2023年 · 第03卷第04期

To facilitate the achieving of the goal of "eliminating viral hepatitis as a major public health threat by 2030" set by the World Health Organization, the Chinese Society of Hepatology together with the Chinese Society of Infectious Diseases (both are branches of the Chinese Medical Association) organized a panel of experts and updated the guidelines for prevention and treatment of chronic hepatitis B in China (version 2022). With the support of available evidence, this revision of the guidelines focuses on active prevention, large-scale testing, and expansion of therapeutic indication of chronic hepatitis B with the aim of reducing the hepatitis B–related disease burden.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a multi-organ systemic damage that can lead to long-term consequences. Little is known about the possible long-term effects of COVID-19 on circulating leukocyte kinetics and functional T-cell activity after recovery. To investigate immune system changes, we designed a cohort study. Methods: Volunteer screening and sample collection were performed at the Irkutsk Research Anti-Plague Institute of Rospotrebnadzor. Sixty-four volunteers who have had COVID-19 (recovered volunteers (RVs)) between May 2020 and May 2021, 33 volunteers who had been in contact with COVID-19 patients (contact volunteers (CVs)) within the family setting but had not become ill, and 47 healthy volunteers (HVs) participated in the study. We performed immunophenotyping of peripheral blood cells using flow cytometry. Serum was tested for SARS-CoV-2 anti-nucleocapsid immunoglobulin G antibodies by enzyme-linked immunosorbent assay (Ab(+), people with specific anti-N antibodies to SARS-CoV-2; Ab(-), people without specific antibodies). Results: There were no serious disturbances in the internal environment of the body in RVs and CVs. In the evaluation of the general state of the immune system, the most informative indicator was the index of the ratio of neutrophils to blood monocytes – decreased on the 1st terms of observation (1 and 3 months post-symptom onset (PSO)/post-contact onset (PCO)), on average, 1.3 times compared with HVs (8.6% (7.5%–10.5%), P < 0.05), which recovered by the 6th month of observation. Redistribution of the cells responsible for the development of the adaptive immune response was noted only in RVs – increased B-lymphocyte content (HVs, 9.1% (6.4%-10.2%)) and immunoregulatory index ratio (HVs, 1.6% (1.2%–2.1%)) due to redistribution of T-helper and cytotoxic T cells throughout the follow-up period by an average of 1.2-fold compared with HVs (P < 0.05). However, CVs with specific antibodies to SARS-CoV-2 N-protein also had an increased proportion of CD3-CD19+ cells after 1 month PCO (Ab(+), 11.4% (10.2%-15.1%); Ab(-), 8.6% (5.7%–9.7%); P = 0.006). A significant difference between RVs and CVs is that the RVs showed significant activation of circulating T cells, which persisted up to the 6th month of the study, whereas in CVs, it persisted for 3 months PCO. The highest proportion of HLA-DR+ T-lymphocytes was recorded after 1 month PSO/PCO in Ab(+) RVs and CVs: Ab(+) volunteers, 8.1% (6.0%–11.2%) and 4.4% (2.7%–6.4%), respectively; Ab(-) volunteers, 4.2% (2.6%–5.4%) and 5.1% (3.7%–5.6%); and HVs, 3.5% (2.5%–4.7%) (P < 0.01). In CVs, natural killer cells also played a major role in preventing manifest infection (CVs, 10.8% ± 4.3%; HVs, 15.9% ± 7.6%; P < 0.05). Conclusion: In this study, we demonstrated the dynamics of returning to the initial state of health in RVs and CVs. In CVs, we observed changes in the studied immunological parameters similar to those of RVs, but which are less intense and prolonged. Complete recovery of the studied immunological parameters occurs within 6 months.

