WHO raportti Covid-19 pandemian /epidemian nykypiirteistä

 https://www.who.int/publications/m/item/covid-19-epidemiological-update---22-december-2023

SARS-CoV-2 variants of interest and variants under monitoring
Geographic spread and prevalence
Globally, during the 28-day period from 20 November to 17 December 2023, 22 413 SARS-CoV-2 sequences were shared through GISAID. In comparison, in the two previous 28-day periods, there were 62 927 and 77 550 sequences shared, respectively. As there is usually a several-week average delay between case incidence and sequence reporting, it remains to be seen whether there will be an increase in reported sequences in the coming weeks commensurate to the current increase in new cases reported, or whether this decline in reported sequences will persist as countries continue to scale down sequencing. The data are periodically updated to retrospectively include sequences with earlier collection dates, so the number of submissions in a given time period may change.

WHO is currently tracking several SARS-CoV-2 variants, including:
• Five variants of interest (VOIs): XBB.1.5, XBB.1.16, EG.5, BA.2.86 and JN.1
• Five variants under monitoring (VUMs): DV.7, XBB, XBB.1.9.1, XBB.1.9.2 and XBB.2.3
Table 6 shows the number of countries reporting VOIs and VUMs, and their prevalence from epidemiological week 44 (30 October to 5 November 2023) to week 48 (27 November to 3 December 2023).

Globally, EG.5 remains to be the most reported VOI (now reported by 93 countries), however it has shown declining trends over the past few weeks, accounting for 36.3% of sequences in week 48 compared to 53.7% in week 44.

JN.1, a sub-lineage of the BA.2.86 Omicron variant, was designated a VOI on 18 December 2023, due to its rapid increase in prevalence in recent weeks. Previously WHO was tracking it as part of the BA.2.86 VOI. JN.1 accounted for 27.1% of SARS-CoV-2 sequences in week 48 compared to 3.3% in week 44. This is a notable increase when comparing to its parent lineage, BA.2.86, which accounted for 5.9% of sequences in week 48 compared to 4.4% in week 44. The initial risk evaluation for JN.1 was published on 18 December 2023, with an overall evaluation of low additional public health risk at the global level based on available evidence.

The other VOIs, XBB.1.5 and XBB.1.16, have decreased in global prevalence, respectively, during the same period:
XBB.1.5 accounted for 7.3% of sequences in week 48, a slight decrease from 8.2% in week 44; XBB.1.16 accounted for 4 .2% of sequences in week 48, a decrease from 9.6% in week 44 (Figure 10, Table 6).

All VUMs have shown a decreasing trend over the reporting period (Table 6).

Sufficient sequencing data to calculate variant prevalence at the regional level during weeks 44 to 48 were available from three WHO regions: the Region of the Americas, the Western Pacific Region, and the European Region (Table 7). 

Among the VOIs, JN.1 was the most reported variant and showed an increasing trend in the European and Western Pacific regions, whilst EG.5 remained the most reported variant in the Regions of the Americas. 

BA.2.86, XBB.1.5 and XBB.1.16 showed increasing or stable trends in all three regions.

 All VUMs in all three regions observed decreasing or stable trends.

 
With declining rates of testing and sequencing globally (Figure 10), it is increasingly challenging to estimate the severity impact of emerging SARS-CoV-2 variants. There are currently no reported laboratory or epidemiological findings indicating any association between VOIs/VUMs and increased disease severity. 

As shown in Figure 9 and Figure 10, low and unrepresentative levels of SARS-CoV-2 genomic surveillance continue to pose challenges in adequately assessing the variant landscape.

COVID-19 rokotus ja Ca mammae kirurgian ajoitus

 

Review

. 2021 Aug;188(3):825-826.

doi: 10.1007/s10549-021-06293-6. Epub 2021 Jun 22.

