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  1. AU="DeVone, Frank"
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  1. Article ; Online: Durability of immunity and clinical protection in nursing home residents following bivalent SARS-CoV-2 vaccination

    Gravenstein, Stefan / Devone, Frank / Oyebanji, Oladayo / Abul, Yasin / Cao, Yi / Chan, Philip / Halladay, Christopher / McConeghy, Kevin / Nugent, Clare / Bosch, Jurgen / King, Christopher / Wilson, Brigid / Balazs, Alejandro Benjamin / White, Elizabeth / Canaday, David H.

    medRxiv

    Abstract: Background: Vaccines have substantially mitigated the disproportional impact of SARS-CoV-2 on the high morbidity and mortality experienced by nursing home residents. However, variation in vaccine efficacy, immune senescence and waning immunity all ... ...

    Abstract Background: Vaccines have substantially mitigated the disproportional impact of SARS-CoV-2 on the high morbidity and mortality experienced by nursing home residents. However, variation in vaccine efficacy, immune senescence and waning immunity all undermine vaccine effectiveness over time. The introduction of the bivalent vaccine in September 2022 aimed to counter this increasing susceptibility and consequences of breakthrough infection, however data on the durability and protection of the vaccine are limited. We evaluated the durability of immunity and protection after the first bivalent vaccination to SARS-CoV-2 in nursing home residents. Methods: For the immunologic evaluation, community nursing home volunteers agreed to serial blood sampling before, at two weeks, three and six months after each vaccination for antibodies to spike protein and pseudovirus neutralization activity over time. Concurrent clinical outcomes were evaluated by reviewing electronic health record data from residents living in Veterans Administration managed nursing home units. Residents without recent infection but prior vaccination to SARS-CoV-2 were followed over time beginning with administration of the newly available bivalent vaccine using a target trial emulation (TTE) approach; TTE compared time to breakthrough infection, hospitalization and death between those who did and did not receive the bivalent vaccine. Results: We evaluated antibodies in 650 nursing home residents; 452 had data available following a first monovalent booster, 257 following a second monovalent booster and 321 following a bivalent vaccine. We found a rise in BA.5 neutralization activity from the first and second monovalent boosters through the bivalent vaccination regardless of prior SARS-CoV-2 history. Titers declined at three and six months after the bivalent vaccination but generally exceeded those at three months compared to either prior boost. BA.5 neutralization titers six months after the bivalent vaccination were diminished but had detectable levels in 80% of infection-naive and 100% of prior infected individuals. TTE evaluated 5903 unique subjects, of whom 2235 received the bivalent boost. TTE demonstrated 39% or greater reduction in risk of infection, hospitalization or death at four months following the bivalent boost. Conclusion: Immunologic results mirrored those of the TTE and suggest bivalent vaccination added substantial protection for up to six months after bivalent vaccination with notable exceptions. However, the level of protection declined over this period, and by six months may open a window of added vulnerability to infection before the next updated vaccine becomes available. We strongly agree with the CDC recommendation that those who have not received a bivalent vaccination receive that now and these results support a second bivalent booster for those at greatest risk which includes many nursing home residents.
    Keywords covid19
    Language English
    Publishing date 2023-04-25
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2023.04.25.23289050
    Database COVID19

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  2. Article ; Online: Association of mortality and aspirin use for COVID-19 residents at VA Community Living Center Nursing Homes

    Abul, Yasin / Devone, Frank / Bayer, Thomas / Halladay, Christopher / McConeghy, Kevin / Mujahid, Nadia / Singh, Mriganka / Leeder, Ciera / Gravenstein, Stefan / Rudolph, James L

    medRxiv

    Abstract: Background/Objectives: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state and increased thrombotic risk in infected individuals. Several complex and varied coagulation abnormalities were proposed for this association1 ... ...

