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Kumar S, Bhowmik B. EffiCOVID-net: A highly efficient convolutional neural network for COVID-19 diagnosis using chest X-ray imaging. Methods 2025; 240:81-100. [PMID: 40252941 DOI: 10.1016/j.ymeth.2025.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 04/04/2025] [Accepted: 04/14/2025] [Indexed: 04/21/2025] Open
Abstract
The global COVID-19 pandemic has drastically affected daily life, emphasizing the urgent need for early and accurate detection to provide adequate medical treatment, especially with limited antiviral options. Chest X-ray imaging has proven crucial for distinguishing COVID-19 from other respiratory conditions, providing an essential diagnostic tool. Deep learning (DL)-based models have proven highly effective in image diagnostics in recent years. Many of these models are computationally intensive and prone to overfitting, especially when trained on limited datasets. Additionally, conventional models often fail to capture multi-scale features, reducing diagnostic accuracy. This paper proposed a highly efficient convolutional neural network (CNN) called EffiCOVID-Net, incorporating diverse feature learning units. The proposed model consists of a bunch of EffiCOVID blocks that incorporate several layers of convolution containing (3×3) filters and recurrent connections to extract complex features while preserving spatial integrity. The performance of EffiCOVID-Net is rigorously evaluated using standard performance metrics on two publicly available COVID-19 chest X-ray datasets. Experimental results demonstrate that EffiCOVID-Net outperforms existing models, achieving 98.68% accuracy on the COVID-19 radiography dataset (D1), 98.55% on the curated chest X-ray dataset (D2), and 98.87% on the mixed dataset (DMix) in multi-class classification (COVID-19 vs. Normal vs. Pneumonia). For binary classification (COVID-19 vs. Normal), the model attains 99.06%, 99.78%, and 99.07% accuracy, respectively. Integrating Grad-CAM-based visualizations further enhances interpretability by highlighting critical regions influencing model predictions. EffiCOVID-Net's lightweight architecture ensures low computational overhead, making it suitable for deployment in resource-constrained clinical settings. A comparative analysis with existing methods highlights its superior accuracy, efficiency, and robustness performance. However, while the model enhances diagnostic workflows, it is best utilized as an assistive tool rather than a standalone diagnostic method.
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Affiliation(s)
- Sunil Kumar
- Maharshi Patanjali CPS Lab, BRICS Laboratory, Department of Computer Science and Engineering, National Institute of Technology Karnataka, Mangalore 575025, Karnataka, India.
| | - Biswajit Bhowmik
- Maharshi Patanjali CPS Lab, BRICS Laboratory, Department of Computer Science and Engineering, National Institute of Technology Karnataka, Mangalore 575025, Karnataka, India
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2
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Ortiz-Brizuela E, Carabali M, Jiang C, Merckx J, Talbot D, Schnitzer ME. Potential biases in test-negative design studies of COVID-19 vaccine effectiveness arising from the inclusion of asymptomatic individuals. Am J Epidemiol 2025; 194:844-856. [PMID: 39160637 PMCID: PMC11879563 DOI: 10.1093/aje/kwae288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 05/21/2024] [Accepted: 08/13/2024] [Indexed: 08/21/2024] Open
Abstract
The test-negative design (TND) is a popular method for evaluating vaccine effectiveness (VE). A "classical" TND study includes symptomatic individuals tested for the disease targeted by the vaccine to estimate VE against symptomatic infection. However, recent applications of the TND have attempted to estimate VE against infection by including all tested individuals, regardless of their symptoms. In this article, we use directed acyclic graphs and simulations to investigate potential biases in TND studies of COVID-19 VE arising from the use of this "alternative" approach, particularly when applied during periods of widespread testing. We show that the inclusion of asymptomatic individuals can potentially lead to collider stratification bias, uncontrolled confounding by health and healthcare-seeking behaviors (HSBs), and differential outcome misclassification. While our focus is on the COVID-19 setting, the issues discussed here may also be relevant in the context of other infectious diseases. This may be particularly true in scenarios where there is either a high baseline prevalence of infection, a strong correlation between HSBs and vaccination, different testing practices for vaccinated and unvaccinated individuals, or settings where both the vaccine under study attenuates symptoms of infection and diagnostic accuracy is modified by the presence of symptoms.
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Affiliation(s)
- Edgar Ortiz-Brizuela
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec H3A 1G1, Canada
- Unidad de Investigación en Salud en el Trabajo, Instituto Mexicano del Seguro Social, Ciudad de México 6720, México
| | - Mabel Carabali
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec H3A 1G1, Canada
| | - Cong Jiang
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec H3A 1G1, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Université Laval, Québec, Québec G1V 0A6, Canada
| | - Mireille E Schnitzer
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec H3T 1J4, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec H3N 1X9, Canada
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Riedmann U, Chalupka A, Richter L, Sprenger M, Rauch W, Schenk H, Krause R, Willeit P, Oberacher H, Høeg TB, Ioannidis JPA, Pilz S. Estimates of SARS-CoV-2 Infections and Population Immunity After the COVID-19 Pandemic in Austria: Analysis of National Wastewater Data. J Infect Dis 2025:jiaf054. [PMID: 39964838 DOI: 10.1093/infdis/jiaf054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 01/28/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Postpandemic surveillance data on coronavirus disease 2019 (COVID-19) infections may help inform future public health policies regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, vaccinations, or other COVID-19 measures. We estimate the total SARS-CoV-2 infections in Austria after the end of the pandemic from wastewater data and utilize these estimates to calculate the average national levels of SARS-CoV-2 infection protection and COVID-19 death protection. METHODS We estimated the total SARS-CoV-2 infections in Austria after the end of the pandemic (5 May 2023, per World Health Organization) up to May 2024 from wastewater data using a previously published model. These estimates were used in an agent-based model (ABM) to estimate average national levels of SARS-CoV-2 infection protection and COVID-19 death protection, based on waning immunity estimates of infections and vaccination in previous literature. RESULTS We estimate approximately 3.2 million infections between 6 May 2023 and 23 May 2024, with a total of 17.8 million infections following 12 May 2020. The ABM estimates that the national average death protection was approximately 82% higher in May 2024 than before the pandemic. This represents a relative decrease of 8% since May 2023. It also shows that 95% of people in Austria were infected with SARS-CoV-2 at least once by May 2024. National infection protection remained relatively low after the onset of Omicron. CONCLUSIONS These findings should be considered for public health decisions on SARS-CoV-2 testing practices and vaccine booster administrations.
