RGUHS Nat. J. Pub. Heal. Sci Vol No: 16 Issue No: 3 pISSN:
Dear Authors,
We invite you to watch this comprehensive video guide on the process of submitting your article online. This video will provide you with step-by-step instructions to ensure a smooth and successful submission.
Thank you for your attention and cooperation.
1Government Dental College and Research Institute, Bangalore, Karnataka, India.
2Dr. Renuga S, Postgraduate Student, Department of Oral Pathology and Microbiology, Government Dental College and Research Institute, Bangalore.
3Department of Oral Pathology and Microbiology, Government Dental College and Research Institute, Bangalore, Karnataka, India.
4Department of Oral Pathology and Microbiology, Government Dental College and Research Institute, Bangalore, Karnataka, India.
5Department of Oral Pathology and Microbiology, Government Dental College and Research Institute, Bangalore, Karnataka, India.
6Department of Oral Pathology and Microbiology, Government Dental College and Research Institute, Bangalore, Karnataka, India.
*Corresponding Author:
Dr. Renuga S, Postgraduate Student, Department of Oral Pathology and Microbiology, Government Dental College and Research Institute, Bangalore., Email: renugasampath2795@gmail.com
Abstract
Background: The Corona virus spread like a wild fire and took millions of lives worldwide. New variants with new symptoms are evolving periodically. The complete understanding of virus and its virulence is much needed to save lives. The present study on susceptibility and severity of Corona virus among the individuals belonging to various blood groups will help in better understanding of this deadly infection.
Aim: To study the susceptibility and severity of COVID infection among the previously COVID infected individuals belonging to different blood groups.
Method: This was an online questionnaire survey which included 353 COVID infected individuals. The questionnaire was prepared in Google forms based on the required data and was circulated on various social media platforms.
Results: A significant difference was noted among the individuals of various blood groups with respect to COVID symptoms (especially diarrhoea), frequency of COVID infection, mode of treatment, breathlessness among the hospitalized individuals, post COVID complications and speed of recovery.
Conclusion: Elaborate studies on susceptibility and severity of infection among various blood groups may serve as an efficient biomarker and also effective tool for triaging the high-risk groups. This would further help to take precautionary steps in treating individuals belonging to more susceptible blood groups.
Keywords
Downloads
-
1FullTextPDF
Article
Introduction
The Corona virus severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) spread like a wild fire throughout the world and took millions of lives. Added to this, at regular intervals of time, new variants and new strains are giving rise to next waves. Some people experienced mild symptoms while others had to be hospitalized requiring ventilation. Hence triaging of Coronavirus disease 2019 (COVID) infected patients is critical and challenging.1
The role of zoonotic links, spillover conjuncture among animals, cross-species transmission and human transmission before acquiring the direct human-to-human contact are notable.2-4 This cross-species transmission agent such as virus and its virions further cause severe respiratory illness that results in pneumonia, cardiac arrest and multi-organ failure.
The term ‘Corona virus’ is derived from Latin word “corona” which means “crown”, representing the spike proteins (peplomers). These spike proteins project over the virus envelope.4,5
These spike proteins help the virus receptors present in bird’s and animal’s bodies to bind with other potentially competent hosts, especially humans. The alterations in spike proteins can result in zoonotic spilling and cross over between diverse species.6
Structure of Corona virus
The Corona virus comprises of spherical envelope with single-stranded RNA and helical symmetry. It belongs to the order “Nidovirales”. The subfamily is further classified into four genera namely- alpha, beta, gamma and delta Corona viruses. Among these genera, only alpha and beta Corona virus have tendency to infect human beings due to which they are assigned as human CoV (HCoVs). The Alpha Corona virus includes HCoVNL63 and HCoV-229E and beta Corona virus includes HCoV-HKU1, HCoV-OC43, MERSCoV, SARS-CoV-1 and SARS-CoV2.7,10 In total this family includes seven viruses, of which four produce mild respiratory illness, other three (current SARS-CoV-2, SARSCoV-1, MERS) are virulent resulting in high mortality rates.9
These viruses bind to the receptors present in host body (bats, rodents, civets, cats, Malayan pangolins, camels, among other potentially competent hosts and humans) through spike proteins.11-13 Alterations in spike proteins can result in zoonotic spilling and cross over among different species. Additionally, genomic similarities between the SARS-COVID 2 confirmed their origin from bats as their natural ancestral host.14-18
The RNA genomes of the Corona virus proves to be the largest (27-32 kb) of all RNA viruses.8 It comprises of enveloped membrane with 4-5 proteins attached over it. The beta family is made up of four proteins, among which SEMN is notable. SEMN is elaborated as S-spike protein, E- envelope protein, M- membrane protein and N-nucleocapsid protein. The alpha family along with four proteins SEMN, additionally contains HE protein.8
ABO blood grouping
The discovery of ABO blood grouping by Austin immunologist Karl Landsteiner in 1900 to explain the phenomenon of RBC agglutination is a well-documented hypothesis. Various experimental analysis have proved that a significant relation between ABO blood grouping and susceptibility, as well as resistance to various infections and infectious diseases exists.19,20 Blood group antigens represent polymorphic traits that are inherited among individuals, thus becoming an area of interest in view of epidemiological studies.
