Elevated risk of infection with SARS-CoV-2 Beta, Gamma, and Delta variants compared with Alpha variant in vaccinated individuals

The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) break through infection- or vaccine-induced immunity is not well understood. We analyzed 28,578 sequenced SARS-CoV-2 samples from individuals with known immune status obtained through national community testing in the Netherlands from March to August 2021. We found evidence of an increased risk of infection by the Beta (B.1.351), Gamma (P.1), or Delta (B.1.617.2) variants compared with the Alpha (B.1.1.7) variant after vaccination. No clear differences were found between vaccines. However, the effect was larger in the first 14 to 59 days after complete vaccination compared with ≥60 days. In contrast to vaccine-induced immunity, there was no increased risk for reinfection with Beta, Gamma, or Delta variants relative to the Alpha variant in individuals with infection-induced immunity.</p

High quality of SARS-CoV-2 molecular diagnostics in a diverse laboratory landscape through supported benchmark testing and External Quality Assessment

A two-step strategy combining assisted benchmark testing (entry controls) and External Quality Assessments (EQAs) with blinded simulated clinical specimens to enhance and maintain the quality of nucleic acid amplification testing was developed. This strategy was successfully applied to 71 diagnostic laboratories in The Netherlands when upscaling the national diagnostic capacity during the SARS-CoV-2 pandemic. The availability of benchmark testing in combination with advice for improvement substantially enhanced the quality of the laboratory testing procedures for SARS-CoV-2 detection. The three subsequent EQA rounds demonstrated high quality testing with regard to specificity (99.6% correctly identified) and sensitivity (93.3% correctly identified). Even with the implementation of novel assays, changing workflows using diverse equipment and a high degree of assay heterogeneity, the overall high quality was maintained using this two-step strategy. We show that in contrast to the limited value of Cq value for absolute proxies of viral load, these Cq values can, in combination with metadata on strategies and techniques, provide valuable information for laboratories to improve their procedures. In conclusion, our two-step strategy (preparation phase followed by a series of EQAs) is a rapid and flexible system capable of scaling, improving, and maintaining high quality diagnostics even in a rapidly evolving (e.g. pandemic) situation.</p

High quality of SARS-CoV-2 molecular diagnostics in a diverse laboratory landscape through supported benchmark testing and External Quality Assessment

A two-step strategy combining assisted benchmark testing (entry controls) and External Quality Assessments (EQAs) with blinded simulated clinical specimens to enhance and maintain the quality of nucleic acid amplification testing was developed. This strategy was successfully applied to 71 diagnostic laboratories in The Netherlands when upscaling the national diagnostic capacity during the SARS-CoV-2 pandemic. The availability of benchmark testing in combination with advice for improvement substantially enhanced the quality of the laboratory testing procedures for SARS-CoV-2 detection. The three subsequent EQA rounds demonstrated high quality testing with regard to specificity (99.6% correctly identified) and sensitivity (93.3% correctly identified). Even with the implementation of novel assays, changing workflows using diverse equipment and a high degree of assay heterogeneity, the overall high quality was maintained using this two-step strategy. We show that in contrast to the limited value of Cq value for absolute proxies of viral load, these Cq values can, in combination with metadata on strategies and techniques, provide valuable information for laboratories to improve their procedures. In conclusion, our two-step strategy (preparation phase followed by a series of EQAs) is a rapid and flexible system capable of scaling, improving, and maintaining high quality diagnostics even in a rapidly evolving (e.g. pandemic) situation.</p

Safety and side effects of non-pharmacological interventions as a therapy for cancer

Persons diagnosed with cancer are increasingly using non-pharmacological interventions as a therapy for cancer, either independently or in addition to usual medical treatment. Within mainstream medical systems, information availability and access to these therapies is generally limited and patients’ usage is commonly self-initiated. Self-initiation raises issues regarding personal safety, efficacy of the intervention, and the minimisation of potential side effects. A search was undertaken to identify relevant scientific literature related to the use of 15 non-pharmacological interventions widely used in cancer populations as therapy: acupuncture, biofeedback, exercise, meditation, music, visualization/guided imagery, yoga, kinesiology, massage, reflexology, healing touch, Qigong, Reiki, and transcutaneous electrical nerve stimulation. These interventions were classified as mind-body, touch-based or energy-based therapies. This literature search was not intended to be a systematic review, but a comprehensive assessment of current scientific publications relating to the safety and side effects of each intervention. This chapter reveals that such interventions had been used in a number of different countries worldwide, in a variety of cancer populations, to address approximately 23 different symptoms associated with the experience of cancer. For all of the interventions reviewed, the recorded occurrence of side effects was minimal. Safety issues and precautions were rarely discussed in the literature relating to these non-pharmacological therapies, apart from the literature relating to the use of exercise. For hospitals considering the use of non-pharmacological interventions, a framework to facilitate the safe administration of non-pharmacological interventions as a therapy for cancer is presented. There are six main elements of this framework: the considered selection of non-pharmacological interventions, recruitment of quality practitioners, provision of oncology education and preparation for the care of persons with cancer, the use of clinical practice guidelines for each intervention, careful monitoring of persons receiving non-pharmacological interventions, and adherence to the principles of occupational health and safety. It is important that these elements are addressed by hospitals offering non-pharmacological interventions. In addition, the provision of detailed and accurate information to enable patients to continue certain therapies independently and after hospitalisation is also essential