Publications by authors named "Paul Randell"

Background: Hybrid SARS-CoV-2 immunity may provide longer duration protection against severe SARS-CoV-2 infection and hospitalisation than purely vaccine-derived immunity. Older adults represent a high-risk group for severe disease, yet available data is skewed towards younger adults.

Methods: A prospective longitudinal study at a large London long-term care facility (LTCF) was conducted from March 2020 to April 2022 to assess the effect of hybrid versus vaccine-only immunity on SARS-CoV-2 infection in older adults during Omicron variant dominance.

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The COVID-19 pandemic has highlighted the need for rapid and reliable diagnostics that are accessible in resource-limited settings. To address this pressing issue, we have developed a rapid, portable, and electricity-free method for extracting nucleic acids from respiratory swabs (i.e.

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Background: Older adults, particularly in long-term care facilities (LTCF), remain at considerable risk from SARS-CoV-2. Data on the protective effect and mechanisms of hybrid immunity are skewed towards young adults precluding targeted vaccination strategies.

Methods: A single-centre longitudinal seroprevalence vaccine response study was conducted with 280 LCTF participants (median 82 yrs, IQR 76-88 yrs; 95.

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  • A study focused on 42 individuals with unclear HIV status found that most were HIV elite controllers, meaning they can suppress the virus without treatment.
  • The research confirmed HIV infection in 30 participants and excluded it in 10, while 2 remained unconfirmed, with elite controllers showing normal immune cell counts.
  • The study highlights the need for more research on different molecular categories within elite controllers, as 95% of the HIV statuses were resolved during the investigation.*
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  • A 48-year-old man with poorly controlled HIV experienced severe human monkeypox (hMPXV) infection, leading to painful lesions and complications like Ludwig's angina after incomplete treatment with tecovirimat.
  • He was treated with intravenous cidofovir (not officially approved for hMPXV), which resulted in significant improvement after the first dose; he received multiple doses and was discharged after 52 days.
  • Cidofovir's use for hMPXV is limited to animal studies and a few documented cases, highlighting the urgent need for more research on its effectiveness and proper treatment protocols.
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SARS-CoV-2 infection, and resulting disease, COVID-19, has a high mortality amongst patients with haematological malignancies. Global vaccine rollouts have reduced hospitalisations and deaths, but vaccine efficacy in patients with haematological malignancies is known to be reduced. The UK-strategy offered a third, mRNA-based, vaccine as an extension to the primary course in these patients.

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Monoclonal antibody therapy has been approved for prophylaxis and treatment of severe COVID-19 infection. Greatest benefit appears limited to those yet to mount an effective immune response from natural infection or vaccination, but concern exists around ability to make timely assessment of immune status of community-based patients where laboratory-based serodiagnostics predominate. Participants were invited to undergo paired laboratory-based (Abbott Architect SARS-CoV-2 IgG Quant II chemiluminescent microparticle immunoassay) and lateral flow assays (LFA; a split SARS-CoV-2 IgM/IgG and total antibody test) able to detect SARS-CoV-2 anti-spike antibodies.

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The early transmission dynamics of SARS-CoV-2 in the UK are unknown but their investigation is critical to aid future pandemic planning. We tested over 11,000 anonymised, stored historic antenatal serum samples, given at two north-west London NHS trusts in 2019 and 2020, for total antibody to SARS-CoV-2 receptor binding domain (anti-RBD). Estimated prevalence of seroreactivity increased from 1% prior to mid-February 2020 to 17% in September 2020.

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A number of studies have highlighted physiological data from the first surge in critically unwell Covid-19 patients but there is a paucity of data describing emerging variants of SARS-CoV-2, such as B.1.1.

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IntroductionImmunoassays targeting different SARS-CoV-2-specific antibodies are employed for seroprevalence studies. The degree of variability between immunoassays targeting anti-nucleocapsid (anti-NP; the majority) vs the potentially neutralising anti-spike antibodies (including anti-receptor-binding domain; anti-RBD), particularly in mild or asymptomatic disease, remains unclear.AimsWe aimed to explore variability in anti-NP and anti-RBD antibody detectability following mild symptomatic or asymptomatic SARS-CoV-2 infection and analyse antibody response for correlation with symptomatology.