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Affiliation(s)
- Uwe Riedmann
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Alena Chalupka
- Institute for Surveillance and Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Lukas Richter
- Institute for Surveillance and Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety, Vienna, Austria
- Institute of Statistics, Graz University of Technology, Graz, Austria
| | - Martin Sprenger
- Institute of Social Medicine and Epidemiology, Medical University Graz, Graz, Austria
| | - Wolfgang Rauch
- Department of Environmental Engineering, University of Innsbruck, Innsbruck, Austria
| | - Hannes Schenk
- Department of Environmental Engineering, University of Innsbruck, Innsbruck, Austria
| | - Robert Krause
- Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Peter Willeit
- Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics, and Informatics, Medical University of Innsbruck, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Ignaz Semmelweis Institute, Interuniversity Institute for Infection Research, Vienna, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine, Medical University of Innsbruck, Innsbruck, Austria
- Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tracy Beth Høeg
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Clinical Research, University of Southern Denmark, Syddanmark, Denmark
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California, USA
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Horino T, Ono K, Sugawara E, Matsumoto T, Yotsuyanagi H, Yoshida M. A questionnaire survey of infection control measures during the coronavirus infectious disease 2019 pandemic era. J Infect Chemother 2024; 30:1089-1096. [PMID: 39128616 DOI: 10.1016/j.jiac.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/19/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE To clarify the infection control measures required in the event of a new infectious disease outbreak, we conducted a questionnaire survey on the infection control measures implemented against coronavirus disease 2019 (COVID-19). METHODS An invitation to participate in this survey was sent to the heads of 2689 facilities affiliated with the members of the Japanese Society for Infection Prevention and Control in February 2023, requesting responses to the online survey using Google Forms by March 2023. RESULTS Six hundred and forty-five facilities, including 20 clinics and 625 hospitals, participated in the survey. This survey revealed that various infection control measures were implemented, including universal masking in the non-COVID-19 ward (96.5 %), screening tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on scheduled admission (89.0 %), SARS-CoV-2 tests (98.7 %), and isolation in private rooms (76.5 %) for inpatients with fever. However, nosocomial infections and clusters of COVID-19 occurred in 94.4 % and 90.9 % of cases during the investigation period, respectively. One of the reasons for these results is that healthcare personnel (HCP) and patients were common index cases of nosocomial infections, and the most common cause of clusters was the work of symptomatic HCPs. These results suggest that HCPs should understand that they can be index cases or spreaders. On the other hand, the most common support from external facilities was healthcare centers, followed by physicians or nurses from other hospitals. CONCLUSION In response to the emergence of infections, it is important to consider implementing infection control measures for HCPs and patients.
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Affiliation(s)
- Tetsuya Horino
- Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Tokyo, Japan.
| | - Kazuyo Ono
- Institute of Integrated Hospital Administration, Tokyo Medical and Dental University, Tokyo, Japan
| | - Erisa Sugawara
- Division of Infection Prevention and Control, Tokyo Healthcare University Postgraduate School, Japan
| | - Tetsuya Matsumoto
- Department of Infectious Diseases, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Masaki Yoshida
- Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Tokyo, Japan
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Iijima K, Osako H, Iwata K. Comparing the effectiveness of universal admission testing and risk-based testing at emergency admission for preventing nosocomial COVID-19: a multicenter retrospective cohort study in Japan. Infect Control Hosp Epidemiol 2024; 46:1-9. [PMID: 39434373 PMCID: PMC11717481 DOI: 10.1017/ice.2024.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 10/23/2024]
Abstract
OBJECTIVE To compare the effectiveness of universal admission testing (UAT) and risk-based testing (RBT) in preventing nosocomial coronavirus disease 2019 (COVID-19) after the implementation of strict infection control measures. DESIGN Retrospective multicenter cohort study. SETTING Five community hospitals in Japan. PATIENTS 14,028 adult patients admitted emergently from June 1, 2022, to January 31, 2023. METHODS We calculated crude incidence density rates of community-acquired COVID-19 (positive test ≤4 days postadmission), hospital-acquired COVID-19 (positive test ≥8 days postadmission), total postadmission COVID-19 (all cases of positive test postadmission), and primary cases (sporadic and index cases). A generalized estimating equation model was used to adjust for local incidence (new COVID-19 patients per 100,000 population), single-bed room proportion, and admission proportion of patients older than 65 years. RESULTS The weekly local incidence in the study areas was less than 1,800 per 100,000 population (1.8%). Two hospitals implemented RBT and 3 implemented UAT. The median admission testing rate was higher in the UAT group than in the RBT group (95% vs 55%; difference 45.2%, 95% CI, 40.3%-48.8%). Crude and adjusted analyses revealed no significant associations between incidence density rates (IRR; >1 indicates higher incidence with UAT) and admission strategies for any of the outcomes: community-acquired cases (adjusted IRR = 1.23; 95% CI, 0.46-3.31), hospital-acquired cases (1.46; 0.80-2.66), total postadmission COVID-19 (1.22; 0.79-1.87), and primary cases (0.81; 0.59-1.12). CONCLUSIONS Compared with risk-based testing, universal admission testing may have limited additional benefits in preventing nosocomial COVID-19 transmission during a period of low-moderate local incidence.
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Affiliation(s)
- Kenta Iijima
- Department of Infectious Disease and General Internal Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hitomi Osako
- Department of Infection Control, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kentaro Iwata
- Division of Infectious Disease, Kobe University Hospital, Kobe, Japan
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Osaka H, Tagashira Y, Takeuchi H, Tanaka Y, Tanimoto K, Gu Y. Nosocomial Outbreak of SARS-CoV-2 in a Hospital Ward during the Omicron Variant-Dominant Wave with a Review of the Relevant Literature. Jpn J Infect Dis 2024; 77:253-259. [PMID: 38825458 DOI: 10.7883/yoken.jjid.2023.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Clusters of nosocomial coronavirus disease 2019 (COVID-19) have been reported globally during the recent pandemic. Unfortunately, these clusters negatively affect inpatient morbidity, mortality, and hospital functioning. Using epidemiological data and whole-genome sequencing (WGS) of SARS-CoV-2, this study investigated the outbreak of COVID-19 at a university hospital. Eight inpatients and 13 healthcare workers tested positive for SARS-CoV-2 during a 1-month period. WGS of the virus in 11 patients revealed that the two variants of concern belonging to the Omicron sublineages, BA.2.3 and BA1.1.2, caused an outbreak when the proportion of the Omicron lineage in the community changed. When variants of concern undergo mutation, a response to the outbreak should be made with multiple variants in mind, even in the absence of epidemiological data showing close contact or other potential vectors of infection. Awareness of infection prevention and control should be raised to safeguard patient safety.