    Abstract Background/Objectives: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state and increased thrombotic risk in infected individuals. Several complex and varied coagulation abnormalities were proposed for this association1 .Acetylsalicylic acid(ASA, aspirin) is known to have inflammatory, antithrombotic properties and its use was reported as having potency to reduce RNA synthesis and replication of some types of coronaviruses including human coronavirus-299E (CoV-229E) and Middle East Respiratory Syndrome (MERS)-CoV 2,3. We hypothesized that chronic low dose aspirin use may decrease COVID-19 mortality relative to ASA non-users. Methods: This is a retrospective, observational cohort analysis of residents residing at Veterans Affairs Community Living Centers from December 13, 2020, to September 18, 2021, with a positive SARS-CoV-2 PCR test. Low dose aspirin users had low dose (81mg) therapy (10 of 14 days) prior to the positive COVID date and were compared to aspirin non-users (no ASA in prior 14 days). The primary outcome was mortality at 30 and 56 days post positive test and hospitalization within 14 days of positive test result. Results: We identified 1.823 residents who had SARS-CoV-2 infection and 1,687 residents were eligible as a final analytic sample after excluding high dose and intermittent/partial dose aspirin users. Overall mean age was 72.28+/-11.66 years and 3.3% (n=67) female in the final analytic sample. Among the 511 (30.3%) residents taking chronic low dose aspirin, 30-day mortality after an initial SARS-CoV-2 test establishing infection was 6.46% (n=33) compared to 10.29% (n=121) of non-users (SMD >0.1). 56-day mortality after initial SARS-CoV-2 test establishing infection was 9.0% (n=46) compared to 13.18% (n=155) not taking low dose aspirin (SMD >0.1). Cox proportional hazards model showed that aspirin use was independently associated with a reduced risk of 30 days of mortality (adjusted HR, 0.60, 95% CI, 0.40-0.90) and 56 days of mortality (adjusted HR, 0.67, 95% CI, 0.47-0.95) Conclusion: In this retrospective observational study of VA Community Living Center residents infected with SARS-CoV-2, low dose aspirin use for primary or secondary prevention of cardiovascular events is associated with lower COVID-19 mortality and fewer breakthrough cases. Although additional randomized controlled trials are required to understand these associations and the potential implications more fully for improving care, aspirin remains a medication with known side effects and clinical practice should not change based on these findings.
    Keywords covid19
    Language English
    Publishing date 2022-08-04
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2022.08.03.22278392
    Database COVID19

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  3. Article ; Online: Can we clinically identify pre-symptomatic and asymptomatic COVID-19?

    Elhamamsy, Salaheldin / Devone, Frank / Bayer, Tom / Halladay, Christopher / Cadieux, Marilyne / McConeghy, Kevin / Rajan, Ashna / Sachar, Moniyka / Mujahid, Nadia / Nanda, Aman / McNicoll, Lynn / Rudolph, James / Gravenstein, Stefan

    medRxiv

    Abstract: Objectives: COVID-19 has had a severe impact on morbidity and mortality among nursing home (NH) residents. Earlier detection of SARS-CoV-2 may position us to better mitigate risk of spread. Both asymptomatic or pre-symptomatic transmission are common in ... ...

    Abstract Objectives: COVID-19 has had a severe impact on morbidity and mortality among nursing home (NH) residents. Earlier detection of SARS-CoV-2 may position us to better mitigate risk of spread. Both asymptomatic or pre-symptomatic transmission are common in outbreaks, and threshold temperatures, such as 38C, for screening for infection could miss timely detection in the majority. Design: Retrospective cohort study using electronic health records Methods: We hypothesized that in long-term care residents, temperature trends with SARS-CoV-2 infection could identify infection in pre-symptomatic and asymptomatic individuals earlier. We collected information about age and other demographics, baseline temperature, and specific comorbidities. We created standardized definitions, and an alternative hypothetical model to test measures of temperature variation and compare outcomes to the VA reality. Settings and participants: Our subjects were 6,176 residents of the VA NHs who underwent SARS-CoV-2 trigger testing. Results: We showed that a change from baseline of >0.4C identifies 47% of the SARS-CoV-2 positive NH residents early, and achieves earlier detection by 42.2 hours. Range improves early detection to 55% when paired with a 37.2C cutoff, and achieves earlier detection by 44.4 hours. Temperature elevation >0.4C from baseline, when combined with a 0.7C range, would detect 52% early, leading to earlier detection by more than 3 days in 22% of the residents. This earlier detection comes at the expense of triggering 57,793 tests, as compared to the number of trigger tests ordered in the VA system of 40,691. Conclusion and implications: Our model suggests that current clinical screening for SARS-CoV-2 in NHs can be substantially improved upon by triggering testing using a patient-derived baseline temperature with a 0.4C degree relative elevation or temperature variability of 0.7C trigger threshold for SARS-CoV2 testing. Such triggers could be automated in facilities that track temperatures in their electronic records.
    Keywords covid19
    Language English
    Publishing date 2021-07-26
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.07.23.21260676
    Database COVID19

    Full text online

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    Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

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