So, the present study aimed to determine the susceptibility and severity of COVID infection among previously infected individuals belonging to different blood groups.
Materials and Methods
It was an online questionnaire survey which included 353 COVID infected individuals.
The online survey was created on Google forms and was circulated on various social media platforms. Participants affected by COVID-19 received a brief explanation of the study and were asked to fill the form and submit their responses online after providing informed consent. The questionnaire was prepared based on required data.
The Google form created included questions on the following:
Statistical analysis
SPSS (Statistical Package for Social Sciences) version 20. (IBM SPASS statistics, IBM Corp. released 2011] was used to perform the statistical analysis.
• Inferential statistics like Chi-square test was applied for qualitative variables.
• The level of significance was set at 5%.
Discussion
According to our study results, there exists a significant difference among the individuals of various blood groups with respect to COVID symptoms (especially diarrhea), frequency of COVID infection, mode of treatment, breathlessness among the hospitalized individuals, post COVID complication and speed of recovery. ABO antibodies, holding receptors for antigens (viruses, bacteria, etc.) facilitate the colonization and play a significant role in innate immunity.21
Harris et al. 22 suggested that among all the blood groups, O group individuals are more prone to cholera (Vibrio cholera strains O1 El Tor and O139); however, according to Glass RI et al., blood group B is more prone to cholera, whereas blood group O is less prone for the same.
In 1996, in Scotland, there was a sudden outbreak of gastrointestinal infections by E.coli and the mortality rate of about 87.5% of patients with blood group O was documented.23 Individuals with blood group A showed more susceptibility to pandemic spread of smallpox in Europe. The past studies have suggested that a correlation between blood group and genetic link of susceptibility of infectious diseases exists.24-27
According to previous studies, several diseases have associations with ABO polymorphism. This association was demonstrated through statistical analysis as well as Genome-wide Association studies (GWAS). Among these GWAS, the SNP (single nucleotide polymorphism) markers are noteworthy. These GWAS not only evaluate the presence or absence of association between various diseases with ABO blood groups, but also determines how significant that association is.28
In 2020, Zhao et al. conducted a study among 2173 COVID-19 confirmed patients from hospitals in Wuhan and Shenzhen, China. The study correlated the COVID infected patient’s ABO blood group and concluded that among the blood groups, blood group A was associated with higher risk, whereas blood group O was associated relatively with a lower risk.7 However, this study had certain limitations like smaller sample size, lack of information on demographic details and influence of systemic conditions on multivariate analysis.
Yamamoto in 2020 suggested that according to Karl Landsteiner law of agglutination, S protein produced in A, B and AB blood group individuals, with their antigens will produce their respective antibodies. These antibodies would block interaction with S protein and ACE receptors.5
In 2020, Tanigawa et al.29 reviewed the literature and provided currently updated significant analysis on association of COVID-19 with phenotypes. Across five populations in UK Biobank, the authors analyzed human leukocyte antigen and ABO blood type frequencies in 337,579 cases. The results suggested that there exists a significant and consistent risk reduction in blood group O and the result is in accordance with the study conducted by Zhao et al. 7 The study conducted by Bommanavar et al.6 in 2020 concluded that males with B+ve blood group are at higher risk compared to other blood groups.
Strength
The study attempted to analyze susceptibility and severity of COVID infection among the ABO groups with respect to various aspects such as COVID symptoms, post COVID complications, frequency of infection, vaccination status, mode of treatment, recovery status.
Limitations
We did not include details such as personal habits (smoking, alcohol), diet, socioeconomic status,geographic details. Inclusion of larger sample size could have yielded more reliable results.
Conclusion
According to our study results, a significant difference among the ABO group individuals with respect to susceptibility and severity of COVID infection exists. Further studies in this area should be encouraged which may serve as an efficient biomarker and an effective tool for triaging the high-risk groups. This would also help to take precautionary measures to treat susceptible individuals.
Conflict of Interest
None
Supporting File
References
- Samra S, Habeb M, Nafae R. ABO groups can play a role in susceptibility and severity of COVID-19. The Egypt J Bronchol 2021;15(1):1-5.
- Rodriguez-Morales AJ, Bonilla-Aldana DK, Tiwari R, Sah R, Rabaan AA, Dhama K. COVID-19, an emerging coronavirus infection: Current scenario and recent developments - An overview. J Pure Appl Microbiol 2020;14:1-8.