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Affiliation(s)
- Hilary Osaka
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan
| | - Yasuaki Tagashira
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan
- Division of Infection Prevention and Control, Tokyo Medical and Dental University Hospital, Japan
| | - Hiroaki Takeuchi
- Department of High-risk Infectious Disease Control, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan
| | - Yukie Tanaka
- Department of Molecular Microbiology and Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan
| | - Kousuke Tanimoto
- Research Core, Institute of Research, Tokyo Medical and Dental University (TMDU), Japan
| | - Yoshiaki Gu
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan
- Division of Infection Prevention and Control, Tokyo Medical and Dental University Hospital, Japan
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7
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Grimm M, Ziegler L, Seglias A, Mademilov M, Magdieva K, Mirzalieva G, Taalaibekova A, Suter S, Schneider SR, Zoller F, Bissig V, Reinhard L, Bauer M, Müller J, Ulrich TL, Carta AF, Bader PR, Bitos K, Reiser AE, Champigneulle B, Ashyralieva D, Scheiwiller PM, Ulrich S, Sooronbaev TM, Furian M, Bloch KE. SARS-CoV-2 Transmission during High-Altitude Field Studies. High Alt Med Biol 2024; 25:197-204. [PMID: 38634740 DOI: 10.1089/ham.2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Grimm, Mirjam, Lucie Ziegler, Annina Seglias, Maamed Mademilov, Kamila Magdieva, Gulzada Mirzalieva, Aijan Taalaibekova, Simone Suter, Simon R. Schneider, Fiona Zoller, Vera Bissig, Lukas Reinhard, Meret Bauer, Julian Müller, Tanja L. Ulrich, Arcangelo F. Carta, Patrick R. Bader, Konstantinos Bitos, Aurelia E. Reiser, Benoit Champigneulle, Damira Ashyralieva, Philipp M. Scheiwiller, Silvia Ulrich, Talant M. Sooronbaev, Michael Furian, and Konrad E. Bloch. SARS-CoV-2 Transmission during High-Altitude Field Studies. High Alt Med Biol. 25:197-204, 2024. Background: Throughout the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, virus transmission during clinical research was of concern. Therefore, during high-altitude field studies performed in 2021, we took specific COVID-19 precautions and investigated the occurrence of SARS-CoV-2 infection. Methods: From May to September 2021, we performed studies in patients with chronic obstructive pulmonary disease (COPD) and in healthy school-age children in Kyrgyzstan in high-altitude facilities at 3,100 m and 3,250 m and at 760 m. The various implemented COVID-19 safety measures included systematic SARS-CoV-2 rapid antigen testing (RAT). Main outcomes were SARS-CoV-2-RAT-positive rate among participants and staff at initial presentation (prevalence) and SARS-CoV-2-RAT-positive conversion during and within 10 days after studies (incidence). Results: Among 338 participants and staff, SARS-CoV-2-RAT-positive prevalence was 15 (4.4%). During mean ± SD duration of individual study participation of 3.1 ± 1.0 day and within 10 days, RAT-positive conversion occurred in 1/237(0.4%) participants. Among staff working in studies for 31.5 ± 29.3 days, SARS-CoV-2-RAT-positive conversion was 11/101(10.9%). In all 338 individuals involved in the studies over the course of 15.6 weeks, the median SARS-CoV-2-RAT-positive incidence was 0.00%/week (quartiles 0.00; 0.64). Over the same period, the median background incidence among the total Kyrgyz population of 6,636 million was 0.06%/week (0.03; 0.11), p = 0.013 (Wilcoxon rank sum test). Conclusions: Taking precautions by implementing specific safety measures, SARS-CoV-2 transmission during clinical studies was very rare, and the SARS-CoV-2 incidence among participants and staff was lower than that in the general population during the same period. The results are reassuring and may help in decision-making on the conduct of clinical research in similar settings.
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Affiliation(s)
- Mirjam Grimm
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Lucie Ziegler
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Annina Seglias
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Maamed Mademilov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Kamila Magdieva
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Gulzada Mirzalieva
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Aijan Taalaibekova
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Simone Suter
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Simon R Schneider
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Fiona Zoller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Vera Bissig
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Lukas Reinhard
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Meret Bauer
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Julian Müller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Tanja L Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Arcangelo F Carta
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Patrick R Bader
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Konstantinos Bitos
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Aurelia E Reiser
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | | | - Damira Ashyralieva
- National Institute of Public Health, Ministry of Health, Bishkek, Kyrgyz Republic
| | - Philipp M Scheiwiller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Talant M Sooronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
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Abbas S, Stevens MP. Horizontal versus vertical strategies for infection prevention: current practices and controversies. Curr Opin Infect Dis 2024; 37:282-289. [PMID: 38820054 DOI: 10.1097/qco.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
PURPOSE OF REVIEW Healthcare-associated infections (HAIs) represent a major burden on healthcare facilities. Effective infection prevention strategies are essential to prevent the spread of HAIs. These can be broadly classified as vertical and horizontal interventions. Through this review, we aim to assess the merits of these strategies. RECENT FINDINGS Vertical strategies include active surveillance testing and isolation for patients infected or colonized with a particular organism. These strategies are beneficial to curb the spread of emerging pathogens and during outbreaks. However, the routine use of contact precautions for organisms such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus remains controversial. Horizontal interventions are larger-scale and reduce HAIs by targeting a common mode of transmission shared by multiple organisms. Among these, hand hygiene, chlorhexidine gluconate bathing of select patients and environmental decontamination are the most high-yield and must be incorporated into infection prevention programs. As antimicrobial stewardship is also an effective horizontal strategy, antimicrobial stewardship programs must operate in synergy with infection prevention programs for maximal impact. SUMMARY Overall, horizontal interventions are considered more cost-effective and have a broader impact. Infection control programs may opt for a combination of vertical and horizontal strategies based on local epidemiology and available resources.
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Affiliation(s)
- Salma Abbas
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab, Pakistan
| | - Michael P Stevens
- Department of Internal Medicine, Division of Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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9
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Sato L, Tagashira Y, Shigeno N, Gu Y. Contact tracing in the hospital setting during the omicron wave of the coronavirus disease 2019 pandemic: persons and periods of concern for nosocomial infection prevention and control. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e84. [PMID: 38751943 PMCID: PMC11094374 DOI: 10.1017/ash.2024.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/18/2024]
Abstract
This study evaluating the efficacy of coronavirus disease 2019 contact tracing in the hospital setting during the omicron variant era found a high incidence of nosocomial severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in outbreaks, especially among individuals having close contact with infected persons. Identifying close contacts and outbreaks is essential to prevent nosocomial SARS-CoV-2 transmission.
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Affiliation(s)
- Lubna Sato
- Department of Infectious Diseases, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences, Tokyo, Japan
- Department of Infection Prevention and Control, Tokyo Medical and Dental University (TMDU) Hospital, Tokyo, Japan
| | - Yasuaki Tagashira
- Department of Infectious Diseases, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences, Tokyo, Japan
- Department of Infection Prevention and Control, Tokyo Medical and Dental University (TMDU) Hospital, Tokyo, Japan
- TMDU Center for Infectious Disease Education and Analysis, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Narumi Shigeno
- Department of Infection Prevention and Control, Tokyo Medical and Dental University (TMDU) Hospital, Tokyo, Japan
| | - Yoshiaki Gu
- Department of Infectious Diseases, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences, Tokyo, Japan
- Department of Infection Prevention and Control, Tokyo Medical and Dental University (TMDU) Hospital, Tokyo, Japan
- TMDU Center for Infectious Disease Education and Analysis, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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10
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Natori Y, Anjan S, Hand J. Is it time to reconsider universal severe acute respiratory syndrome coronavirus 2 polymerase chain reaction screening for asymptomatic potential nonlung solid organ transplant donors? Am J Transplant 2024; 24:879-880. [PMID: 38266710 DOI: 10.1016/j.ajt.2024.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Yoichiro Natori
- Miami Transplant Institute, Jackson Health System, Miami, Florida, USA; Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine Miami, Florida, USA.
