PREVALENCE OF SARS-COV-2-IGG ANTIBODIES IN CHILDREN WITH CKD OR IMMUNOSUPPRESSION
←
→
Trascrizione del contenuto della pagina
Se il tuo browser non visualizza correttamente la pagina, ti preghiamo di leggere il contenuto della pagina quaggiù
CJASN ePress. Published on June 7, 2021 as doi: 10.2215/CJN.00330121
Prevalence of SARS-CoV-2-IgG Antibodies in Children with
CKD or Immunosuppression
Journal: Clinical Journal of the American Society of Nephrology
Manuscript ID CJASN-0033-01-21.R2
Manuscript Type: Research Letters
Date Submitted by the
15-Apr-2021
Author:
Complete List of Authors: Morello, William; Fondazione IRCCS Cà Granda, Ospedale Maggiore
Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit
Mastrangelo, Antonio; Fondazione IRCCS Cà Granda, Ospedale Maggiore
Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit
Guzzo, Isabella; Bambino Gesù Children’s Hospital, IRCCS, Nephrology
and Dialysis Unit, Pediatric Subspecialties Department
Cusinato, Lisa; University Hospital of Padua, Pediatric Nephrology,
Dialysis and Transplant Unit, Department of Women's and Children's
Health
Petruzzelli, Luigi; Santobono Children's Hospital, Pediatric Nephrology
and Dialysis Unit
Benvenuta, Chiara; Regina Margherita Children’s Hospital, AOU Città
della Salute e della Scienza di Torino, Pediatric Nephrology Unit
Martelli, Laura; Papa Giovanni XXIII Hospital, Paediatric Unit
Dall'Amico, Roberto; Azienda per l'Assistenza Sanitaria n 5 Friuli
Occidentale, Department of Pediatrics
Vianello, Federica Alessandra; Fondazione IRCCS Cà Granda, Ospedale
Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit
Puccio, Giuseppe; University of Palermo, Department of Sciences for
Health Promotion
Massella, Laura; Bambino Gesù Children’s Hospital, IRCCS, Nephrology
and Dialysis Unit, Pediatric Subspecialties Department
Benetti, Elisa; University Hospital of Padua, Pediatric Nephrology,
Dialysis and Transplant Unit, Department of Women's and Children's
Health
Pecoraro, Carmine; Santobono Children’s Hospital, Pediatric Nephrology
and Dialysis Unit
Peruzzi, Licia; Regina Margherita Children’s Hospital, AOU Città della
Salute e della Scienza di Torino, Pediatric Nephrology Unit
Montini, Giovanni; Fondazione IRCCS Cà Granda, Ospedale Maggiore
Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit; University
of Milan, Department of Clinical Sciences and Community Health
COVID-19, SARS-CoV-2 IgG, CKD, immunosuppression, children, chronic
Keywords:
kidney disease, idiopathic nephrotic syndrome
Clinical Journal of the American Society of NephrologyPage 1 of 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Clinical Journal of the American Society of Nephrology
Page 2 of 8
1
2
3 Authors: Morello, William; Mastrangelo, Antonio; Guzzo, Isabella; Cusinato, Lisa; Petruzzelli, Luigi;
4
Benvenuta, Chiara; Martelli, Laura; Dall'Amico, Roberto; Vianello, Federica Alessandra; Puccio,
5
6
Giuseppe; Massella, Laura; Benetti, Elisa; Pecoraro, Carmine; Peruzzi, Licia; Montini, Giovanni
7
8 Title: Prevalence of SARS-CoV-2-IgG Antibodies in Children with CKD or Immunosuppression
9
10 Running head: SARS-CoV-2-IgG in Italian Children with Chronic Nephropathies
11
12 Manuscript Type: Research Letters
13
14
15 Funders: “Associazione del Bambino Nefropatico (ABN onlus)â€, (Grant / Award Number: 'All
16 phases of this study were supported by the “')
17 “La rete del MaReâ€., (Grant / Award Number: 'All phases of this study were supported by the
18 “')
19
20 Financial Disclosure: No L. Annicchiarico Petruzzelli reports employment with Santobono Pausilipon.
21
22
R. Dall'Amico reports employment with Azienda Sanitaria Friuli Occidentale.
23
24
25 I. Guzzo reports employment with Bambino Gesù Children's Hospital.
26
27 L. Martelli reports employment with Ospedale Papa Giovanni XXIII, Bergamo.
28
29 L. Massella reports employment with Bambino Gesù Children's Hospital and Research Institute and
30
serving on the Editorial board of Nephron, section "Case Studies in Genetics."
