Jonna Lorenz is a freelance journalist with more than 20 years of experience. Her background is in business and health care news, including reporting, editing and research for newspapers and websites.

Jonna Lorenz

Infants born to mothers with SARS-CoV-2 infection were at low risk of contracting the virus, with the primary factors associated with adverse health effects being maternal social vulnerability and preterm birth, a new study found.

, included 255 babies born to women who tested positive for SARS-CoV-2 infection at 11 hospitals in Massachusetts. Of those, 225 (88.2%) were tested for SARS-CoV-2, with 5 (2.2%) testing positive during birth hospitalization (95% CI, 1.0-5.1). One infant tested positive for SARS-CoV-2 after discharge during non-routine clinical visits.

The study found minimal direct health effects from SARS-CoV-2 infection within 30 days of hospital discharge.

“We found low rates of SARS-CoV-2 transmission from mothers who tested positive around the time of delivery to their infants, at 2.2%, and overall favorable short-term neonatal outcomes in Massachusetts,” lead author Asimenia Angelidou, MD, PhD, neonatologist at Boston Children’s College and instructor in pediatrics at Harvard Medical School told 

. “This is consistent with data from other large international cohorts (Spain, UK). Neonates were mostly affected by the virus indirectly, for example through preterm birth and its sequelae.”

Maternal social vulnerability, determined by ZIP code using a US Centers of Disease Control and Prevention index of factors such as poverty, unemployment and education, was identified as a risk factor for positive SARS-CoV-2 testing in newborns.

“We expected the mode of delivery or the degree of maternal illness to increase the risk of newborn infection,” Angelidou said. “What surprised our team was that not only was this not the case, but also the most significant risk factor for positive testing in a newborn was being born to a socially-vulnerable mother, which increased their risk 5-fold.”

Those born positive for SARS-CoV-2 had minimal adverse health effects, the study noted. For those whose mothers had worsening COVID-19 symptoms, the risks were greater for preterm birth and associated adverse health outcomes such as the need for resuscitation, CPAP or mechanical ventilation and longer hospital stay.

A social vulnerability index score of 90th percentile or higher was present for 68 mothers (27.2%). Twenty-three mothers (9.2%) had worsening COVID-19 symptoms that prompted delivery. A total of 62 (24.3%) newborns were born with low birth weight or preterm delivery.

“Our results highlight that even during public health emergencies like COVID-19, careful thought is required to avoid unnecessary premature deliveries,” Angelidou said. “​The low rates of neonatal infection and favorable outcomes during the pandemic surge should reassure pediatricians that newborns are unlikely to get acutely ill from the virus in the first month of life. However, newborns 

be infected, can have atypical signs of disease and the long-term sequelae of the virus are unknown, so we should remain vigilant, especially with the circulation of new variants. Clinicians and healthcare providers should be mindful of health disparities, which are complex and extend far beyond racial factors.”

The study results were consistent with the PRIORITY study, which evaluated infant outcomes following maternal SARS-CoV-2 infection in the United States.

 have shown that infants are unlikely to experience severe illness from COVID-19 and that the virus is unlikely to spread from mother to baby.

 found that pregnant mothers with COVID-19 pass antibodies across the placenta to their babies.

“The mechanisms of perinatal viral transmission (from the mother to the fetus) require further investigation,” Angelidou said. “Social vulnerability likely affects health and immunity and our study supports further research in this area. Other next steps include investigations of the long-term effects of the virus on newborns and young children.”

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Maternal social vulnerability and preterm birth were associated with higher risk of adverse health outcomes among infants born to mothers with SARS-CoV-2 infection, a new study found.

Adverse Outcomes for Newborns of Mothers with COVID-19 Associated with Social Vulnerability, Preterm Birth

The antibody response induced by mRNA vaccination against coronavirus disease 2019 (COVID-19) is stronger and more variable than that of natural infection, a new study found.

 preprint server, used data from ongoing seroprevalence studies in Orange County, Calif., before and after a campaign to administer mRNA vaccines.

“MRNA vaccine induced antibody levels are spectacular and appear rapidly within a few days after vaccination,” corresponding author Philip Felgner, PhD, professor in residence and director of the Vaccine R&D Center at the University of California, Irvine told 

. “Only in our dreams we could have imagined a vaccine that that could be developed so quickly, works so well, can be manufactured at scale, distributed and administered to billions of people worldwide within months.”

The study included a cohort of 6724 health care workers from the University of California Irvine Medical Center, who were vaccinated within 3 weeks as part of an intensive vaccination campaign that began Dec. 16. It also included participants in a countywide study in Orange County and a focused community study in Santa Ana.

Before the vaccination campaign, seropositivity among health care workers increased from 4.5% in May to 13% in December. After vaccination, seropositivity rose to 78% by the last week of January, 93% by the last week of February and 98.7% by the last week of March.

