27 research outputs found
Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study
No full textAbstract
Background Acute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients’ characteristics, care setting, preliminary diagnosis, and management.
Methods A prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium.
Results In this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was
10 mg/L (IQR < 5–29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13–113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10–58) compared to
7 mg/L (IQR < 5–19) when they were not prescribed.
Conclusion A low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule.sponsorship: This study was funded by the National Institute for Health and Disability Insurance (RIZIV, Belgium) under reference CGV no 2012/235 and the Research Foundation Flanders (FWO Vlaanderen) under research project no G067509N. (National Institute for Health and Disability Insurance (RIZIV, Belgium)|2012/235, Research Foundation Flanders (FWO Vlaanderen)|G067509N)status: Published onlin
Additional file 3 of Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study
No full textSupplementary Material
Additional file 2 of Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study
No full textSupplementary Material
Additional file 1 of Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study
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Exploring TREC and KREC Levels in Nursing Home Residents and Staff and Their Association with SARS-CoV-2 Antibody Response After Vaccination
No full textBackground: T-cell receptor excision circles (TRECs) and kappa-deleting recombination excision circles (KRECs) are markers of recent thymic and bone marrow output, respectively. As they have previously been associated with immunosenescence, we aimed to investigate their association with anti-spike SARS-CoV-2 (S1RBD) IgG antibody response after COVID-19 vaccination in nursing home residents (NHRs) and staff (NHS). Methods: We measured TREC and KREC levels and S1RBD IgG antibody levels from dried blood spots (DBSs) using in-house qPCRs and a commercial ELISA kit, respectively, in 200 participants (50 NHRs and 150 NHS). DBSs were collected in April 2021, approximately two months after primary course COVID-19 vaccination (BNT162b2). We assessed the association between TREC and KREC as dependent variables and age, sex, infection-priming status, and post-vaccination S1RBD-specific IgG concentrations as independent variables by simple and multiple linear regression. Results: TREC and KREC levels were significantly lower in NHRs compared with NHS and were negatively correlated with age (p 0.05). Conclusions: In our study population, TREC and KREC levels decreased with age and were statistically significantly lower in NHRs than NHS. They were, however, not associated with the antibody response after COVID-19 vaccination. Yet, additional research is warranted to explore their potential relevance in cellular immune responses or in combination with other biomarkers of immune function
SARS-CoV-2 seropositivity in nursing home staff and residents during the first SARS-CoV-2 wave in Flanders, Belgium
No full text(1)Background: early in the COVID-19 pandemic, reverse transcription polymerase chain reaction (RT-PCR) testing was limited. Assessing seroprevalence helps understand prevalence and reinfection risk. However, such data are lacking for the first epidemic wave in Belgian nursing homes. Therefore, we assessed SARS-CoV-2 seroprevalence and cumulative RT-PCR positivity in Belgian nursing homes and evaluated reinfection risk.
(2) Methods: we performed a cross-sectional study in nine nursing homes in April and May 2020. Odds ratios (ORs) were calculated to compare the odds of (re)infection between seropositive and seronegative participants.
(3) Results: seroprevalence was 21% (95% CI: 18–23): 22% (95% CI: 18–25) in residents and 20% (95% CI: 17–24) in staff. By 20 May 2020, cumulative RT-PCR positivity was 16% (95% CI: 13–21) in residents and 8% (95% CI: 6–12) in staff. ORs for (re)infection in seropositive (compared to seronegative) residents and staff were 0.22 (95% CI: 0.06–0.72) and 3.15 (95% CI: 1.56–6.63), respectively.