31
32
33 A. Mastrangelo reports employment with Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
34 Milano.
35
36 G. Montini reports consultancy agreements with Alnyalam and Bayern.
37
38
W. Morello reports employment with Pediatric Nephrology, Dialysis an Transplant Unit,
39
40
41 Fondazione IRCCS Ca''Granda, Ospedale Maggiore Policlinico Milano and receiving honoraria from
42 Sanofi-Genzyme.
43
44 L. Peruzzi reports employment with Regina Margherita Children's Hospital; Citta della Salute e della
45 Scienza di Torino and receiving honoraria from Alnylam, Chiesi, and Dicerna.
46
47
48
G. Puccio reports receiving honoraria from Associazione per il Bambino Nefropatico ABN-Onlus and
49 serving as a scientific advisor or member of EuroMediterranean Biomedical Journal.
50
51 The remaining authors have nothing to disclose.
52
53 Total number of words: 794
54
55
56
57
58
59
60 Clinical Journal of the American Society of NephrologyPage 3 of 8 Copyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version.
1
2 Prevalence of SARS-CoV-2 IgG Antibodies in Children with CKD or Immunosuppression
3
4
5
6
William Morello1*, Antonio Mastrangelo1*, Isabella Guzzo2, Lisa Cusinato 3, Luigi
7
8 Annicchiarico Petruzzelli4, Chiara Benvenuta5, Laura Martelli6, Roberto Dall'Amico7, Federica
9
10 Alessandra Vianello1, Giuseppe Puccio8, Laura Massella2, Elisa Benetti3, Carmine Pecoraro4,
11
12 Licia Peruzzi5, Giovanni Montini1,9 on behalf of the Italian Society of Pediatric Nephrology
13
14
15 * Contributed equally as co-first authors
16
17
18
19 Affiliations:
20 1. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale
21
22 Maggiore Policlinico, Milan, Italy
23
24 2. Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù
25
26
Children’s Hospital, IRCCS, Rome, Italy.
27 3. Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's
28
29 Health, University Hospital of Padua, Italy
30
31 4. Pediatric Nephrology and Dialysis Unit Santobono Children’s Hospital, Naples, Italy
32
5. Pediatric Nephrology Unit, Regina Margherita Children’s Hospital, AOU Città della Salute e
33
34 della Scienza di Torino, Turin, Italy
35
36 6. Paediatric Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
37
38 7. Department of Pediatrics, Azienda per l'Assistenza Sanitaria n 5 Friuli Occidentale,
39 Pordenone, Italy.
40
41 8. Department of Sciences for Health Promotion, University of Palermo, Italy.
42
43 9. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
44
45
46 Address correspondence to: Giovanni Montini, Pediatric Nephrology, Dialysis and Transplant
47
48 Unit, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, University of Milan, Via
49
50 della Commenda, 9, 20122, Milan, Italy.
