Utilising large scale bio monitoring of nursing home residents for rapid detection of emerging respiratory infections and immunity

PI(s)/Head responsible for the resource:

Mattias Forsell

Host organisation(s):

Umeå University

Resource description:

The PLP2 program “Preparedness by early detection of infections in the elderly” has led to the establishment of a platform where immune responses to vaccination and infections at Swedish nursing homes can be coupled and combined with national registry data of vaccinations, infections, comorbidities and medication. We have provided proof-of-concept that the platform can be utilised to produce information of high national and international interest for the development of prophylactic strategies against COVID-19 infections (Vikström et al, Lancet Regional Health-Europe, 2023 and Blom et al, Lancet Infectious Diseases 2023). Here, we will expand on these studies to demonstrate the versatility of the platform for pandemic preparedness against other respiratory infections of clinical relevance, and for the detection of impending outbreaks in the nursing home population. Hence, we aim to (1) transition from measuring immunity COVID-19 vaccines to addition respiratory infectious agents or vaccines of clinical interest (i.e. RSV, Influenza, Metapneumovirus, etc), (2) to monitoring infectious agents that are circulating in the air of nursing homes and (3) to effectivise sampling and processing strategies of capillary blood samples. The end goals of this proposal is to provide further proof-of-concept of the dynamic potential of the platform for its general use (i.e. looking at any infectious agent/vaccine of interest, not only COVID-19), to demonstrate the potential of the platform to act as an “early warning system” for spread of known and emerging infectious agents within an environment where susceptible individuals live, and to enhance processing and analysis of capillary samples.

Research findings:

We have described the strategy and implementation of large scale capillary blood testing in a self-sampling setting with subsequent high quality analysis (Wigren-Byström, Eurosurveillance 2023). Having validated the strategy, assisted self-sampling was implemented at over 100 Swedish nursing homes in Sept 2021 for longitudinal capillary sampling of nursing home residents at three-to-four-month intervals. By coupling individual immune responses to Covid- 19 vaccination we were able to generate data to identify individual vulnerabilities after Covid- 19 (Vikström et al, Lancet RHE 2023) and the efficacy of bi-annual vaccination schedules for increased protection of the Swedish nursing home population against fatal infection (Blom et al, Lancet ID 2023). As a continuation, and on request by PHAS, we proceeded to evaluate the efficacy of substituting mRNA with Subunit vaccination as an 8th booster in the Swedish nursing home population (Malagi et al, manuscript). In parallel, we have verified that different capillary blood sampling technologies may be implemented in the platform (unpublished). This provides robustness of the platform and demonstrates that we are not dependent on specific vendors for continuation of the project.

We then proceeded with developing a multiplex laboratory analysis system for monitoring RSV-, VZV- and Influenza infections in the same population. There, we find seasonal variation in serological responses to respective infection. Moreover, by inclusion of pathogen-specific IgG or IgM-detection, we have preliminary data that indicate that we can determine “recent” infections by RSV (Moar et al, manuscript). This provides a baseline for future studies of infection pressure, preventive measures such as vaccine programs and to estimate the impact prevention initiatives will have on clinically relevant outcomes for other infections than SARS- CoV-2 infections.

We have also implemented aerobiology capabilities (in collaboration with REPLP1 001 and PLPTEST:G:003) in a subsection of nursing homes within the project. There, we investigated the presence of respiratory virus and measured air quality. We sampled air and surfaces from shared spaces where residents congregate, and monitored the air for particulate matter, CO2, humidity and temperature. Using a sensitive molecular detection assay developed by National Pandemic Center we detected different respiratory viruses in the environment. These measurements will be combined with records of respiratory illness in the residents to evaluate if they can be used in a predictive model.

Impact on prepardness for future pandemics:

Through our interactions with PHAS (weekly / bi-weekly meetings during 2022-2024) we have contributed significantly to the current national vaccination strategies against Covid-19. This was possible by continuously providing pre-publication data that have informed PHAS with regards to intervals and mortality in the study population. These data have also been presented to ECDC and been discussed by PHAS in their own meetings. As such, the project has contributed with social impact with regards to health and quality of life of approximately 80 000 residents at Swedish nursing homes, and provided information on vaccination efficacy to their relatives. Under the assumption that our platform can be maintained over time, the data collected until now suggest that the platform is flexible and can be modified to measure any infection in the population under study. Such capacity to monitor large vulnerable populations will have a significant impact on both monitoring spread of a new pandemic and rapidly evaluate the efficacy of countermeasures, such as vaccines or (potentially) antibiotics or antivirals. Importantly, we have shown that the platform can be implemented quickly at large scale in low-resource settings using a self-sampling or assisted self-sampling strategy, without the need to engage any extra personnel to collect samples.

Contact information:

Mattias Forsell
Associate Professor
Email: mattias.forsell@umu.se