COVID-19 vaccination and breast cancer surgery timing

Gary Ko  ¹ , Susy Hota  ² , Tulin D Cil  ²

Affiliations

• PMID: 34156582
• PMCID: PMC8217777
• DOI: 10.1007/s10549-021-06293-6

Free PMC article  Abstract

There have been recent reports in the breast imaging literature of unilateral axillary lymphadenopathy following COVID-19 vaccination. It has been estimated to occur in 11.6% of people after receiving their first dose and 16% of people after receiving their second dose of the Moderna COVID-19 vaccine [1]. This has prompted a proposal for breast screening to occur either before a patient receives the COVID-19 vaccine or 4–6 weeks after, in order to avoid false positives on imaging. Physicians should inquire about recent COVID-19 vaccination for patients who have unilateral axillary lymphadenopathy. In patients who have unilateral axillary lymphadenopathy on imaging and a history of receiving a COVID-19 vaccine in the ipsilateral arm within 4 weeks, short term follow-up imaging in 4–12 weeks after the second vaccine dose should be considered instead of excision. If the lymphadenopathy persists on follow-up imaging, lymph node sampling (e.g. FNA or core biopsy) should be performed to exclude malignancy [2].

Most breast cancer surgery involves the retrieval of sentinel lymph nodes. It is unclear whether the reactive lymphadenopathy may affect the accuracy of the sentinel lymph node biopsy procedure. Furthermore, side effects secondary to the vaccine (such as low-grade fever) may be similiar to usual post-operative symptoms. The key is to minimize risk of confusing symptoms that may lead to over-diagnosis of surgical site infections (e.g. skin rashes, enlarged lymph nodes) when they are actually due to lingering vaccine-related side effects.

We have not found any guidelines regarding the timing of the COVID-19 vaccine and breast cancer surgery. As such, our breast surgical oncology service has formulated the following recommendations after a review of the available literature [3] and in consultation with our infectious disease specialists at the University Health Network in Toronto, Ontario, Canada.

1. 1)

   We recommend scheduling the COVID-19 vaccine at least one week before surgery so symptoms such as fever can be correctly attributed to side effects from the vaccine rather than surgery.

2. 2)

   Since the COVID-19 vaccines can cause lymphadenopathy, we recommend the vaccine be administered on the OPPOSITE arm to the affected breast, if possible. The anterolateral thigh can be also be considered as an injection site.

3. 3)

   Post-operative antibiotics (e.g. commonly prescribed after breast reconstructive surgery) should not interfere with administration of the COVID-19 vaccine.

4. 4)

   Vaccination can also occur once patients are recovered, one to two weeks after breast surgery. This timing can be re-assessed on an individual basis and is dependent on the clinical status of the patient.

Ultimately, the risks of delaying a COVID-19 vaccine for surgical therapy needs to be balanced with the risks of reactive lymphadenopathy and possibly masking side effects of surgery. Patients should make an informed decision after discussing with their physicians about the timing of COVID-19 vaccine with their breast cancer treatment.

Keywords: Breast Cancer; Covid-19; Lymphadenopathy; Vaccine.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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mRNA Cov Vaccine ja assosiaatio adenopatiaan ja syöpään

e. 2022 Aug;32(8):5752-5758.

doi: 10.1007/s00330-022-08655-0. Epub 2022 Mar 5.

Frequency and outcomes of MRI-detected axillary adenopathy following COVID-19 vaccination

Joao V Horvat  ¹ , Varadan Sevilimedu  ² , Anton S Becker  ³ , Rocio Perez-Johnston  ³ , Randy Yeh  ³ , Kimberly N Feigin  ³

Affiliations

• PMID: 35247087
• PMCID: PMC8897548
• DOI: 10.1007/s00330-022-08655-0

Free PMC article

Abstract

Objectives: To assess the frequency of ipsilateral axillary adenopathy on breast MRI after COVID-19 vaccination. To investigate the duration, outcomes, and associated variables of vaccine-related adenopathy.