| | - Shweta Anjan
- Miami Transplant Institute, Jackson Health System, Miami, Florida, USA; Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine Miami, Florida, USA
| | - Jonathan Hand
- Ochsner Health, New Orleans, Louisiana, USA; Department of Medicine, Division of Infectious Disease, University of Queensland School of Meidcine, New Orleansm Louisiana, USA
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11
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Pop-Vicas AE, Anderson L, Hatas G, Stevens L, Buys A, O’Connor D, Wilson N, Riemersma K, Haddock Soto LA, Richardson A, Clemens C, Packham J, Shirley D, Safdar N. A severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial cluster with inter-facility spread: Lessons learned. Infect Control Hosp Epidemiol 2024; 45:635-643. [PMID: 38173365 PMCID: PMC11027079 DOI: 10.1017/ice.2023.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Despite infection control guidance, sporadic nosocomial coronavirus disease 2019 (COVID-19) outbreaks occur. We describe a complex severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cluster with interfacility spread during the SARS-CoV-2 δ (delta) pandemic surge in the Midwest. SETTING This study was conducted in (1) a hematology-oncology ward in a regional academic medical center and (2) a geographically distant acute rehabilitation hospital. METHODS We conducted contact tracing for each COVID-19 case to identify healthcare exposures within 14 days prior to diagnosis. Liberal testing was performed for asymptomatic carriage for patients and staff. Whole-genome sequencing was conducted for all available clinical isolates from patients and healthcare workers (HCWs) to identify transmission clusters. RESULTS In the immunosuppressed ward, 19 cases (4 patients, 15 HCWs) shared a genetically related SARS-CoV-2 isolate. Of these 4 patients, 3 died in the hospital or within 1 week of discharge. The suspected index case was a patient with new dyspnea, diagnosed during preprocedure screening. In the rehabilitation hospital, 20 cases (5 patients and 15 HCWs) positive for COVID-19, of whom 2 patients and 3 HCWs had an isolate genetically related to the above cluster. The suspected index case was a patient from the immune suppressed ward whose positive status was not detected at admission to the rehabilitation facility. Our response to this cluster included the following interventions in both settings: restricting visitors, restricting learners, restricting overflow admissions, enforcing strict compliance with escalated PPE, access to on-site free and frequent testing for staff, and testing all patients prior to hospital discharge and transfer to other facilities. CONCLUSIONS Stringent infection control measures can prevent nosocomial COVID-19 transmission in healthcare facilities with high-risk patients during pandemic surges. These interventions were successful in ending these outbreaks.
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Affiliation(s)
- Aurora E. Pop-Vicas
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura Anderson
- Department of Infection Control and Prevention, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Gabrielle Hatas
- Department of Infection Control and Prevention, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Linda Stevens
- Nursing Quality and Safety, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Ashley Buys
- Employee Health Services, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - David O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Nancy Wilson
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Kasen Riemersma
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Luis A Haddock Soto
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Abby Richardson
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Christine Clemens
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Jennylynde Packham
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Daniel Shirley
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Memorial Veterans’ Affairs Medical Center, Madison, Wisconsin
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12
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Petrie JG, Moore R, Lauring AS, Kaye KS. Incidence and outcomes of hospital-associated respiratory virus infections by viral species. Infect Control Hosp Epidemiol 2024; 45:618-629. [PMID: 38073596 PMCID: PMC11031349 DOI: 10.1017/ice.2023.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Although the incidence of hospital-associated respiratory virus infection (HARVI) is well recognized, the risk factors for infection and impact on patient outcomes are not well characterized. METHODS We identified a cohort of all inpatient admissions ≥24 hours duration at a single academic medical center from 2017 to 2020. HARVI were defined as respiratory virus detected in a test ordered after the 95th percentile of the virus-specific incubation period. Risk factors for HARVI were assessed using Cox proportional hazards models of the competing outcomes of HARVI and discharge. The associations between time-varying HARVI status and the rates of ICU admission, discharge, and in-hospital death were estimated using Cox-proportional hazards models in a competing risk framework. RESULTS HARVI incidences were 8.8 and 3.0 per 10,000 admission days for pediatric and adult patients, respectively. For adults, congestive heart failure, renal disease, and cancer increased HARVI risk independent of their associations with length of stay. HARVI risk was also elevated for patients admitted in September-June relative to July admissions. For pediatric patients, cardiovascular and respiratory conditions, cancer, medical device dependence, and admission in December increased HARVI risk. Lengths of stay were longer for adults with HARVI compared to those without, and hospital-associated influenza A was associated with increased risk of death. Rates of ICU admission were increased in the 5 days after HARVI identification for adult and pediatric patients. HARVI was not associated with length of stay or death among pediatric patients. CONCLUSIONS HARVI is associated chronic health conditions and increases morbidity and mortality.
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Affiliation(s)
- Joshua G. Petrie
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Riley Moore
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Adam S. Lauring
- Department of Microbiology and Immunology and Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Keith S. Kaye
- Division of Allergy, Immunology and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
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13
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Schmitz E, Anderson L, Hatas G, Stevens L, Osman F, Schweizer M, Safdar N, Shirley D. Population and hospital-level COVID-19 measures are associated with increased risk of hospital-onset COVID-19. Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38495006 DOI: 10.1017/ice.2024.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
A review of hospital-onset COVID-19 cases revealed 8 definite, 106 probable, and 46 possible cases. Correlations between hospital-onset cases and both HCW and inpatient cases were noted in 2021. Rises in community measures were associated with rises in hospital-onset cases. Measures of community COVID-19 activity might predict hospital-onset cases.
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Affiliation(s)
- Emily Schmitz
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | | | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Marin Schweizer
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Shirley
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- UW Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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14
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Epstein L, Diekema DJ, Morgan DJ, Fakih MG, Lee F, Gottlieb L, Leung E, Yen C, Sullivan KV, Hayden MK. Diagnostic stewardship and the coronavirus disease 2019 (COVID-19) pandemic: Lessons learned for prevention of emerging infectious diseases in acute-care settings. Infect Control Hosp Epidemiol 2024; 45:277-283. [PMID: 37933951 DOI: 10.1017/ice.2023.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of stewardship of viral diagnostic tests to aid infection prevention efforts in healthcare facilities. We highlight diagnostic stewardship lessons learned during the COVID-19 pandemic and discuss how diagnostic stewardship principles can inform management and mitigation of future emerging pathogens in acute-care settings. Diagnostic stewardship during the COVID-19 pandemic evolved as information regarding transmission (eg, routes, timing, and efficiency of transmission) became available. Diagnostic testing approaches varied depending on the availability of tests and when supplies and resources became available. Diagnostic stewardship lessons learned from the COVID-19 pandemic include the importance of prioritizing robust infection prevention mitigation controls above universal admission testing and considering preprocedure testing, contact tracing, and surveillance in the healthcare facility in certain scenarios. In the future, optimal diagnostic stewardship approaches should be tailored to specific pathogen virulence, transmissibility, and transmission routes, as well as disease severity, availability of effective treatments and vaccines, and timing of infectiousness relative to symptoms. This document is part of a series of papers developed by the Society of Healthcare Epidemiology of America on diagnostic stewardship in infection prevention and antibiotic stewardship.1.
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Affiliation(s)
- Lauren Epstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Atlanta VA Healthcare System, Atlanta, Georgia, United States
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine and VA Maryland Healthcare System, Baltimore, Maryland, United States
| | - Mohamad G Fakih
- Quality Department, Ascension Health Care, and Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Lindsey Gottlieb
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Elizabeth Leung
- Department of Pharmacy, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Christina Yen
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kaede V Sullivan
- Department of Pathology & Laboratory Medicine, Lewis Katz School of Medicine at Temple University and Temple University Health System, Philadelphia, Pennsylvania, United States
| | - Mary K Hayden
- Division of Infectious Diseases, Department of Internal Medicine, Rush University, Chicago, Illinois, United States
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15
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Brust KB, Kobayashi T, Diekema DJ. Asymptomatic Testing of Hospital Admissions for SARS-CoV-2: Is it OK to Stop? Clin Infect Dis 2024; 78:356-360. [PMID: 37463415 DOI: 10.1093/cid/ciad423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of all persons admitted to acute care hospitals has become common practice. We describe why 1 hospital discontinued this practice after weighing potential benefits against known harms. Considerations around the benefits shifted as we saw a decline in SARS-CoV-2 community transmission and coronavirus disease 2019 (COVID-19) severity of illness, increased availability of vaccines and treatments, and better understood the many other transmission pathways in the healthcare environment. Considerations around harms included the additional strain on laboratory and infection prevention resources, and several unintended adverse consequences of admission screening for patients, including unnecessary isolation, antiviral treatments, and delays in care delivery. Poor test performance for detection of infectiousness also played a significant role in determining to stop universal screening. No increase in hospital-onset COVID-19 has been documented since discontinuation of admission testing. We continue to apply other established layers of prevention while monitoring for any change in incidence of within-facility transmission of SARS-CoV-2.
