinated individuals. Cell Rep July 01, 2021. https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(21)00204-4

Contre les variants, pas seulement l'immunité humorale mais aussi l'immunité cellulaire. Les lymphocytes T reconnaissent les variants : anglais, sud-africain, brésilien, californien.

The SARS-CoV-2 variants B.1.1.7, B.1.351, P.1 and CAL.20C do not significantly disrupt the total SARS-CoV-2 T cell reactivity. T cells of exposed donors or vaccinees effectively recognized SARS-CoV-2 variants.

The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19A Meta-analysis. JAMA July 6, 2021. https://jamanetwork.com/journals/jama/fullarticle/2781880?resultClick=1

Espoir dans les antagonistes de l'interleukine 6.

This prospective meta-analysis of 27 randomized trials included 10,930 patients. The 28-day all-cause mortality was lower among patients who received IL-6 antagonists compared with those who received usual care or placebo (summary odds ratio, 0.86). Administration of IL-6 antagonists was also associated with lower progression to IMV or death, cardiovascular support or death.

Vouga M, Favre G, Martinez-Perez O, et al. Maternal outcomes and risk factors for COVID-19 severity among pregnant women. Sci Rep Jul 6, 2021, 11, 13898. https://www.nature.com/articles/s41598-021-92357-y

Grossesse et covid : une association préoccupante.

In this large study, several risk factors for developing severe complications of SARS-CoV-2 infection among 926 pregnant women were identified including pulmonary co-morbidities, hypertensive disorders and diabetes. Obstetric and neonatal outcomes appear to be influenced by the severity of maternal disease.

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 15^th.

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

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.¹ Recently, several cases have been published of myopericarditis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.^2, 3

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/

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 aussi : https://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%.