Methods: In this retrospective cohort study, our database was queried for patients who underwent breast MRI following COVID-19 vaccination from January 22, 2021, to March 21, 2021. The frequency of ipsilateral axillary adenopathy and possible associated variables were evaluated, including age, personal history of ipsilateral breast cancer, clinical indication for breast MRI, type of vaccine, side of vaccination, number of doses, and number of days between the vaccine and the MRI exam. The outcomes of the adenopathy were investigated, including the duration of adenopathy and biopsy results.

Results: A total of 357 patients were included. The frequency of adenopathy on breast MRI was 29% (104/357 patients). Younger patients and shorter time intervals from the second dose of the vaccine were significantly associated with the development of adenopathy (p = 0.002 for both). Most adenopathy resolved or decreased on follow-up, with 11% of patients presenting persistence of adenopathy up to 64 days after the second dose of the vaccine. Metastatic axillary carcinoma was diagnosed in three patients; all three had a current ipsilateral breast cancer diagnosis.

Conclusions: Vaccine-related adenopathy is a frequent event after COVID-19 vaccination; short-term follow-up is an appropriate clinical approach, except in patients with current ipsilateral breast cancer. Adenopathy may often persist 4-8 weeks after the second dose of the vaccine, thus favoring longer follow-up periods.

Key points: • MRI-detected ipsilateral axillary adenopathy is a frequent benign finding after mRNA COVID-19 vaccination. • Axillary adenopathy following COVID-19 vaccination often persists > 4 weeks after vaccination, favoring longer follow-up periods. • In patients with concurrent ipsilateral breast cancer, axillary adenopathy can represent metastatic carcinoma and follow-up is not appropriate.

Keywords: Breast neoplasms; Lymphadenopathy; Magnetic resonance imaging; Pandemic; Vaccines.

© 2022. The Author(s), under exclusive licence to European Society of Radiology.

PubMed Disclaimer

Seroprevalence of IgM and IgG Against SARS-CoV-2 after Two Doses of Pfizer-BioNTech COVID-19 Vaccine in Women with Breast Cancer.

Almehmadi M, Salih MM, Shafie A, Alsharif A, Alsiwiehr N, El-Askary A, Alzahrani K, Al-Hazmi A, Aljuaid A, Abdulazziz O, Almalki AA, Allahyani M, Eed E, Alharbi AM, Halawi M, Allam HH, Abutawil H, Alosimi E, Gharib AF. Clin Lab. 2022 Nov 1;68(11). doi: 10.7754/Clin.Lab.2022.220316. PMID: 36378000

METHODS: Overall, 103 breast cancer patients were included. Individuals who had had two doses of Pfizer-BioNTech vaccine, patients who were earlier diagnosed with COVID-19 infection, had not finalized immunization plan, or who received the second dose recently were …

5

Lymphadenopathy after the third Covid-19 vaccine.

Özütemiz C, Potter DA, Özütemiz AÖ, Steinberger D. Curr Probl Cancer Case Rep. 2021 Dec;4:100127. doi: 10.1016/j.cpccr.2021.100127. Epub 2021 Oct 30. PMID: 34746900 Free PMC article.

Axillary lymphadenopathy ipsilateral to the vaccination site has been clinically and radiologically reported after administration of COVID-19 vaccines. This can be an important diagnostic dilemma, particularly in cancer patients who are being staged or re-staged, as this benign entity may mimic metastasis, cause unnecessary biopsies and changes in therapy. Here we present a breast cancer patient and a patient with squamous cell carcinoma of the head and neck, who had already received the first two doses of mRNA type COVID-19 vaccines before, now presenting with new hypermetabolic reactive lymphadenopathy on FDG PET/CT after the third booster dose.

Keywords: CDC, The Center for Disease Control; Covid 19; FDA, The United States Food and Drug Administration; RAL, Reactive ipsilateral axillary lymphadenopathy; booster; lymphadenopathy; mRNA; vaccination; vaccine.