51
Telephone: +39.02.5503.2883
52
53 Mail to: giovanni.montini@unimi.it
54
55
56
57
58
59
60
Clinical Journal of the American Society of NephrologyCopyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version. Page 4 of 8
1
2 COVID-19 TASK FORCE of the Italian Society of Pediatric Nephrology:
3 Licia Peruzzia (coordinator and president of the Italian Society of Pediatric Nephrology), Luigi
4 Annicchiarico Petruzzellib, Francesca Becheruccic, Elisa Benettid, Chiara Benevenutaa, Milena
5 Brugnarae, Luca Casadiof, Roberto Chimenzg, Giovanni Contig, Ciro Corradoh, Viviana
6
D’Agostinoi, Roberto Dall’Amicoj, Bruno Gianoglioa, Mario Giordanok, Chiara Gualenil, Stefano
7
8 Guarinom, Isabella Guzzon, Angela La Mannab, Claudio La Scolao, Laura Martellip, Laura
9 Massellan, Antonio Mastrangeloi, Marco Materassic, Giovanni Montini i,q, William Morelloi,
10 Antonello Panir, Teresa Papalias, Andrea Pasinio, Carmine Pecorarob, Piernicola Pellicciat, Marco
11 Pennesiu, Fabrizio Pugliesev, Ilse Maria Ratschv, Paola Romagnanic, Rosa Maria Ropertoc, Chiara
12 Tamburelloi, Gianluca Verginew, Antonio Vergorii, Federica Alessandra Vianellou, Enrico
13 Vidalx.
14
15
a. Pediatric Nephrology Unit, Regina Margherita Children’s Hospital, AOU Città della
16 Salute e della Scienza di Torino, Turin, Italy
17 b. Pediatric Nephrology and Dialysis Unit Santobono Children’s Hospital, Naples, Italy
18 c. Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
19 d. Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and
20 Children's Health, University Hospital of Padua, Italy.
21
e. Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric
22
23
Division, University of Verona, Verona, Italy.
24 f. Pediatric Unit, Ravenna, Italy
25 g. Pediatric Nephrology and Rheumatology Unit with Dialysis, AOU G. Martino, Messina,
26 Italy.
27 h. Pediatric Nephrology Unit, Children’s Hospital ‘G. Di Cristina’, A.R.N.A.S. ‘Civico’,
28 Palermo, Italy.
29
i. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda,
30
31 Ospedale Maggiore Policlinico, Milan, Italy
32 j. Department of Pediatrics, Azienda per l'Assistenza Sanitaria n 5 Friuli Occidentale,
33 Pordenone, Italy.
34 k. Nephrology Unit, Giovanni XXIII Children’s Hospital, Bari, Italy.
35 l. Department of Pediatrics, Azienda Ospedaliera Spedali Civili, Brescia, Italy
36 m. Department of Woman, Child and General and Specialized Surgery, Seconda Universita
37
38
degli Studi di Napoli, Napoli, Italy.
39 n. Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù
40 Children’s Hospital, IRCCS, Rome, Italy.
41 o. Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero
42 Universitaria, Policlinico Sant’Orsola-Malpighi, Bologna, Italy.
43 p. Paediatric Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
44
q. Department of Clinical Sciences and Community Health, University of Milan, Milan,
45
46
Italy
47 r. Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari,
48 Italy.
49 s. Annunziata Hospital, Cosenza, Italy
50 t. Department of Paediatrics, University of Chieti-Pescara, Chieti, Italy
51 u. Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy.
52
v. Department of Pediatrics, University of Ancona, Ancona, Italy.
53
54 w. Department of Pediatrics, Infermi Hospital Rimini, ASL Romagna, Italy.
55 x. Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
56
57
58
59
60
Clinical Journal of the American Society of NephrologyPage 5 of 8 Copyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version.
1
2 Abbreviations:
3 SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2
4 CKD: Chronic Kidney Disease
5 COVID-19: 2019 novel coronavirus disease
6
RT-PCR: Real Time Polymerase Chain Reaction
7
8
9 Manuscript word count: 794
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Clinical Journal of the American Society of NephrologyCopyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version. Page 6 of 8
1
2 Coronavirus Disease (COVID-19) rapidly spread from China as a pandemic, Italy being one of
3
4 the most affected Countries worldwide. Unlike adults, children have a milder presentation, even
5 when affected by Chronic Kidney Diseases (CKD) or on immunosuppressive therapy for
6
7 glomerulopathies and kidney transplantation1. In a nationwide study, by the Italian Society of
8
9 Pediatric Nephrology, involving 1572 pediatric patients with kidney diseases requiring
10
immunosuppressive treatment or CKD stages 3-5d, we have previously reported a low
11
12 prevalence (0.2%) of clinically detectable COVID-19 and no severe cases2. As asymptomatic
13
14 infections are common and the testing, early on in the pandemic, was restricted to a limited
15
16 number of children, we implemented a study in order to evaluate the prevalence of SARS-CoV-
17 2-IgG antibodies in the initial cohort.
