Kids with heart conditions prone to severe COVID-19
Congenital and acquired heart conditions such as biventricular defects, cardiac arrest, and heart failure are associated with increased COVID-19 severity in US children, suggests a multicenter study published yesterday in JAMA Network Open.
Researchers from Children's Health of Orange County in California led the retrospective study of 171,416 US children 2 months to 17 years old who tested positive for COVID-19 and had a history of 1 of 26 studied heart conditions.
The patients were seen at 85 health systems from Mar 1, 2020, to Jan 31, 2021. Their heart conditions had been identified from Jan 1, 2015, to Dec 31, 2019. Median age was 8 years, half were boys, and 10% had severe COVID-19.
Of all patients, 64% were White, 44.4% were Hispanic or Latino, 14.5% were Black, 1.6% were Asian or Pacific Islander, 1.4% were American Indian or Alaska Native, and 18.5% were of mixed, other, or unknown race.
The likelihood of severe COVID-19 among patients with heart conditions was elevated: cardiac arrest (odds ratio [OR], 9.9); cardiogenic shock (OR, 3.1); heart surgery (OR, 3.0); cardiopulmonary disease (OR, 1.9); heart failure (OR, 1.8); low blood pressure (OR, 1.6); nontraumatic cerebral hemorrhage (OR, 1.5); pericarditis (OR, 1.5); simple biventricular defects (OR, 1.5); venous embolism and thrombosis (OR, 1.4); complex biventricular defects (OR, 1.3); and essential high blood pressure (OR, 1.2).
A total of 194 of 258 patients (75.2%) with a history of cardiac arrest were younger than 12 years. Of these patients, 79.5% had severe COVID-19, and 27.9% died. Also, 5.0% of patients required oxygen via a nasal cannula, 0.1% received bilevel or continuous positive airway pressure, 6.7% needed a high-flow nasal cannula, 2.4% required mechanical ventilation, 0.02% received extracorporeal membrane oxygenation, and 0.1% died.
"The data presented in this study highlight the need for pediatric health care professionals to provide careful monitoring and timely care to pediatric patients with preexisting cardiovascular disease and SARS-CoV-2 infection," the researchers wrote.
May 17 JAMA Netw Open study
mRNA COVID vaccines show stronger immune response against variants
COVID-19 mRNA vaccines, made by Pfizer-BioNTech and Moderna, elicited stronger antibody responses against four variants of concern (VOCs) and the original virus compared to viral vector vaccines developed by Johnson & Johnson (J&J) and AstraZeneca. The research is published in PLOS Medicine.
The study was conducted by using blood samples gathered from 165 healthcare workers in the Netherlands 3 and 4 weeks after first and second vaccinations, respectively, for the Pfizer, Moderna, and AstraZeneca vaccines, and at 4 and 8 weeks after J&J vaccine administration.
Four weeks after completing the initial vaccination series, SARS-CoV-2 wild-type neutralizing antibody titers were highest in recipients of Moderna, followed by recipients of Pfizer (geometric mean titers (GMT) of 358 IU/mL [95% confidence interval (CI), 231 to 556] and 214 [95% CI, 153 to 299], respectively; P < 0.05), and substantially lower in those vaccinated with AstraZeneca and J&J (GMT of 18 [95% CI 11 to 30] and 14 [95% CI 8 to 25] IU/mL, respectively).
The researchers then challenged the blood serum samples with variants, including Alpha, Beta, Gamma, Delta and Omicron. When challenged with VOCs, both the Pfizer and Moderna serum samples produced significantly higher antibody titers, but neutralization was reduced in all vaccine groups, especially against the Omicron variant.
"The antibodies in SARS-CoV-2 vaccine recipients, sampled around the expected peak of their immunity, showed a marked decrease in neutralization potency against the VOCs, especially the Omicron variant, which was shown to form a separate antigenic cluster," the authors wrote.
Overall this study supports the use of mRNA vaccines, especially as mix-and-match boosters for those who initially received a viral vector COVID-19 vaccine.
May 17 PLoS Med study