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Affiliation(s)
- Karen B Brust
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
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16
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Rhee C, Klompas M, Pak TR, Köhler JR. In Support of Universal Admission Testing for SARS-CoV-2 During Significant Community Transmission. Clin Infect Dis 2024; 78:439-444. [PMID: 37463411 PMCID: PMC11487105 DOI: 10.1093/cid/ciad424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Many hospitals have stopped or are considering stopping universal admission testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We discuss reasons why admission testing should still be part of a layered system to prevent hospital-acquired SARS-CoV-2 infections during times of significant community transmission. These include the morbidity of SARS-CoV-2 in vulnerable patients, the predominant contribution of presymptomatic and asymptomatic people to transmission, the high rate of transmission between patients in shared rooms, and data suggesting surveillance testing is associated with fewer nosocomial infections. Preferences of diverse patient populations, particularly the hardest-hit communities, should be surveyed and used to inform prevention measures. Hospitals' ethical responsibility to protect patients from serious infections should predominate over concerns about costs, labor, and inconvenience. We call for more rigorous data on the incidence and morbidity of nosocomial SARS-CoV-2 infections and more research to help determine when to start, stop, and restart universal admission testing and other prevention measures.
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Affiliation(s)
- Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Theodore R Pak
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia R Köhler
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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17
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Gohil SK, De St. Maurice A, Yokoe DS, Cohen SH, Torriani FJ, Grein JD, Robinson PA, Mabalot S, Park J, Pedrani P, Platt R, Huang SS. Assessing past versus present severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection: A survey of criteria for discontinuing precautions in asymptomatic patients testing positive on admission. Infect Control Hosp Epidemiol 2024; 45:237-240. [PMID: 37702088 PMCID: PMC10877527 DOI: 10.1017/ice.2023.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 09/14/2023]
Abstract
Infection prevention program leaders report frequent use of criteria to distinguish recently recovered coronavirus disease 2019 (COVID-19) cases from actively infectious cases when incidentally positive asymptomatic patients were identified on routine severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing. Guidance on appropriate interpretation of high-sensitivity molecular tests can prevent harm from unnecessary precautions that delay admission and impede medical care.
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Affiliation(s)
- Shruti K. Gohil
- Epidemiology & Infection Prevention Program, University of California, Irvine Health (UC Irvine Health), Irvine, California
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Annabelle De St. Maurice
- Division of Pediatric Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Deborah S. Yokoe
- University of California, San Francisco, Division of Infectious Diseases, San Francisco, California
| | - Stuart H. Cohen
- University of California, Davis, Division of Infectious Diseases, Davis, California
| | - Francesca J. Torriani
- University of California, San Diego, Division of Infectious Diseases, San Diego, California
| | - Jonathan D. Grein
- Cedars Sinai Medical Center, Division of Infectious Diseases, Los Angeles, California
| | - Philip A. Robinson
- Hoag Memorial Hospital Presbyterian, Department of Infection Prevention, Newport Beach and Irvine, California
| | - Shannon Mabalot
- Infection Prevention, Sharp Metropolitan Medical Campus, San Diego, California
| | - Jessica Park
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Paula Pedrani
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Richard Platt
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Susan S. Huang
- Epidemiology & Infection Prevention Program, University of California, Irvine Health (UC Irvine Health), Irvine, California
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
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18
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Tayyar R, Kiener MA, Liang JW, Contreras G, Rodriguez-Nava G, Zimmet AN, Contag CA, Srinivasan K, McIntyre K, Subramanian A, Shepard J, Tompkins LS, Pinsky BA, Salinas JL. Low infectivity among asymptomatic patients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) admission test at a tertiary care center, 2020-2022. Infect Control Hosp Epidemiol 2024; 45:241-243. [PMID: 37746805 PMCID: PMC10910729 DOI: 10.1017/ice.2023.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
We used a strand-specific RT-qPCR to evaluate viral replication as a surrogate for infectiousness among 242 asymptomatic inpatients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) admission test. Only 21 patients (9%) had detectable SARS-CoV-2 minus-strand RNA. Because most patients were found to be noninfectious, our findings support the suspension of asymptomatic admission testing.
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Affiliation(s)
| | | | - Jane W. Liang
- Stanford University School of Medicine, Stanford, California
| | | | | | - Alex N. Zimmet
- Stanford University School of Medicine, Stanford, California
| | | | | | - Karen McIntyre
- Stanford University School of Medicine, Stanford, California
| | | | - John Shepard
- Stanford University School of Medicine, Stanford, California
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19
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Uno S, Goto R, Honda K, Uchida S, Uwamino Y, Namkoong H, Yoshifuji A, Mikita K, Takano Y, Matsumoto M, Kitagawa Y, Hasegawa N. Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 Polymerase Chain Reaction Screening: A Cost-Utility Analysis. Clin Infect Dis 2024; 78:57-64. [PMID: 37556365 PMCID: PMC10810706 DOI: 10.1093/cid/ciad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND An early report has shown the clinical benefit of the asymptomatic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening test, and some clinical guidelines recommended this test. However, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to investigate the cost-effectiveness of universal preoperative screening of asymptomatic patients for SARS-CoV-2 using polymerase chain reaction (PCR) testing. METHODS We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model from a payer perspective, assuming that the test-positive rate was 0.07% and the screening cost was 8500 Japanese yen (JPY) (approximately 7601 US dollars [USD]). The input parameter was derived from the available evidence reported in the literature. A willingness-to-pay threshold was set at 5 000 000 JPY/quality-adjusted life-year (QALY). RESULTS The incremental cost of 1 death averted was 74 469 236 JPY (approximately 566 048 USD) and 291 123 368 JPY/QALY (approximately 2 212 856 USD/QALY), which was above the 5 000 000 JPY/QALY willingness-to-pay threshold. The incremental cost-effectiveness ratio fell below 5 000 000 JPY/QALY only when the test-positive rate exceeded 0.739%. However, when the probability of developing a postoperative pulmonary complication among SARS-CoV-2-positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of how high the test-positive rate became. CONCLUSIONS Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base case analysis. The cost-effectiveness mainly depends on the test-positive rate, the frequency of postoperative pulmonary complications, and the screening costs; however, no matter how high the test-positive rate, the cost-effectiveness is poor if the probability of developing postoperative pulmonary complications among patients positive for SARS-CoV-2 is sufficiently reduced.
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Affiliation(s)
- Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Rei Goto
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Business Administration, Keio University, Kanagawa, Japan
- Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Kimiko Honda
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
| | - Sho Uchida
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Uwamino
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Yoshifuji
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Kei Mikita
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yaoko Takano
- Division of Infectious Diseases and Infection Control, Keio University Hospital, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedics, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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20
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Schrank GM, Harris-Williams M, Schiavone K, Lusby MC, Dove C, Leekha S. Evaluation of an antigen-test-based strategy to reduce duration of transmission-based precautions for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in hospitalized patients. Infect Control Hosp Epidemiol 2024; 45:114-116. [PMID: 37539701 DOI: 10.1017/ice.2023.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
An academic hospital implemented a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antigen-test-based strategy to facilitate discontinuation of precautions for patients admitted with a positive SARS-CoV-2 test. Of 171 patients that underwent antigen testing, 68% had an initial negative test performed a median of 5 days after admission. Antigen testing reduced isolation time by 144 hours.