18
19 The study population included two subgroups of children who were enrolled in our previous
20
21 study2. The Randomized group consisted of 200 children selected by random sampling, stratified
22
23
by geographical area, to be representative of the whole cohort. Testing was extended to their
24 siblings and cohabitants. The Symptomatic group included all 197 children who had reported
25
26 symptoms suggestive for a viral infection in the original cohort, including 29 subjects from the
27
28 Randomized group (Figure 1).
29
The serological testing for SARS-CoV-2-IgG was initiated 3 months after the clinical study and
30
31 was conducted from July 15th to September 15th, 2020, by a COVID-19 Rapid Test (Model:
32
33 GCCOV-402a). The test has a sensitivity of 93% and a specificity of 99% for IgG, compared to
34
35 Real Time Polymerase Chain Reaction (RT-PCR).3 The rate of seroprevalence was compared
36 with the pediatric report from the Italian Ministry of Health together with the Italian National
37
38 Institute of Statistics,4 and the clinical prevalence of our previous study.2 The study was approved
39
40 by the local Ethics Committees of each participating center.
41
42
As regards the randomized group, a total of 178 patients (median age 11 years), 90 siblings
43 (median age 10 years) and 271 cohabitants (median age 42 years) were tested. Twenty-two
44
45 families denied the consent and 85 cohabitants were not tested due to the restrictions in place for
46
47 the pandemic. Among the enrolled patients, 98 had a glomerular disease treated with
48
immunosuppressive agents (from 1 to 3), 36 were kidney transplant recipients, 32 had CKD and
49
50 12 were on dialysis. 29/178 had reported nonspecific infectious symptoms during the pandemic
51
52 peak.
53
54 A positive test for SARS-CoV-2-IgG was detected in 3/178 patients (1.7%), 6/90 (7%) siblings,
55 and 9/271 (3%) cohabitants. Only the difference between patients and siblings was statistically
56
57 significant (p=0.03; chi-square test). As expected, in the randomized group, patients who had
58
59 previously reported nonspecific infectious symptoms were more likely to be found positive,
60
Clinical Journal of the American Society of NephrologyPage 7 of 8 Copyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version.
1
2 compared to those who had not (2/29 vs 1/149; p=0.02; chi-square test). The seroprevalence in
3
4 asymptomatic patients was 0.7%.
5 Among the three positive patients, two were transplant recipients, with a history of fever and
6
7 upper respiratory tract infection respectively, and one was an asymptomatic child on
8
9 immunosuppression for idiopathic nephrotic syndrome. In all cases, SARS-CoV-2 infection was
10
not previously documented by swab RT-PCR testing. No child required hospitalization,
11
12 experienced multisystem inflammatory syndrome or worsening of renal function.
13
14 Furthermore, the percentage of children with kidney diseases who tested positive for SARS-
15
16 CoV-2-IgG in our sample was not statistically different from the corresponding Italian healthy
17 population aged 0-17 years (1.7% vs 2.2%; p=0.54; chi-square test).4 Similar to the general
18
19 Italian population,4 in our series the prevalence of humoral response was found to be 8.5 times
20
21 higher than the clinical prevalence of SARS-CoV-2 infection identified in our previous study
22
23
(1.7% vs 0.2%).
24 Overall, during the study we identified SARS-CoV-2 spreading in nine families, all living in the
25
26 most affected areas of Italy: Milan (6), Bergamo (2), and Turin (1). In four families only one
27
28 subject tested positive, none of which was the nephropathic child. This supports the low risk of
29
infection in our population.