“Ab levels induced by the vaccine are much higher than levels induced by natural exposure and infection,” Felgner said. “The vaccine also induces cross reactive Abs against other novel CoV strains that are not induced by natural exposure and infection. This offers hope that the vaccine will be effective against emerging virus variants that are circulating around the world.”

The vaccines induced robust reactivity levels, including antibodies against the full-length spike protein, S1 and S2 subunits, and the receptor binding domain (RBD) of the SARS-CoV-2 spike protein, which binds to the angiotensin-converting enzyme 2 (ACE2) receptor on host cells. Cross-reactive antibodies between the spike protein and RBD induced by the vaccine could possibly provide protection against emerging variants.

This differs from the response from natural infection, which had weak antibody levels against RBD but produced the highest levels of antibodies against nucleocapsid protein (NP) antigens. Anti-nucleocapsid antibodies weren’t affected by the vaccines and could indicate prior natural exposure.

After the second dose of the vaccine, antibody titers were up to 10 times higher than those of patients who had recovered from natural COVID-19 infection, suggesting that even those with prior exposure could benefit from vaccination.

The study also found that people who have had prior exposure to SARS-CoV-2 had a stronger immune response to the vaccine, developing antibody levels faster than those who hadn’t been exposed to the virus.

Weekly monitoring of 9 individuals before and after vaccination showed differences in responses to first and second doses of the vaccine and suggested that for many individuals a more robust response only occurred after the second shot.

Felgner said further research is needed to discover ways to boost immunity in immune compromised individuals, who do not develop high antibody levels after vaccination. Further research also is needed to measure the duration of immunity and to compare immune responses of different vaccines.

“Nucleic acid vaccination was discovered 30 years ago,” Felgner said. “Thirty years of scientific discovery by hundreds of scientists, clinical development and manufacturing supported with billions of dollars from the NIH and several companies led to the outcome we’re experiencing today, and saving the world.”

Pfizer announced recently that individuals who received the BNT162b2 COVID-19 vaccine will most likely need a 

 within 12 months of being fully vaccinated, and annual vaccinations may be necessary.

After the success of its COVID-19 vaccine, Moderna announced that it has 14 

 in clinical trials for viruses including respiratory syncytial virus (RSV), cytomegalovirus (CMV) and human immunodeficiency virus (HIV).

Antibody levels induced by mRNA COVID-19 vaccines are much higher than those induced by natural infection and confer cross-reactivity that could be effective against new variants, a new study from the University of California, Irvine, found.

Immune Response From mRNA COVID-19 Vaccines Is More Robust Than Natural Infection

Patients with cancer had a higher burden of hospital-associated 

 aureus bacteraemia (HA-SAB) and Clostridioides difficile infection (HA-CDI), according to a retrospective study in Australia.

The study, accepted for publication by the 

, included data on SAB and CDI from the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, from December 2018 to July 2020.

“Our findings demonstrate a higher burden of HA-SAB and HA-CDI in a cancer cohort when compared with state data and highlight the need for cancer-specific targets and benchmarks to meaningfully support quality improvement,” the investigators wrote in their study.

A total of 10,608 SAB cases and 13,118 CDI cases at 139 health care facilities in Victoria, including 1 dedicated cancer center, were included. Those cases were divided into cohorts, with 105 SAB cases and 316 CDI cases in the cancer-specific cohort, which included patients admitted to the Peter MacCallum Cancer Centre, compared with 10,503 and 12,802 cases in the statewide cohort respectively.

Cases in the cancer cohort were more likely to be health care associated than those of the broader group, accounting for 85% of SAB cases and 88% of CDI cases in the cancer group (consistent with previous reports), compared with 34% and 66% respectively in the statewide group.

Compared with the statewide group, the study found that HA-SAB events were more than twice as likely in the cancer group (2.25 [95% CI: 1.74-2.77] vs. 1.11 [95% CI:1.07-1.15] HA-SABs/10,000 OBDs) and HA-CDI events more than three times as likely (6.26 [95% CI: 5.12-7.41] vs. 2.31 [95% CI: 2.21-2.42] HA-CDIs/10,000 OBDs).

Possible contributing factors for the higher SAB risk among cancer patients include the use of indwelling medical devices for the treatment of cancer, frequent or prolonged hospitalization and high prevalence of colonization with 

Contributing factors for CDI risk may include frequent use of broad-spectrum antibiotics, changes in gut microbiome and cancer-related surgery.

Limitations of the study include that the comparison cohort of mixed and general hospital patient populations likely included patients with underlying conditions including cancer. Also, the cancer specific cohort only included patients from one center. Participation by private health care facilities was voluntary, introducing the possibility of self-selection bias.

