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      Seroconversion in patients with cancer and oncology healthcare workers infected by SARS-CoV-2

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          Abstract

          Background

          Patients with cancer have high risk for severe complications and poor outcome to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (coronavirus disease 2019 [COVID-19]). Almost all subjects with COVID-19 develop anti-SARS-CoV-2 immunoglobulin-G (IgG) within three weeks after infection. No data are available on the seroconversion rates of cancer patients and COVID-19.

          Material and methods

          We conducted a multicenter, observational, prospective study that enrolled: 1) patients and oncology health professionals with SARS-CoV-2 infection confirmed by real time polymerase chain reaction (RT-PCR) assays on nasal/pharyngeal swab specimens; 2) patients and oncology health professionals with clinical or radiological suspicious of infection by SARS-CoV-2; and 3) patients with cancer who are considered at high risk for infection and eligible for active therapy and/or major surgery. All enrolled subjects were tested with the 2019-nCoV IgG/IgM Rapid Test Cassette, which is a qualitative membrane-based immunoassay for the detection of IgG and IgM antibodies to SARS-CoV-2. The aim of the study was to evaluate anti-SARS-CoV-2 seroconversion rate in patients with cancer and oncology healthcare professionals with confirmed or clinically suspected COVID-19.

          Results

          From March 30 to May 11, 2020, 166 subjects were enrolled in the study. Among them, cancer patients and health workers were 61 (36.7%) and 105 (63.3%), respectively. Overall, 86 subjects (51.8%) had confirmed SARS-CoV-2 diagnosis by RT-PCR testing on nasopharyngeal swab specimen, while 60 (36.2%) had a clinical suspicious of COVID-19. Median time between symptom onset (for cases not confirmed by RT-PCR) or RT-PCR confirmation to serum antibody test was 17 days (interquartile range, 26). In the population with confirmed RT-PCR, 83.8% was IgG positive. No difference in IgG positivity was observed between cancer patients and health workers (87.9% vs 80.5%; P = 0.39).

          Conclusions

          Our data indicate that SARS-CoV-2-specific IgG antibody detection do not differ between cancer patients and healthy subjects

          Highlights

          • Patients with cancer have high risk for severe complications and poor outcome to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (coronavirus disease 2019 [COVID-19]).

          • No difference in terms of anti-SARS-CoV-2 immunoglobulin-G (IgG) positivity rates by rapid qualitative membrane-based immunoassay was observed between cancer patients and health workers

          • Median time from SARS-CoV-2 diagnosis to IgG detection was comparable between cancer patients and health workers

          • Our data showed that SARS-CoV-2-specific IgG antibody detection is not different between cancer patients and healthy subjects

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          Most cited references35

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

            Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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              Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

              Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.
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                Author and article information

                Journal
                Ann Oncol
                Ann Oncol
                Annals of Oncology
                European Society for Medical Oncology. Published by Elsevier Ltd.
                0923-7534
                1569-8041
                21 October 2020
                21 October 2020
                Affiliations
                [1 ]Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy
                [2 ]Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
                [3 ]Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
                [4 ]U.O. Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
                [5 ]Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
                [6 ]Department of Management, University of Turin, Turin, Italy
                [7 ]Centre for Research on Health and Social Care Management (CeRGAS), SDA Bocconi School of Management, Milan, Italy
                [8 ]Division of Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
                [9 ]Scientific Direction, IEO, European Institute of Oncology IRCCS, Milan, Italy
                Author notes
                [] Corresponding author: Prof Giuseppe Curigliano, Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, University of Milan, Department of Oncology and Haemato-Oncology, Via Giuseppe Ripamonti 435, 20141, Milan, Italy. .
                [#]

                These authors contributed equally to this work

                Article
                S0923-7534(20)42965-5
                10.1016/j.annonc.2020.10.473
                7577226
                33098994
                16ceca73-a4d1-4531-9961-a53ff13c24a1
                © 2020 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 18 May 2020
                : 29 September 2020
                : 4 October 2020
                Categories
                Original Article

                Oncology & Radiotherapy
                cancer,healthcare workers,covid-19,sars-cov-2,coronavirus,antibody response,seroconversion

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