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Effects of Biological Sex and Pregnancy on SARS-CoV-2 Pathogenesis and Vaccine Outcomes

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Sex and Gender Differences in Infection and Treatments for Infectious Diseases

Part of the book series: Current Topics in Microbiology and Immunology ((CT MICROBIOLOGY,volume 441))

Abstract

SARS-CoV-2 is the causative agent of COVID-19 in humans and has resulted in the death of millions of people worldwide. Similar numbers of infections have been documented in males and females; males, however, are more likely than females to be hospitalized, require intensive care unit, or die from COVID-19. The mechanisms that account for this are multi-factorial and are likely to include differential expression of ACE2 and TMPRSS2 molecules that are required for viral entry into hosts cells and sex differences in the immune response, which are due to modulation of cellular functions by sex hormones and differences in chromosomal gene expression. Furthermore, as comorbidities are also associated with poorer outcomes to SARS-CoV-2 infection and several comorbidities are overrepresented in males, these are also likely to contribute to the observed sex differences. Despite their relative better prognosis following infection with SARS-CoV-2, females do have poorer outcomes during pregnancy. This is likely to be due to pregnancy-induced changes in the immune system that adversely affect viral immunity and disruption of the renin-angiotensin system. Importantly, vaccination reduces the severity of disease in males and females, including pregnant females, and there is no evidence that vaccination has any adverse effects on the outcomes of pregnancy.

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Authors and Affiliations

  1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Janna R. Shapiro & Sabra L. Klein

  2. Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK

    Craig W. Roberts, Kasandra Arcovio & Lisa Reade

  3. W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Sabra L. Klein & Santosh Dhakal

  4. Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA

    Santosh Dhakal

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  1. Janna R. Shapiro
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Correspondence to Santosh Dhakal .

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  1. W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Sabra L. Klein

  2. Department of Parasitology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK

    Craig W. Roberts

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Shapiro, J.R., Roberts, C.W., Arcovio, K., Reade, L., Klein, S.L., Dhakal, S. (2023). Effects of Biological Sex and Pregnancy on SARS-CoV-2 Pathogenesis and Vaccine Outcomes. In: Klein, S.L., Roberts, C.W. (eds) Sex and Gender Differences in Infection and Treatments for Infectious Diseases. Current Topics in Microbiology and Immunology, vol 441. Springer, Cham. https://doi.org/10.1007/978-3-031-35139-6_4

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