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Affiliation(s)
- Gregory M Schrank
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Martha C Lusby
- University of Maryland Medical Center, Baltimore, Maryland
| | - Cindy Dove
- University of Maryland Medical Center, Baltimore, Maryland
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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21
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Hammer MM, Sodickson AD, Marshall AD, Faust JS. Prevalence of Pneumonia Among Patients Who Died with COVID-19 Infection in Ancestral Versus Omicron Variant Eras. Acad Radiol 2024; 31:1-6. [PMID: 37271637 PMCID: PMC10172968 DOI: 10.1016/j.acra.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
RATIONALE AND OBJECTIVES The Omicron variant of COVID-19 is less severe than the ancestral strain, leading to the potential for deaths in patients infected with the virus but who die of other causes. This study evaluated the difference in rates of pneumonia among patients who died with SARS-CoV-2 infection in the ancestral vs Omicron eras. MATERIALS AND METHODS We identified patients who died within 30days of a positive SARS-CoV-2 test, from March 2020 through December 2022; variants were assigned based on the prevalent variant in the US at that time. We also obtained a control group from patients who died within 30days of a negative SARS-CoV-2 test in January 2022. The first CT after the test was reviewed in a blinded fashion and assigned a category from the RSNA Consensus Reporting Guidelines. The primary outcome was the difference in rates of positive (typical or indeterminate) COVID-19 findings in the ancestral vs Omicron eras. RESULTS A total of 598 patients died during the ancestral era and 400 during the Omicron era, and 347 decedents comprised the control group. The rate of positive COVID-19 findings was 67/81 (83%) in the ancestral era and 43/81 (53%) in the Omicron era (P < .001), an absolute difference of 30% (95% CI 16%-43%). The rate of positive findings in the control group was 23/76 (30%). CONCLUSION During the Omicron era, 30% fewer SARS-CoV-2-associated deaths were associated with COVID-19 pneumonia and were caused either by nonpulmonary effects of the infection or were unrelated to the infection.
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Affiliation(s)
- Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, (M.M.H., A.D.S.).
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, (M.M.H., A.D.S.)
| | - Andrew D Marshall
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, (A.D.M., J.S.F.)
| | - Jeremy S Faust
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, (A.D.M., J.S.F.)
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22
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Wu HH, Su CH, Chien LJ, Tseng SH, Chang SC. Coronavirus disease 2019 (COVID-19) universal admission screening in patients and companions in Taiwan from May 2021 to June 2022: A nationwide multicenter study. Infect Control Hosp Epidemiol 2024; 45:68-74. [PMID: 37462097 PMCID: PMC10782195 DOI: 10.1017/ice.2023.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Universal admission screening and follow-up symptom-based testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may play critical roles in controlling nosocomial transmission. We describe the performance of test strategies for inpatients and their companions during various disease incidences in Taiwan. DESIGN Retrospective population-based cohort study. SETTING The study was conducted across 476 hospitals in Taiwan. METHODS The data for both testing strategies by reverse transcription-polymerase chain reaction for SARS-CoV-2 in newly admitted patients and their companions during May 2021-June 2022 were extracted and analyzed. RESULTS The positivity rate of universal admission screening was 0.76% (14,640 of 1,928,676) for patients and 0.37% (5,372 of 1,438,944) for companions. The weekly community incidences of period 1 (May 2021-June 2021), period 2 (July 2021-March 2022), and period 3 (April 2022-June 2022) were 6.57, 0.27, and 1,261, respectively, per 100,000 population. The positivity rates of universal admission screening for patients and companions (4.39% and 2.18%) in period 3 were higher than those in periods 1 (0.29% and 0.04%) and 2 (0.03% and 0.003%) (all P < .01). Among the 22,201 confirmed cases, 9.86% were identified by symptom-based testing. The costs and potential savings of universal admission screening for patients and companions achieved a breakeven point when the test strategy was implemented in a period with weekly community incidences of 27 and 358 per 100,000 population, respectively. CONCLUSIONS Universal admission screening and follow-up symptom-based testing is important for reducing nosocomial transmission. Implementing universal admission screening at an appropriate time would balance the benefits with costs and potential unintended harms.
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Affiliation(s)
- Hao-Hsin Wu
- Division of Infection Control and Biosafety, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Chiu-Hsia Su
- Division of Infection Control and Biosafety, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Li-Jung Chien
- Division of Infection Control and Biosafety, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Shu-Hui Tseng
- Division of Infection Control and Biosafety, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
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23
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Gohil SK, Septimus E, Sands KE, Blanchard EJ, Moody J, de St. Maurice A, Yokoe D, Kwon J, Grein J, Cohen S, Uslan D, Vasudev M, Mauricio A, Mabalot S, Coady MH, Sljivo S, Smith K, Carver B, Poland R, Perlin J, Platt R, Huang SS, for the Centers for Disease Control and Prevention Epicenters Program. Coronavirus disease 2019 (COVID-19) infection prevention practices that exceed Centers for Disease Control and Prevention (CDC) guidance: Balancing extra caution against impediments to care. Infect Control Hosp Epidemiol 2023; 44:2074-2077. [PMID: 37260365 PMCID: PMC10755143 DOI: 10.1017/ice.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 06/02/2023]
Abstract
In a survey of infection prevention programs, leaders reported frequent clinical and infection prevention practice modifications to avoid coronavirus disease 2019 (COVID-19) exposure that exceeded national guidance. Future pandemic responses should emphasize balanced approaches to precautions, prioritize educational campaigns to manage safety concerns, and generate an evidence-base that can guide appropriate infection prevention practices.
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Affiliation(s)
- Shruti K. Gohil
- Epidemiology & Infection Prevention Program, University of California Irvine Health (UC Irvine Health), Irvine, California
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Edward Septimus
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Annabelle de St. Maurice
- Division of Pediatric Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Deborah Yokoe
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California
| | - Jennie Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan Grein
- Division of Infectious Diseases, Cedars Sinai Medical Center, Los Angeles, California
| | - Stuart Cohen
- Division of Infectious Diseases, University of California Davis, Davis, California
| | - Daniel Uslan
- Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Milind Vasudev
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Amarah Mauricio
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Shannon Mabalot
- Infection Prevention, Sharp Metropolitan Medical Campus, San Diego, California
| | - Micaela H. Coady
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Selsebil Sljivo
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Richard Platt
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Susan S. Huang
- Epidemiology & Infection Prevention Program, University of California Irvine Health (UC Irvine Health), Irvine, California
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
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24
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Honda H, Nakagawa M, Nisida R, Shintani C, Hamagishi M, Uehara Y, Iwata M, Doi Y. Discontinuation of admission screening for coronavirus disease 2019 (COVID-19) and the impact on in-hospital clusters of COVID-19: Experience at a tertiary-care center. Infect Control Hosp Epidemiol 2023; 44:1877-1880. [PMID: 37088552 DOI: 10.1017/ice.2023.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
We evaluated the impact of discontinuing universal preadmission screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) on the occurrence of nosocomial clusters of coronavirus disease 2019 (COVID-19) during the SARS-CoV-2 o (omicron) variant period. No increasing trend in nosocomial clusters was observed during community-based surges before and after discontinuation. This finding supports the safety of the practice change.
