Impact of malaria on shaping immunity to EBV in the etiology of Burkitt lymphoma

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This administrative supplement is in response to NOT-CA-21-033 and aims to investigate the impact of the COVID-19 pandemic on Kenyan children diagnosed with endemic Burkitt lymphoma (eBL). The parent R01 CA189806-06 investigates malaria-induced immunoregulatory mechanisms that influence T cell cytotoxicity against EBV-infected B cells and eBL tumors. Kenyan children diagnosed with eBL and a cohort of healthy are being followed longitudinally to test the parent study objectives. The timely addition of COVID-related studies will determine the impact of COVID-19 public health protocols put into place by the Kenyan government in April 2020, on access to care and overall survival for Kenyan children with eBL. The supplemental activities include: 1) implementing a Knowledge, Attitude and Practices (KAP) psychosocial survey to ask parents of children enrolled in our study about COVID-19 and COVID-19 vaccines in order to assess barriers to prompt diagnosis, out-patient treatment compliance and research study participation; 2) SARS-CoV-2 monthly serosurveys which are easily added to our existing multiplex Luminex seroprofiling assay that has been validated by Dr. Moormann’s NCI SeroNet partnership (NIH/NCI 1U01 CA261276-01) with the Frederick National Laboratory standards; 3) SARS-CoV-2 molecular testing to compare variants that infect cancer patients compared to healthy age-matched controls and which may have implications for vaccine efficacy; 4) testing the use of innovative and low-cost digital health technologies to monitor health metrics (skin temperature, breathing and heart rate, etc) of eBL patients during the course of their care when they are out- patients; 5) community engagement activities such as key-informant interviews and focus group discussions to learn more about the impact of the COVID-19 pandemic on cancer prevention and control programs that are well established in Kenya. The immediate outcomes from this supplemental study will be achieved within the year. We will determine how the COVID-19 public health measures have inadvertently impacted health-care access specific to cancer diagnosis and eBL survivorship. With community advice, we will implement strategies to overcome these obstacles, including exploring sustainable use of remote sensing, digital medicine technologies to monitor cancer recovery. If children in our study have been infected with SARS-CoV-2, then we will include this as a cofactor when testing the mechanistic objectives pertaining to immune regulation proposed in the parent study. We do not believe that SARS-CoV-2 will increase the incidence of eBL; however, we are still learning what this virus is capable of and its prolonged effects on multiple organs. In addition, our study will assess COVID-19 variants and vaccine efficacy for eBL patients compared to healthy children. COVID-19 vaccines were introduced in Kenya during March 2021 and we anticipate childhood vaccinations will be recommended to stop the pandemic. This is of concern for immunocompromised cancer patients, who may require a booster to achieve immune protection against SARS-CoV-2.