Mucosal COVID-19 vaccines:Risks,benefits and control of the pandemic

Based on mucosal immunization to promote both mucosal and systemic immune responses,next-generation coronavirus disease 2019(COVID-19)vaccines would be administered intranasally or orally.The goal of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccines is to provide adequate immune protection and avoid severe disease and death.Mucosal vaccine candidates for COVID-19 including vector vaccines,recombinant subunit vaccines and live attenuated vaccines are under development.Furthermore,subunit protein vaccines and virus-vectored vaccines have made substantial progress in preclinical and clinical settings,resulting in SARS-CoV-2 intranasal vaccines based on the previously successfully used nasal vaccines.Additional to their ability to trigger stable,protective immune responses at the sites of pathogenic infection,the development of‘specific’mucosal vaccines targeting coronavirus antigens could be an excellent option for preventing future pandemics.However,their efficacy and safety should be confirmed.

Effectiveness and safety of COVID-19 vaccines in patients with diabetes as a factor for vaccine hesitancy

Diabetes mellitus is one of the most common comorbid conditions encountered in patients with severe acute respiratory syndrome coronavirus 2 infection accompanied by significantly increased mortality,prolonged hospital stay,and requirement of invasive mechanical ventilation.This review aims to present the effectiveness and safety profile of available coronavirus disease 2019(COVID-19)vaccines in people with diabetes as a potential cause of hesitancy for vaccination.Data from published research proves a robust immune response following immunization for COVID-19 in diabetic patients with substantial production of virus-neutralizing antibodies;however,the observed immune response was unequivocally weaker than that in individuals without diabetes.This observation was further enhanced by the findings that worse glycemic control was associated with more suppressed antibody production.In contrast,individuals with optimal glycemic control performed similarly to healthy controls.In addition to the need for strict glucose monitoring and adequate diabetes treatment,those findings reinforce the concept of diabetes-induced secondary immune deficiency and necessitate the application of booster doses to diabetic patients with priority.Nevertheless,after vaccination,reported adverse events were not different from those in the general population.No increase in severe adverse events was documented.While single case reports detected transient increases in blood glucose post-vaccination,more extensive trials could not replicate such a relationship.

Hypotheses and facts for genetic factors related to severe COVID-19

Genome-wide association analysis allows the identification of potential candidate genes involved in the development of severe coronavirus disease 2019(COVID-19).Hence,it seems that genetics matters here,as well.Nevertheless,the virus's nature,including its RNA structure,determines the rate of mutations leading to new viral strains with all epidemiological and clinical consequences.Given these observations,we herein comment on the current hypotheses about the possible role of the genes in association with COVID-19 severity.We discuss some of the major candidate genes that have been identified as potential genetic factors associated with the COVID-19 severity and infection susceptibility:HLA,ABO,ACE2,TLR7,ApoE,TYK2,OAS,DPP9,IFNAR2,CCR2,etc.Further study of genes and genetic variants will be of great benefit for the prevention and assessment of the individual risk and disease severity in different populations.These scientific data will serve as a basis for the development of clinically applicable diagnostic and prognostic tests for patients at high risk of COVID-19.

COVID-19 in patients with gastrointestinal stromal tumors: Recommendations for management and vaccination

The coronavirus disease 2019(COVID-19)pandemic profoundly affected the management and treatment of patients with malignancies.Based on the progress reported in the literature,we reviewed the recommendations for treatment and vaccination in patients with gastrointestinal stromal tumor(GIST)during COVID-19.We focus on whether there is a risk and what could be the possible effects of vaccinating patients with GIST/cancer.Since the situation is quickly changing,and the health services have been severely disrupted,the diagnosis,treatment and recommendations for vaccination of these patients against COVID-19 are still not updated.The approval of vaccines in the pandemic gave hope that we would soon be able to return to a more normal life.However,the oncology community needs to adapt and provide the most effective treatment and care models for patients with rare cancer,such as GIST.Collecting data on the impact of vaccination in patients with GIST/cancer also will be beneficial in expanding knowledge about the future planning of treatment strategies and optimizing care in the event of a subsequent pandemic.

Pandemic control-do's and don'ts from a control theory perspective

Managing a pandemic is a difficult task.Pandemics are part of the dynamics of nonlinear systems with multiple different interactive features that co-adapt to each other(such as humans,animals,and pathogens).The target of controlling such a nonlinear system is best achieved using the control system theory developed in engineering and applied in systems biology.But is this theory and its principles actually used in controlling the current coronavirus disease-19 pandemic?We review the evidence for applying principles in different aspects of pandemic control related to different goals such as disease eradication,disease containment,and short-or long-term economic loss minimization.Successful policies implement multiple measures in concordance with control theory to achieve a robust response.In contrast,unsuccessful policies have numerous failures in different measures or focus only on a single measure(only testing,vaccines,etc.).Successful approaches rely on predictions instead of reactions to compensate for the costs of time delay,on knowledge-based analysis instead of trial-and-error,to control complex nonlinear systems,and on risk assessment instead of waiting for more evidence.Iran is an example of the effects of delayed response due to waiting for evidence to arrive instead of a proper risk analytical approach.New Zealand,Australia,and China are examples of appropriate application of basic control theoretic principles and focusing on long-term adaptive strategies,updating measures with the evolution of the pandemic.