30
31 Regarding the Symptomatic group, 161 of 197 children who reported symptoms (mainly upper
32
33 respiratory tract infections and fever) from our previous study were tested, including 29 subjects
34
35 from the Randomized group. Even in this population, potentially considered at higher risk of
36 previous SARS-CoV-2 infection, the seroprevalence was low, with only 6 children (4%) positive
37
38 for SARS-CoV-2-IgG.
39
40 The study has some limitations, such as the relatively small numbers and the timing when
41
42
serological testing was performed. However, since the humoral response to SARS-CoV-2 is
43 proven to last at least 4 months after infection5, our results should not be affected.
44
45 In conclusion, the serological assessment may detect previous asymptomatic infections, not
46
47 clinically identified. Nevertheless, the seroprevalence of SARS-CoV-2 antibodies in pediatric
48
patients with kidney diseases is low and similar to that of general pediatric population.
49
50 According to our data, we do not suggest reducing immunosuppressive therapy in this
51
52 population. Moreover, we do not recommend more stringent protective measures, compared to
53
54 healthy peers.
55
56
57
58
59
60
Clinical Journal of the American Society of NephrologyCopyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version. Page 8 of 8
1
2 Disclosures:
3
4 L. Annicchiarico Petruzzelli reports employment with Santobono Pausilipon.
5 R. Dall'Amico reports employment with Azienda Sanitaria Friuli Occidentale.
6
7 I. Guzzo reports employment with Bambino Gesù Children's Hospital.
8
9 L. Martelli reports employment with Ospedale Papa Giovanni XXIII, Bergamo.
10
L. Massella reports employment with Bambino Gesù Children's Hospital and Research Institute
11
12 and serving on the Editorial board of Nephron, section "Case Studies in Genetics."
13
14 A. Mastrangelo reports employment with Fondazione IRCCS Ca' Granda Ospedale Maggiore
15
16 Policlinico Milano.
17 G. Montini reports consultancy agreements with Alnyalam and Bayern.
18
19 W. Morello reports employment with Pediatric Nephrology, Dialysis an Transplant Unit,
20
21 Fondazione IRCCS Ca''Granda, Ospedale Maggiore Policlinico Milano and receiving honoraria
22
23
from Sanofi-Genzyme.
24 L. Peruzzi reports employment with Regina Margherita Children's Hospital; Citta della Salute e
25
26 della Scienza di Torino and receiving honoraria from Alnylam, Chiesi, and Dicerna.
27
28 G. Puccio reports receiving honoraria from Associazione per il Bambino Nefropatico ABN-
29
Onlus and serving as a scientific advisor or member of EuroMediterranean Biomedical Journal.
30
31 The remaining authors have nothing to disclose.
32
33
34
35 Funding: All phases of this study were supported by the “Associazione del Bambino
36 Nefropatico (ABN onlus)” and “La rete del MaRe”.
37
38
39
40 Acknowledgments:
41
42
A. Mastrangelo, G. Montini, W. Morello, and L. Peruzzi conceptualized and designed the study;
43 A. Mastrangelo and W.Morello designed the data collection instrument; G. Montini and L.
44
45 Peruzzi coordinated data collection; I. Guzzo, L. Cusinato, L. Annicchiarico Petruzzelli, C.
46
47 Benvenuta, L. Martelli, R. Dall'Amico, F.A. Vianello, L. Massella, E. Benetti, and C. Pecoraro
48
collected data; A. Mastrangelo, G. Montini, W. Morello, and L. Peruzzi supervised data
49
50 collection; G. Puccio performed statistical analysis; A. Mastrangelo and W. Morello drafted the
51
52 initial manuscript; L. Annicchiarico Petruzzelli, C. Benvenuta, E. Benetti, L. Cusinato, R.
53
54 Dall'Amico, I. Guzzo, L. Martelli, R, L. Massella, A. Mastrangelo, W. Morello, C. Pecoraro, G.
55 Puccio, and F.A. Vianello reviewed and revised the manuscript; G. Montini and L. Peruzzi
56
57 critically reviewed the manuscript for important intellectual content; and all authors approved the
58
59 final manuscript as submitted and agree to be accountable for all aspects of the work.