 

WHO tilannetiedotus 24.11. 2023 Covid-19 epidemiasta

 Latest WHO official reports for emergency situations. ( Tarkistettu linkki  12.12.2023 keskiyöllä)

 

 https://www.who.int/publications/m/item/covid-19-epidemiological-update---24-november-2023
SARS-CoV-2 variants of interest and variants under monitoring
Geographic spread and prevalence
Globally, during the 28-day period from 23 October to 19 November 2023, 18 719 SARS-CoV-2 sequences were shared through GISAID. In comparison, in the two previous 28-day periods, there were 67 525 and 84 942 sequences shared, respectively. The data are periodically retrospectively updated to include sequences with earlier collection dates, so the number of submissions in a given time period may change.
WHO is currently tracking several SARS-CoV-2 variants, including:
• Four variants of interest (VOIs): XBB.1.5, XBB.1.16, EG.5 and BA.2.86
• Five variants under monitoring (VUMs): DV.7, XBB, XBB.1.9.1, XBB.1.9.2 and XBB.2.3

 
Table 6 shows the number of countries reporting VOIs and VUMs, and their prevalence from epidemiological week 40 (2 to 8 October 2023) to week 44 (30 October to 5 November 2023). The VOIs and VUMs exhibiting increasing trends are highlighted in yellow, those that have remained stable are highlighted in blue, and those with decreasing trends are highlighted in green.

Globally, all VOIs have been detected in all WHO regions, with EG.5 continuing to be the most prevalent VOI, now reported by 89 countries. EG.5 continues to steadily rise in prevalence, accounting for 51.6% of sequences submitted to GISAID in week 44 in comparison to 47.0% in week 40 (Figure 9, Figure 10 and Table 6). This includes two descendent lineages, HK.3 and HV.1, which have been included under EG.5 since 23 October 2023. The last risk evaluation for EG.5 was published on 21 November 2023, with an overall evaluation of low additional public health risk at the global level based on available evidence. This aligns with the risk associated with the other currently circulating VOIs.
 

As of 20 November 2023, BA.2.86 has been designated as a VOI due to the steady increase in its global prevalence in recent weeks. BA.2.86 accounted for 8.9% of sequences in week 44, an increase from 1.8% in week 40 (Figure 10, Table 6). The initial risk evaluation for BA.2.86 was published on 21 November 2023, with an overall evaluation of low public health risk at the global level based on available evidence.

The other VOIs, XBB.1.5 and XBB.1.16, have remained stable and decreased in global prevalence, respectively, during the same period: XBB.1.5 accounted for 8.3% of sequences in week 44, similar to its prevalence in week 40 at 8.5%;    XBB.1.16 accounted for 8.2% of sequences in week 44, a decrease from 15.9% in week 40 (Figure 10, Table 6).
Among the VUMs, DV.7 and XBB have shown stable trends in the reporting period, accounting for 1.9% and 2.3%, respectively, of sequences in week 44 (Table 6).  

 

The other VUMs, XBB.1.9.1, XBB.1.9.2 and XBB.2.3 continue to
decrease in prevalence, accounting for 6.4%, 1.9% and 3.7% of all sequences in week 44, respectively.
Sufficient sequencing data to calculate variant prevalence at the regional level during weeks 40 to 44 were available from three WHO regions: the Region of the Americas, the Western Pacific Region, and the European Region (Table 7). 

 

Among the VOIs, EG.5 was the most prevalent variant, and BA.2.86 showed an increasing trend in all three regions.
XBB.1.5 and XBB.1.6 showed decreasing or stable trends. Amongst the VUMs, all three regions observed decreasing or stable trends for XBB, XBB.1.9.1, XBB.1.9.2 and XBB.2.3. DV.7 presented an increasing trend in the Region of the
Americas and the Western Pacific region, whereas the European region saw a decreasing trend.
With declining rates of testing and sequencing globally (Figure 10), it is increasingly challenging to estimate the severity impact of emerging SARS-CoV-2 variants. There are currently no reported laboratory or epidemiological reports indicating any association between VOIs/VUMs and increased disease severity.

  As shown in Figure 9 and
Figure 10, low and unrepresentative levels of SARS-CoV-2 genomic surveillance continue to pose challenges in adequately assessing the variant landscape