The investigators noted that more robust surveillance is needed to evaluate infection rates and epidemiology within specific high-risk cancer groups.

“Looking ahead, we propose that existing surveillance infrastructure be modified to enable numerator and denominator data specific to hematology-oncology units in general hospitals be extracted to allow reporting and meaningful comparison of high-risk subpopulations across multiple health services,” the authors wrote.

The study was presented at the 21st ICHS Symposium on Infections in the Immunocompromised Host in February.

Health care-associated infections are an important threat to patient safety, and health officials have made efforts to monitor and prevent these illnesses.

In the United States, CDI sickens more than 400,000 people each year, resulting in about 25,000 deaths. Recent 

 has shown a marked decrease in CDI infections, driven by a 36% decrease in health care-associated CDI between 2011 and 2017.

In 2017, there were about 120,000 cases of SAB in the United States, resulting in 20,000 deaths. A 

 found higher rates of mortality and complications for hospital-onset SAB compared with community-acquired infection.

Cancer patients are more than twice as likely to acquire hospital-associated Staphylococcus aureus bacteraemia (HA-SAB) and Clostridioides difficile infection (HA-CDI) than others, a new study from Australia found.

Hospital-Associated SAB, CDI More Than Twice as Likely Among Cancer Patients

Vaccines against coronavirus disease 2019 (COVID-19) may be less effective among patients with blood cancers, according to new studies published in 

 that found the antibody response to mRNA vaccines to be impaired in patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM).

 included 167 patients with CLL in Israel who received two doses of BNT162b2, the mRNA COVID19 vaccine developed by Pfizer and BioNTech.

“The antibody response to BNT162b2 mRNA COVID19 vaccine in patients with CLL is markedly impaired and affected by disease activity and treatment,” lead author Yair Herishanu, MD, associate professor in hematology and head of the CLL service at the Tel Aviv Sourasky Medical Center in Israel, told 

. “Vaccinated patients with CLL should continue to adhere to masking, social distancing, and vaccination of their close contacts should be strongly recommended.”

The study showed an antibody response rate of 39.5% among CLL patients. A comparison of 52 CLL patients with 52 healthy participants showed a significant difference, with an antibody response rate of 52% among the CLL patients compared with 100% among the healthy control group (adjusted odds ratio = 0.010, 95% CI 0.001-0.162; p<0.001).

Antibody response rates varied among CLL patients, with those under treatment at the time of vaccination seeing the lowest rate (16%), followed by 55.2% among treatment-naïve patients and 79.2% among those who had obtained clinical remission.

The type of treatment received also was associated with differences in antibody response rates, which were 16% among those treated with BTK inhibitors (ibrutinib or acalabrutinib) and 13.6% for venetoclax. None of the patients exposed to anti-CD20 antibodies within 12 months of vaccination showed antibody response.

“A longer follow-up will be required to assess the clinical outcome of the patients with CLL who have been vaccinated, including the infection rate, disease severity and the usefulness of a booster dose,” Herishanu said. “Other aspect of vaccine response known as the cellular response and how long the immune response to the vaccine is maintained should also be studied.”

Patients with CLL should still get vaccinated and consider doing so before the start of CLL treatment, 

 to receive emergency use authorization from the US Food and Drug Administration and was the only vaccine in use in Israel at the time of the study, which took place from December 2020 through February 2021. Investigators expect that the other mRNA vaccine with EUA, developed by Moderna, would likely have similar results.

 included 48 patients with multiple myeloma in Greece, 72.9% of whom were receiving anti-myeloma therapy, and 104 health controls. Both groups had a median age of 83.

“The aim of this study was to evaluate the development of neutralizing antibodies (NAbs) against SARS-CoV-2 after the first dose of the vaccine in myeloma patients,” lead author Evangelos Terpos, MD, PhD, of the National and Kapodistrian University of Athens in Athens, Greece, told 

. “Our knowledge from vaccines against other viruses have suggested that the response of myeloma patients is lower compared to healthy individuals. The key message of our study is that the first dose of BNT162b2 vaccine produces low levels of NAbs response in elderly myeloma patients compared to controls of similar age.”

Investigators measured antibody titers on day 22 after the first dose of the vaccine but before administration of the second dose, and the median response was 20.6% neutralizing antibodies among MM patients compared with 32.5% among healthy controls. Only 8.3% of MM patients had NAb titers of 50% or greater compared with 20.2% of healthy controls. That is the level considered to correspond to clinically relevant viral inhibition.

“More data are needed to know the results of the second dose as well as the results in younger myeloma patients,” Terpos said. “However, it is totally necessary for these patients to receive the second dose of the vaccine.”

A pair of recent studies suggest that the ability of people with blood cancers lymphocytic leukemia and multiple myeloma to produce antibodies in response to COVID-19 vaccines is impaired.