Background: The outbreak and prevalence of the Omicron variant have threatened human health since March 2022 in mainland China. In this study, we aimed to investigate the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) in the Beijing region. Methods: In this retrospective study, we enrolled inpatients admitted for COVID-19 in the Fifth Medical Center of Chinese PLA General Hospital in Beijing between November 10, 2022, and January 30, 2023. Demographic and clinical features and treatment outcomes were comprehensively analyzed. We used logistic regression and linear regression analyses to explore the risk factors associated with disease severity and time of nucleic acid conversion, respectively. Results: A total of 1010 hospitalized patients with COVID-19 were enrolled. The median age was 43.0 years (interquartile range, 28.0–63.0), and patients aged <60 years and ≥60 years comprised 71.2% and 28.8% of total included patients, respectively. The clinical classification of mild (74.6%, 753/1010), moderate (21.0%, 212/1010), severe (2.7%, 27/1010), and unidentified (1.8%, 18/1010) was separately recorded; 1005 patients were discharged, and 5 patients died in the hospital. The outbreak of the emerging epidemic witnessed an evident increase in the proportion of moderate (42.9% vs. 16.4%) and severe (10.3% vs. 1.1%) cases after December 7, 2022. Patients with a moderate/severe classification had higher levels of procalcitonin, IL-6, serum ferritin, C-reactive protein, lactic dehydrogenase, serum urea nitrogen, and D-dimer and lower counts of CD4+ T, CD8+ T, and B cells (all P < 0.001). Multivariable regression analysis revealed that increased odds of disease severity were associated with the following factors: age ≥60 years, IL-6 > 7 pg/mL, lactic dehydrogenase level >245 U/L, cough, and fever at admission. Age ≥80 years and chronic lung disease were independent risk factors in the nonmild group in elderly patients. In addition, the duration for nucleic acid to turn negative was approximately 5.0 d (interquartile range, 3.0–7.0). Prolonged time of nucleic acid conversion was associated with age ≥60 years, serum urea nitrogen level >8.2 mmol/L, neutrophil count >7 × 109/L, and the presence of a chronic lung disease or carcinoma. Finally, unvaccinated patients accounted for 37.3% of enrolled patients; children and the elder people accounted for approximately half of that. The univariable analysis found that booster doses reduced disease severity and shortened the time of nucleic acid conversion in elderly patients. Conclusions: The outbreak of Omicron rapidly increased the number of patients with COVID-19 in Beijing. In elderly patients, booster doses may reduce disease severity and shorten the time of nucleic acid conversion. Healthcare systems should be optimized before an emerging epidemic outbreak.

The Omicron variants have continued to cause severe acute respiratory syndrome coronavirus 2 infections. To better understand the anti-viral effects of vaccination on host-virus interactions during the outbreak of BA.2.2 Omicron, we conducted RNA-seq transcriptome analysis on nasopharyngeal swabs from COVID-19 patients in Shanghai. This study was performed on selected cases from unvaccinated, fully vaccinated, and booster groups with the same founder virus infection background. We observed predominant immune cell chemotaxis and interleukin-1 production, as well as mucosal keratinization and epidermis development, in unvaccinated patients. In contrast, fully vaccinated subjects exhibited an obvious T-cell activation in the local immune response, whereas B-cell activation was higher in booster-vaccinated cases. In conclusion, our findings suggest that full or booster vaccination provides better adaptive immunity and relieve inflammation at the nasopharyngeal site, thereby reducing the risk of cytokine storm during breakthrough infection.

This study aimed to investigate the status of and changes in the vaccination willingness of patients with breast cancer to increase the coronavirus disease 2019 (COVID-19) vaccination rate among these patients. The first survey included patients from the Fifth Medical Center of the PLA General Hospital who participated in the Society of Clinical Oncology Breast Cancer Committee NCP-02 study conducted from September 16 to December 31, 2021. The second survey was conducted from December 9 to December 26, 2022, for those who had not received vaccines previously. In total, 266 patients completed two questionnaires. A total of 143 patients (53.8%) changed their willingness to receive the vaccination. Among them, 45, who were initially unwilling to be vaccinated, changed their stance to become hesitant and 15 changed to become willing. Among those with hesitant attitudes toward vaccines, 45 changed their stance to become willing, and 28 changed to become unwilling; 10 patients with willing attitudes toward vaccines changed to become hesitant. Those who received surgery (odds ratio (OR), 4.24; 95% confidence interval (CI), 1.45–12.42; P = 0.01) and who lived with older adults or children (OR, 2.03; 95% CI, 1.13–3.62; P = 0.02) were more likely to change their attitudes toward COVID-19 vaccines. This finding suggested that patients with breast cancer were cautious about receiving the COVID-19 vaccine. Multiple methods should be used to promote vaccination and reduce vaccine hesitancy.