- Zhu N, Zhang D, Wang W. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.
- Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, HolguinRivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623.
- Yamamoto F. ABO blood groups and SARS-CoV-2 infection. 2020.
- Bommanavar S, Smitha T. ABO blood grouping and COVID 19: Is there any correlation in suspectibility? J Oral Maxillofac Pathol 2020;24(2):212-216.
- Zhao J, Yang Y, Huang H, Li D, Gu D, Lu X, et al. Relationship Between the ABO Blood Group and the Coronavirus Disease 2019 (COVID-19) Susceptibility. Clin Infect Dis. 2021;73(2):328-331.
- Rabaan AA, Al-Ahmed SH, Haque S, Sah R, Tiwari R, Malik YS, et al. SARS-CoV-2, SARS-CoV, and MERS-CoV: A comparative overview. Infez Med 2020;2:174-84.
- Chan JF, Lau SK, To KK, Cheng VC, Woo PC, Yuen KY. Middle East respiratory syndrome coronavirus: Another zoonotic beta coronavirus causing SARS-like disease. Clin Microbiol Rev 2015;28:465-522.
- Wassenaar TM, Zou Y. 2019_nCoV/SARS-CoV-2: Rapid classification of beta coronaviruses and identification of traditional Chinese medicine as potential origin of zoonotic coronaviruses. Lett Appl Microbiol 2020;70:342-8.
- Wang LF, Eaton BT. Bats, civets and the emergence of SARS. Curr Top Microbiol Immunol 2007;315:325-44.
- Paraskevis D, Kostaki EG, Magiorkinis G, Panayiotakopoulos G, Sourvinos G, Tsiodras S. Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event. Infect Genet Evol 2020;79:104212.
- Xiao K, Zhai J, Feng Y, Zhou N, Zhang X, Zou JJ, et al. Isolation and characterization of 2019-nCoVlike Coronavirus from Malayan pangolins. Nature 2020;583(7815):286-289.
- Riccucci M. Bats as materia medica: An ethnomedical review and implications for conservation. Vespertilio 2013;16:249-70.
- Hu B, Ge X, Wang LF, Shi Z. Bat origin of human coronaviruses. Virol J 2015;12:221.
- Li X, Song Y, Wong G, Cui J. Bat origin of a new human coronavirus: There and back again. Sci China Life Sci 2020;63:461-2.
- Malik YS, Sircar S, Bhat S, Sharun K, Dhama K, Dadar M, et al. Emerging novel coronavirus (2019- nCoV) - current scenario, evolutionary perspective based on genome analysis and recent developments. Vet Q 2020;40:68-76.
- Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270-3.
- Imberty A, Varrot A. Microbial recognition of human cell surface glycoconjugates. Curr Opin Struct Biol 2008;18:567-76.
- de Mattos LC. Structural diversity and biological importance of ABO, H, Lewis and secretor histo-blood group carbohydrates. Braz J Hematol Hemother 2016;38:331-40.
- Cooling L. Blood groups in infection and host susceptibility. Clin Microbiol Rev 2015;28:801-70.
- Harris JB, Khan AI, LaRocque RC, Dorer DJ, Chowdhury F, Faruque AS, et al. Blood group, immunity, and risk of infection with Vibrio cholerae in an area of endemicity. Infect Immun 2005;73:7422-7.
- Blackwell CC, Dundas S, James VS, Mackenzie DA, Braun JM, Alkout AM, et al. Blood group and susceptibility to disease caused by Escherichia coli O157. J Infect Dis 2002;185:393-6.
- Duncan SR, Scott S, Duncan CJ. Reappraisal of the historical selective pressures for the CCR5 Delta 32 mutation. J Med Genet 2005;42:205-8.
- Cohn SK Jr., Weaver LT. The black death and AIDS: CCR5 delta 32 in genetics and history. Q J Med 2006;99:497-503.
- Oriol R, Danilovs J, Hawkins BR. A new genetic model proposing that the Se gene is a structural gene closely linked to the H gene. Am J Hum Genet 1981;33:421-31.
- Kukowska-Latallo JF, Larsen RD, Nair RP, Lowe JB. A cloned human cDNA determines expression of a mouse stage-specific embryonic antigen and the Lewis blood group alpha(1,3/1,4) fucosyltransferase. Genes Dev 1990;4(8): 1288-303.
- Johansson Å, Alfredsson J, Eriksson N, Wallentin L, Siegbahn A. Genome-wide association study identifies that the ABO blood group system influences interleukin-10 levels and the risk of clinical events in patients with acute coronary syndrome. PloS One 2015;10(11):e0142518.
- Tanigawa Y, Rivas MA. Initial review and analysis of COVID-19 host genetics and associated phenotypes. [Preprint] 2020:2020030356.