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Affiliation(s)
- Hitoshi Honda
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - Masataka Nakagawa
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Rie Nisida
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Chiyo Shintani
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Manami Hamagishi
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Yuki Uehara
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - Mitsunaga Iwata
- Department of General Internal Medicine, Emergency and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Yohei Doi
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
- Center for Innovative Antimicrobial Therapy, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania, United States
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25
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Aho Glele LS, de Rougemont A. Non-Pharmacological Strategies and Interventions for Effective COVID-19 Control: A Narrative Review. J Clin Med 2023; 12:6465. [PMID: 37892603 PMCID: PMC10607620 DOI: 10.3390/jcm12206465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
The COVID-19 pandemic had a devastating impact on the world, causing widespread illness and death. Focusing on prevention strategies to limit the spread of the disease remains essential. Despite the advent of vaccines, maintaining a vigilant approach to prevention remains paramount. We reviewed effective strategies to prevent COVID-19 transmission, including various prevention measures and interventions and both established practices and unresolved issues that have been addressed in meta-analyses, literature reviews, or in the health care context. Standard precautions are the cornerstone of infection control, with hand hygiene and mask use as key components. The use of surgical masks is recommended to prevent droplet transmission, while eye protection is recommended in combination with masks. In terms of room occupancy, ventilation is critical in reducing the risk of transmission in poorly ventilated environments. Chemical disinfection of indoor air with Triethylene glycol-based products can provide safe additional protection. Since viral RNA detection on surfaces does not necessarily indicate infectivity, the risk of transmission by surface contact remains low if surfaces are properly maintained and hand hygiene is practiced regularly. Thus, prevention of SARS-CoV-2 transmission requires a multifaceted approach, including reducing particle emissions from infected persons by wearing masks, eliminating aerosols by ventilation and air treatment, ensuring physical separation, and protecting exposed persons with masks and eye protection.
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Affiliation(s)
- Ludwig Serge Aho Glele
- Epidemiology and Infection Control Department, University Hospital of Dijon, 21000 Dijon, France
| | - Alexis de Rougemont
- National Reference Centre for Gastroenteritis Viruses, Laboratory of Virology, University Hospital of Dijon, 21000 Dijon, France;
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26
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Greenmyer JR, Kohorst MA, Thompson WS, Kaczor M, Alajbegovic K, Kranz LA, Cain M, Ristagno EH. Nasopharyngeal Swabs in Pediatric Patients With Thrombocytopenia and Anticoagulant Use. J Pediatr Hematol Oncol 2023; 45:e910-e914. [PMID: 37582659 DOI: 10.1097/mph.0000000000002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/06/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Nasopharyngeal (NP) swabbing is a technique that is commonly used to test pediatric patients for viral infections with increased use during the coronavirus disease 2019 pandemic. Complications from NP swabbing are rare and seem to occur more frequently in patients at risk of bleeding. Little is known about institutional or individual practices and experiences with NP swab testing in pediatric patients with risk factors for bleeding. METHODS We conducted a survey study of pediatric hematology/oncology (PHO) attending physicians to assess practices and experiences with NP swab testing in pediatric patients with thrombocytopenia and/or on anticoagulation. RESULTS There were 130 total respondents (5.6%, n = 130/2327) from 6 countries. Relatively few respondents (n = 17/130, 13.1%) reported that their institution had a policy specifying a lower-level platelet cutoff for patients undergoing NP swabbing. The median platelet cutoff below which NP swabs are not performed according to existing policies is 30,000×10(9)/L (interquartile range: 20,000 to 40,000). The median cutoff based on the opinion of the respondents was 10,000 (interquartile range: 10,000 to 20,000). There were 24 episodes of epistaxis among PHO patients that were NP swabbed; many adverse events (56.5%, n = 13/23) were described as persistent, severe, and/or required intervention. Three reported cases of epistaxis with anticoagulation or antiplatelet therapy occurred in patients with concomitant thrombocytopenia. Only 1 respondent (n = 1/130, 0.7%) reported an institutional policy for limiting NP swabs in patients on anticoagulant therapy. NP (66.9%) and nares (33.1%) were the most common sources of coronavirus disease 2019 testing that were reported. CONCLUSION A small percentage of institutions in this survey have a policy restricting NP swabs in PHO patients. The discrepancy between lower platelet cutoffs proposed by experts and institutional policy suggests that existing policies may be too conservative. Expert guidelines are needed on this topic. Other bleeding risk factors (eg, aspirin use and von Willebrand disease) should be considered in policies and guidelines.
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Affiliation(s)
| | | | - Whitney S Thompson
- Pediatric and Adolescent Medicine
- Center for Individualized Medicine
- Neonatal and Perinatal Medicine
- Clinical Genomics
| | | | | | - Lincoln A Kranz
- University of North Dakota School of Medicine, Grand Forks, ND
| | - Meghan Cain
- Pediatric and Adolescent Medicine
- Emergency Medicine
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27
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Şimşek-Yavuz S. COVID-19: An Update on Epidemiology, Prevention and Treatment, September-2023. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:165-187. [PMID: 38633552 PMCID: PMC10986731 DOI: 10.36519/idcm.2023.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 04/19/2024]
Abstract
After a downward trend for more than 12 months, the incidence of COVID-19 has increased in the last months. Although COVID-19 is not as frequent as in the first years of the pandemic, case numbers are still very high, and it causes a significant number of deaths. COVID-19 is not seen with a predictable frequency, at least two times more deadly than the flu, continues as an epidemic, and has not reached the endemic level yet. Currently, the Omicron strains EG.5 and XBB.1.16 are dominant worldwide. Although BA.2.86 and FLip variants, including FL.1.5.1 are not widespread at the moment, both were shown to be highly immune-evasive and require close monitoring. Prevention of COVID-19 relies on vaccinations, surveillance, proper ventilation of enclosed spaces, isolation of patients, and mask usage. Currently, monovalent COVID-19 vaccines, including XBB.1.5 Omicron SARS-CoV-2, are recommended for both primary and booster vaccinations against COVID-19. Monovalent vaccines, including only original SARS-CoV-2 strain, and bivalent vaccines, including original virus plus BA4/5 variant, are no longer recommended against COVID-19. Booster vaccination with XBB.1.5 containing vaccine should be prioritized for patients at high risk for severe COVID-19. Bacillus Calmette-Guérin (BCG) vaccination does not seem to be effective in preventing COVID-19. At the current phase of the pandemic, nirmatrelvir/ritonavir, remdesivir, molnupiravir, sotrovimab (for patients from XBB.1.5 variant dominant settings), and convalescent plasma can be considered for the treatment of high-risk early-stage outpatients with COVID-19, while hospitalized patients with more severe disease can be treated with dexamethasone, anti cytokines including tocilizumab, sarilumab, baricitinib, and tofacitinib and antithrombotic agents including enoxaparin. Remdesivir oral analogues and ensitrelvir fumarate are promising agents for treating acute COVID-19, which are in phase trials now; however, ivermectin, fluvoxamine, and metformin were shown to be ineffective.
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Affiliation(s)
- Serap Şimşek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University School of Medicine, İstanbul, Türkiye
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28
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Pak TR, Rhee C, Wang R, Klompas M. Discontinuation of Universal Admission Testing for SARS-CoV-2 and Hospital-Onset COVID-19 Infections in England and Scotland. JAMA Intern Med 2023; 183:877-880. [PMID: 37273229 PMCID: PMC10242507 DOI: 10.1001/jamainternmed.2023.1261] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/28/2023] [Indexed: 06/06/2023]
Abstract
This quality improvement study examines the association between the discontinuation of universal admission testing for SARS-CoV-2 infections and hospital-onset SARS-CoV-2 infections in England and Scotland.