(4) Conclusion: during the first wave, RT-PCR test programmes underestimated the number of COVID-19 cases. The reinfection rate in residents was 3%, indicating protection, while it was 21% in staff, potentially due to less cautious health behaviour. Future outbreaks should use both RT-PCR and serological testing for complementary insights into transmission dynamics
SARS-CoV-2 seroreversion and all-cause mortality in nursing home residents and staff post-primary course vaccination in Belgium between February and December 2021
No full textAbstract: Background: During COVID-19 vaccine implementation, information on the persistence of antibody response and impact on mortality in nursing home residents was limited, as they were underrepresented in vaccine clinical trials and real-world data was lacking. Objectives: (1) Measure the persistence of the SARS-CoV-2 antibody response and predictors for seroreversion after primary course COVID-19 vaccination in nursing home residents compared to staff and (2) assess all-cause mortality and predictors in nursing home residents after primary COVID-19 vaccination. Methods: Seroprevalence and mortality data were collected within a national serosurveillance study in 1640 residents and 1368 staff from 69 nursing homes proportionally spread across Belgium between February and December 2021. To assess the persistence of the antibody response, parametric exponential survival models with interval censoring were fitted, reported with the percentage of seroreverters 120 and 140 days post-primary course vaccination. Furthermore, all-cause mortality rate was calculated and COVID-19 mortality was descriptively reported. Predictors of seroreversion and all-cause mortality were estimated using Cox proportional hazards model. Results: Nursing home residents were 47% more likely to serorevert in the 10 months after COVID-19 vaccination than staff. Infection naivety, older age and high resident care dependency level were found as predictors for seroreversion. The all-cause mortality rate in vaccinated residents over 10 months was 14 % (95 % CI 13-16 %) (n = 229). In 2 % of cases, COVID-19 infection was the reported cause of death. Older age, being male, having severe renal, lung, or cardiac disease, or active cancer, and high care dependency level were identified as predictors for all-cause mortality, irrespective of history of SARS-CoV-2 or breakthrough infection. Conclusion/practical implication: Future COVID-19 vaccination strategies should prioritize (infection naive) nursing home residents, as they fail to mount a durable antibody response after primary course vaccination. Nevertheless, COVID-19 mortality remained low, representing only 2 % of the all-cause mortality rate. This study was registered on ClinicalTrials.gov (NCT04738695)
SARS-CoV-2 seroprevalence among vaccinated nursing home residents and staff in Belgium in August 2021
No full textThe SCOPE study assesses the prevalence of anti-SARS-CoV-2 antibodies among a representative
sample of residents and staff in Belgian NH (nursing homes). Starting from February 1st 2021, a cohort
of 1,640 residents and 1.368 staff members in 69 Belgian NHs are being tested every two months on
the presence of anti-SARS-CoV-2 antibodies.
This brief communication reports on the prevalence of anti-SARS-CoV-2 antibodies among vaccinated
nursing home residents and staff. At the end of April 2021, the large scale vaccination campaign in
Belgian nursing homes, which took place between January 5th and March 24th 2021, resulted in a
vaccination coverage of 97% in NH residents and 84% in staff members. For these vaccinated groups,
we describe the prevalence of anti-SARS-CoV-2 antibodies immediately following the vaccination
campaign (April, 2021) and the seroprevalence evolution over the two following testing periods (in June
and August 2021). Data collection of the August 2021 testing period was not finished at the time of
compiling this brief communication. The August 2021 testing period comprises the data from 65 out of
the 69 nursing homes. Additionally, some antibody test results are expected the coming weeks in case
of self-sampling (for staff in particular). Results given here are preliminary. Small adaptations in some
data might occur in future reports.SCOP
Dynamics of SARS-CoV-2 IgG in nursing home residents in Belgium throughout three BNT162b2 vaccination rounds : 19-month follow-up
No full textAbstract: Background/Objectives: This study mapped antibody dynamics across three COVID-19 vaccination rounds (primary course, first, and second booster with BNT162b2) in Belgian nursing home residents (NHRs). Methods: Within a national SARS-CoV-2 serosurveillance study (February 2021-September 2022) across Belgian nursing homes, dried blood spots were collected, on which anti-spike SARS-CoV-2 IgG antibodies were quantified by ELISA in international units/mL (IU/mL). Sociodemographic data were collected at the study start and infection history and vaccination data at each sampling round. Results: Infection-na & iuml;ve NHRs had low antibody levels after primary course vaccination (geometric mean concentration (GMC) 292 IU/mL, 95% confidence interval (95% CI): 197-432), but increased tenfold after first booster (GMC 2168 IU/mL, 95% CI: 1554-3027). While antibodies among NHRs significantly declined within six months after primary vaccination (p 0.05). Among primary vaccine non-responders, 92% (95% CI: 82-97%) developed antibodies after the first booster (GMC 594 IU/mL, 95% CI: 416-849), though tenfold lower than initial responders (GMC 4642 IU/mL, 95% CI: 3577-6022). Conclusions: These findings demonstrate that NHRs require tailored vaccination, prioritizing repeated immunization to improve serological outcomes in poor responders such as infection-naive NHRs. Regular immune monitoring could aid in implementing evidence-based vaccine strategies, ensuring optimal protection for vulnerable populations against SARS-CoV-2 and other infectious threats
Effect of booster dose on the prevalence of anti-SARS-CoV-2 antibodies among nursing home residents : brief communication on results of the SCOPE study : december 2021
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