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Article Synopsis
  • Accurate detection of antibodies to SARS-CoV-2 is crucial for managing the pandemic, specifically targeting the viral receptor binding domain (RBD) for neutralizing antibodies.
  • The double antigen binding assay (DABA), utilizing a novel approach with solid-phase S1 and a labeled RBD conjugate, has shown high sensitivity (99.6%) and specificity (100%) in measuring anti-RBD antibodies.
  • This assay helps confirm previous infections, monitor vaccine responses, and assess disease severity, making it valuable for clinical use and public health studies.
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Diagnostic laboratories are currently required to provide routine testing of asymptomatic staff and patients as a part of their clinical screening for SARS-CoV-2 infection. However, these cohorts display very different disease prevalence from symptomatic individuals and testing capacity for asymptomatic screening is often limited. Group testing is frequently proposed as a possible solution to address this; however, proposals neglect the technical and operational feasibility of implementation in a front-line diagnostic laboratory.

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The emergence of variants of SARS-CoV-2 has created challenges for the testing infrastructure. Although large-scale genome sequencing of SARS-CoV-2 has facilitated hospital and public health responses, access to sequencing facilities globally is variable and turnaround times can be significant, so there is a requirement for rapid and cost-effective alternatives. Applying a polymerase chain reaction (PCR)-based single nucleotide polymorphism (SNP) approach enables rapid (<4 h) identification of SARS-CoV-2 lineages from nucleic acid extracts, through the presence or absence of a panel of defined of genomic polymorphisms.

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  • Recent SARS-CoV-2 variants have raised concerns about increased transmission within communities, prompting an investigation into their impact on hospital settings.
  • A study analyzed viral sequences and epidemiological data from patients in nine UK hospitals to assess the likelihood of healthcare-associated infections being caused by the Alpha variant versus community-acquired infections.
  • The results indicated no significant difference in the transmission of the Alpha variant compared to other lineages, suggesting existing infection control measures in UK hospitals are effective at containing the spread of emergent variants.
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  • The study investigated the impact of the SARS-CoV-2 B.1.1.7 variant on hospitalised patients, focusing on transmission rates and disease severity.
  • Analysis included data from 2,341 inpatients, and results indicated no overall increase in mortality or intensive therapy unit (ITU) admissions associated with B.1.1.7 compared to other variants.
  • However, female patients infected with B.1.1.7 demonstrated a higher risk for ITU admission and a modestly increased risk of mortality.
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  • The study evaluated the effectiveness of the Innova lateral flow immunoassay device for COVID-19 testing among 5,076 healthcare staff in a London NHS Trust from November 2020 to January 2021.* -
  • A high positive predictive value (PPV) of 94.21% was found, with 244 out of 259 individuals testing positive via PCR following a positive LFD result, indicating a reliable test performance in this environment.* -
  • The results highlighted that many symptomatic staff members were tested, rather than using the LFD solely for asymptomatic screening, suggesting a need for better implementation of testing strategies in hospitals.*
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Objective: There is an urgent need to assess the impact of immunosuppressive therapies on the immunogenicity and efficacy of SARS-CoV-2 vaccination.

Methods: Serological and T-cell ELISpot assays were used to assess the response to first-dose and second-dose SARS-CoV-2 vaccine (with either BNT162b2 mRNA or ChAdOx1 nCoV-19 vaccines) in 140 participants receiving immunosuppression for autoimmune rheumatic and glomerular diseases.

Results: Following first-dose vaccine, 28.

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  • There is increasing evidence that tracking the amount of SARS-CoV-2 virus in patients can enhance management strategies for both individual cases and public health at large.!* -
  • A duplex RT-qPCR assay was developed to measure the virus while also checking the validity of the sample through a control gene, helping to identify inadequate samples that might lead to false negatives.!* -
  • The assay demonstrated reliable results across a wide range of virus concentrations, allowing for accurate comparisons between samples and enabling better-informed decisions in healthcare and public health planning.!*
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We present a HIV-infected patient who developed severe anaemia due to chronic parvovirus B19 infection and subsequently had an unplanned pregnancy. This is in the context of poor adherence to antiretroviral therapy and significant immunosuppression; there was a delay in diagnosis of chronic parvovirus infection due to attribution of anaemia to HIV. She received immunoglobulin therapy and effective antiretroviral therapy, with reduction in parvovirus load and improvement in anaemia.

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