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Affiliation(s)
- Theodore R. Pak
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Rui Wang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
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29
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Woods KL, Camins BC. Picking up the pieces: Lessons learned about optimal public health and acute-care hospital collaboration during pandemics. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e125. [PMID: 37502241 PMCID: PMC10369428 DOI: 10.1017/ash.2023.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Krystina L. Woods
- Department of Infection Prevention, Mount Sinai West, New York, New York
- Division of Infectious Diseases, Department of Medicine, at Icahn School of Medicine, Mount Sinai, New York, New York
| | - Bernard C. Camins
- Division of Infectious Diseases, Department of Medicine, at Icahn School of Medicine, Mount Sinai, New York, New York
- Department of Infection Prevention, Mount Sinai Health System, New York, New York
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30
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Doron S, Monach PA, Brown CM, Branch-Elliman W. Improving COVID-19 Disease Severity Surveillance Measures: Statewide Implementation Experience. Ann Intern Med 2023. [PMID: 37186921 DOI: 10.7326/m23-0618] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Measurement of the burden of COVID-19 on U.S. hospitals has been an important element of the public health response to the pandemic. However, because of variation in testing density and policies, the metric is not standardized across facilities. Two types of burdens exist, one related to the infection control measures that patients who test positive for SARS-CoV-2 require and one from the care of severely ill patients receiving treatment of COVID-19. With rising population immunity from vaccination and infection, as well as the availability of therapeutics, severity of illness has declined. Prior research showed that dexamethasone administration was highly correlated with other disease severity metrics and sensitive to the changing epidemiology associated with the emergence of immune-evasive variants. On 10 January 2022, the Massachusetts Department of Public Health began requiring hospitals to expand surveillance to include reports of both the total number of "COVID-19 hospitalizations" daily and the number of inpatients who received dexamethasone at any point during their hospital stay. All 68 acute care hospitals in Massachusetts submitted COVID-19 hospitalization and dexamethasone data daily to the Massachusetts Department of Public Health over a 1-year period. A total of 44 196 COVID-19 hospitalizations were recorded during 10 January 2022 to 9 January 2023, of which 34% were associated with dexamethasone administration. The proportion of patients hospitalized with COVID-19 who had received dexamethasone was 49.6% during the first month of surveillance and decreased to a monthly average of approximately 33% by April 2022, where it has remained since (range, 28.7% to 33%). Adding a single data element to mandated reporting to estimate the frequency of severe COVID-19 in hospitalized patients was feasible and provided actionable information for health authorities and policy makers. Updates to surveillance methods are necessary to match data collection with public health response needs.
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Affiliation(s)
- Shira Doron
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts (S.D.)
| | - Paul A Monach
- Rheumatology Section, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts (P.A.M.)
| | - Catherine M Brown
- Massachusetts Department of Public Health, Boston, Massachusetts (C.M.B.)
| | - Westyn Branch-Elliman
- Harvard Medical School; Department of Medicine, Veterans Affairs Boston Healthcare System; and Veterans Affairs Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts (W.B.)
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31
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Damhorst GL, Schoof N, Nguyen PV, Verkerke H, Wilber E, McLendon K, O’Sick W, Baugh T, Cheedarla S, Cheedarla N, Stittleburg V, Fitts EC, Neja MA, Babiker A, Piantadosi A, Roback JD, Waggoner JJ, Mavigner M, Lam WA. Investigation of Blood Plasma Viral Nucleocapsid Antigen as a Marker of Active Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Infection. Open Forum Infect Dis 2023; 10:ofad226. [PMID: 37213426 PMCID: PMC10199120 DOI: 10.1093/ofid/ofad226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023] Open
Abstract
Background Nasopharyngeal qualitative reverse-transcription polymerase chain reaction (RT-PCR) is the gold standard for diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is not practical or sufficient in every clinical scenario due to its inability to distinguish active from resolved infection. Alternative or adjunct testing may be needed to guide isolation precautions and treatment in patients admitted to the hospital. Methods We performed a single-center, retrospective analysis of residual clinical specimens and medical record data to examine blood plasma nucleocapsid antigen as a candidate biomarker of active SARS-CoV-2. Adult patients admitted to the hospital or presenting to the emergency department with SARS-CoV-2 ribonucleic acid (RNA) detected by RT-PCR from a nasopharyngeal swab specimen were included. Both nasopharyngeal swab and a paired whole blood sample were required to be available for analysis. Results Fifty-four patients were included. Eight patients had positive nasopharyngeal swab virus cultures, 7 of whom (87.5%) had concurrent antigenemia. Nineteen (79.2%) of 24 patients with detectable subgenomic RNA and 20 (80.0%) of 25 patients with N2 RT-PCR cycle threshold ≤ 33 had antigenemia. Conclusions Most individuals with active SARS-CoV-2 infection are likely to have concurrent antigenemia, but there may be some individuals with active infection in whom antigenemia is not detectable. The potential for high sensitivity and convenience of a blood test prompts interest in further investigation as a screening tool to reduce reliance on nasopharyngeal swab sampling and as an adjunct diagnostic test to aid in clinical decision making during the period after acute coronavirus disease 2019.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA
| | - Nils Schoof
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Phuong-Vi Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Hans Verkerke
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Eli Wilber
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kaleb McLendon
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - William O’Sick
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Tyler Baugh
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Suneethamma Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Narayanaiah Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Victoria Stittleburg
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Eric C Fitts
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret A Neja
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ahmed Babiker
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Anne Piantadosi
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Jesse J Waggoner
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Maud Mavigner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wilbur A Lam
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
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32
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Pedrazzoli P, Lasagna A, Cassaniti I, Piralla A, Squeri A, Bruno R, Sacchi P, Baldanti F, Di Maio M, Beretta GD, Cinieri S, Silvestris N. Vaccination for seasonal flu, pneumococcal infection, and SARS-CoV-2 in patients with solid tumors: recommendations of the Associazione Italiana di Oncologia Medica (AIOM). ESMO Open 2023; 8:101215. [PMID: 37104930 PMCID: PMC10067463 DOI: 10.1016/j.esmoop.2023.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Patients with cancer have a well-known and higher risk of vaccine-preventable diseases (VPDs). VPDs may cause severe complications in this setting due to the immune system impairment, malnutrition and oncological treatments. Despite this evidence, vaccination rates are inadequate. The Italian Association of Medical Oncology (AIOM) has been involved in vaccination awareness since 2014. Based on a careful review of the available data about the immunogenicity, effectiveness and safety of flu, pneumococcal and anti-SARS-CoV-2 vaccines, we report the recommendations of the Associazione Italiana di Oncologia Medica about these vaccinations in adult patients with solid tumors. AIOM recommends comprehensive education on the issue of VPDs. We believe that a multidisciplinary care model may improve the vaccination coverage in immunocompromised patients. Continued surveillance, implementation of preventive practices and future well-designed immunological prospective studies are essential for a better management of our patients with cancer.
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Affiliation(s)
- P Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - I Cassaniti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Squeri
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy; School of Specialization in Medical Oncology, University of Messina, Messina, Italy
| | - R Bruno
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Sacchi
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Baldanti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - G D Beretta
- Medical Oncology Unit, Santo Spirito Hospital, Pescara, Italy
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
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