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Objective To evaluate the accuracy of an antibody point-of-care lateral flow immunoassay (LFI - Wondfo Biotech Co., Guangzhou, China) in a pediatric population. Methods Children and adolescents (2 months to 18 years) with signs and symptoms suggestive of acute SARS-CoV-2 infection were prospectively investigated with nasopharyngeal RT-PCR and LFI at the emergency room. RT-PCR was performed at baseline, and LFI at the same time or scheduled for those with less than 7 days of the clinical picture. Overall accuracy, sensitivity and specificity were assessed, as well as according to the onset of symptoms (7-13 or ≥14 days) at the time of LFI test. Results In 175 children included, RT-PCR and LFI were positive in 51 (29.14%) and 36 (20.57%), respectively. The overall sensitivity, specificity, positive and negative predictive value was of 70.6% (95%CI 56.2-82.5), 96.8% (95%CI 91.9-99.1), 90.0% (95%CI 77.2-96.0), and 88.9% (95%CI 83.9-92.5), respectively. At 7-13 and ≥14 days after the onset of symptoms, sensitivity was 60.0% (95%CI 26.2-87.8) and 73.2% (95%CI 57.1-85.8) and specificity was 97.9% (95%CI 88.7-99.9) and 96.1% (95%CI 89.0-99.2), respectively. Conclusion Despite its high specificity, in the present study, the sensitivity of LFI in children was lower (around 70%) than most reports in adults. In acute care settings, although a positive result is informative, a negative LFI test cannot rule out COVID-19 in children.

Background: The viral dynamics and the role of children in the spread of SARS-CoV-2 are not completely understood. Our aim was to evaluate how RT-PCR Ct values among children with confirmed SARS-CoV-2 compared with that of adult subjects. Methods: Patients (aged from 2 months to ≤18 years, and adults) with signs and symptoms of acute SARS-CoV-2 infection for less than 7 days, were prospectively enrolled in the study from May to November 2020. All participants performed RT-PCR assay for SARS-CoV-2 detection; Ct values of ORF1ab, N, and S gene-targets, and the average of all the three probes were used as surrogates of viral load. Results: Of the total of 376 participants with confirmed SARS-CoV-2 infection there were 21 infants, 62 children and 293 adults. The RT-PCR Ct values of children under 18 were not significantly different from that of adults, as observed by the analyzed probes (namely ORF1ab, N, and S), and by the mean of all 3 gene-targets. However, infants had significantly lower Ct values compared to children and adults (P = 0.044). Discussion: Ct values for children were not significantly different than that of adults with positive SARS-CoV-2. Interestingly, infants had even lower Ct values when compared to older children and adults. Although viral load is not the only determinant of transmission, infants may play a significant role in the spread of SARS-CoV-2 in the community, especially if or when this population returns to regular daycare activities.

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Human cytomegalovirus (CMV) is a widespread persistent herpes virus requiring lifelong immune surveillance to maintain latency. Such long-term interactions with the immune system may be associated with deleterious effects including immune exhaustion and senescence. Regarding the COVID-19 pandemic, we asked whether CMV-specific cellular and humoral activity could influence immune responses toward SARS-CoV-2 and/or disease severity. All adults with mild ( n = 15) and severe ( n = 14) COVID-19 were seropositive for anti-CMV IgG, but negative for IgM antibodies. Antibody titers did not correlate with COVID-19 severity. Six patients presented elevated frequencies of CMV-specific CD4 + and CD8 + T cells producing IFNγ, IL-17, and TNFα, designated as CMV high responders (hiT CMV). In comparison to low CMV responders, hiT CMV individuals exhibited higher frequencies of SARS-CoV-2-specific CD4 + IL-17 + and CD8 + IFNγ + , IL-17 + or TNFα + T cells. These results indicate that high frequencies of CMV-specific T cells may be associated with a SARS-CoV-2-reactive profile skewed toward Th17-dominated immunity. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s00430-022-00758-1.

Objective: The objective of this study was to estimate treatment costs of Hematopoietic stem cell transplantation (HSCT) at a reference center in Brazil. Methods: The study population consisted of patients from the Unified Health System HSCT who underwent HSCT in southern Brazil between 2016 and 2019. Costs were measured using a micro-costing approach, based on Time-Driven Activity-based Costing (TDABC) adapted for economic studies in health and included the following steps: definition of the research question, structured data collection, and statistical analysis of results. Results: The total cost of HSCT was $155,110 ($92,794 – $249,146 USD). Matched unrelated donor HSCT was more expensive than matched related donor HSCT. The major cost factors involve post-ransplant complications, mainly the occurrence of infections. Concerning cost composition, exams and procedures represent the largest expense in HSCT (45%). Conclusion: These estimates could be applicable to further evaluations for HSCT cost-effectiveness and help healthcare decision-makers in middle-income countries

Introdução/Objetivo Os fatores associados ao risco de hospitalização por COVID19 não são completamente conhecidos. O objetivo deste estudo foi descrever o risco de hospitalização dos participantes ambulatoriais com diagnóstico exclusivo para rinovírus, SARS-CoV-2 e codetecção entre esses dois agentes, durante a pandemia no sul do Brasil. Métodos Participantes ambulatoriais (> 18 anos) com sinais agudos de tosse, febre ou dor de garganta foram recrutados prospectivamente nas tendas de atendimento do Hospital Moinhos de Vento e Hospital Restinga e Extremo Sul, entre maio e novembro de 2020, e foram acompanhados por 28 dias através de entrevistas telefônicas. Para a detecção de SARS-CoV-2 bem como para o painel respiratório, foi utilizada a técnica de RT-PCR. Para detecção de SARS-CoV-2 foi utilizado kit TaqManTM 2019-nCoV Assay Kit v1 (genes S, N e ORF1ab) a partir de swabs orofaríngeo e nasofaríngeo bilateral. Em coleta de outro swab nasofaríngeo foi realizado painel respiratório para detecção de: Bordetella pertussis; Chlamydophila pneumoniae; Mycoplasma pneumoniae; adenovírus; bocavírus; coronavírus tipos HKU1, 229E, NL63 e OC43; vírus influenza A tipos H1 e H3; vírus influenza B; enterovírus humano; metapneumovírus humano; vírus parainfluenza tipos 1, 2 e 3; RSV tipos A e B; e rinovírus). Todas as amostras foram analisadas no Laboratório de Biologia Molecular do Hospital Moinhos de Vento. Resultados Foram recrutados 609 participantes, com idade mediana de 36 anos, sendo a maioria mulheres (63,2%). 282 (46,4%) participantes tiveram detectado apenas rinovírus, seguido por 234 (38,4%) com SARS-CoV-2 exclusivamente. A codetecção entre estes dois agentes ocorreu em 93 (15,3%) dos 608 participantes. Deste total, 26 (4,3%) participantes necessitaram hospitalização após a busca por atendimento ambulatorial. Participantes com codetecção viral apresentaram maior proporção de hospitalização quando comparados aos participantes com SARS-CoV-2 e rinovírus detectados como agentes únicos (9,7% (9/93) vs 6,8% (16/234) vs 0,4% (1/282), p < 0.001). Entretanto, quando comparadas as proporções de coinfecção com SARS-CoV-2 (como agente único), a diferença não é significativa (9,7% (9/93) vs 6,8% (16/234), p = 0.373). Conclusão O rinovírus foi o principal patógeno detectado em adultos, e apesar da alta prevalência não foi associado ao aumento na hospitalização, sendo o maior risco atribuído à detecção de SARS-CoV-2 nessa população.