60
Clinical Journal of the American Society of NephrologyPage 9 of 8 Copyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version.
1
2 W. Morello and A. Mastrangelo contributed equally to this work as co-first authors.
3
4
5 Figure 1
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32 Figure 1. Study population: The Randomized group included 200 children, selected by random
33
34 sampling, stratified by geographical area to be representative of the whole cohort. The
35 Symptomatic group included all children who had reported symptoms suggestive for a viral
36
37 infection during the previous study, for a total of 197 subjects. 29 enrolled patients belonged to
38
39 both groups.
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Clinical Journal of the American Society of NephrologyCopyright 2021 by ASN, Published Ahead of Print on 6/7/21, Accepted/Unedited Version. Page 10 of 8
1
2 REFERENCES
3
4
5 1. Marlais M, Wlodkowski T, Vivarelli M, Pape L, Tönshoff B, Schaefer F, Tullus K: The
6
7 severity of COVID-19 in children on immunosuppressive medication. Lancet Child
8
9 Adolesc. Heal. 4: e17–e18, 2020
10
2. Mastrangelo A, Morello W, Vidal E, Guzzo I, Annicchiarico Petruzzelli L, Benetti E,
11
12 Materassi M, Giordano M, Pasini A, Corrado C, Puccio G, Chimenz R, Pecoraro C,
13
14 Massella L, Peruzzi L, Montini G: Impact of COVID-19 Pandemic in Children with CKD
15
16 or Immunosuppression. Clin. J. Am. Soc. Nephrol. CJN.13120820, 2020
17 3. Hoffman T, Nissen K, Krambrich J, Rönnberg B, Akaberi D, Esmaeilzadeh M, Salaneck
18
19 E, Lindahl J, Lundkvist Å: Evaluation of a COVID-19 IgM and IgG rapid test; an efficient
20
21 tool for assessment of past exposure to SARS-CoV-2. Infect. Ecol. Epidemiol. 10: 2020
22
23
4. https://www.istat.it/it/files/2020/08/ReportPrimiRisultatiIndagineSiero.pdf, Accessed on
24 2020 Dec 23rd
25
26 5. Gudbjartsson DF, Norddahl GL, Melsted P, Gunnarsdottir K, Holm H, Eythorsson E,
27
28 Arnthorsson AO, Helgason D, Bjarnadottir K, Ingvarsson RF, Thorsteinsdottir B,
29
Kristjansdottir S, Birgisdottir K, Kristinsdottir AM, Sigurdsson MI, Arnadottir GA,
30
31 Ivarsdottir E V., Andresdottir M, Jonsson F, Agustsdottir AB, Berglund J, Eiriksdottir B,
32
33 Fridriksdottir R, Gardarsdottir EE, Gottfredsson M, Gretarsdottir OS, Gudmundsdottir S,
34
35 Gudmundsson KR, Gunnarsdottir TR, Gylfason A, Helgason A, Jensson BO, Jonasdottir
36 A, Jonsson H, Kristjansson T, Kristinsson KG, Magnusdottir DN, Magnusson OT,
37
38 Olafsdottir LB, Rognvaldsson S, le Roux L, Sigmundsdottir G, Sigurdsson A,
39
40 Sveinbjornsson G, Sveinsdottir KE, Sveinsdottir M, Thorarensen EA, Thorbjornsson B,
41
42
Thordardottir M, Saemundsdottir J, Kristjansson SH, Josefsdottir KS, Masson G,
43 Georgsson G, Kristjansson M, Moller A, Palsson R, Gudnason T, Thorsteinsdottir U,
44
45 Jonsdottir I, Sulem P, Stefansson K: Humoral Immune Response to SARS-CoV-2 in
46
47 Iceland. N. Engl. J. Med. 383: 1724–1734, 2020
48
49
50
51
52
53
54
55
56
57
58
59
60
Clinical Journal of the American Society of NephrologyPuoi anche leggere
