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Kim NY, Ahn S, Kim G, Kwon D, Park YJ, Lee SE. The First Outbreak of Novel Coronavirus Disease 2019 (COVID-19) at an Outdoor Camping Site in South Korea, 2020. J Epidemiol 2024; 34:203-204. [PMID: 37460295 PMCID: PMC10918332 DOI: 10.2188/jea.je20230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/24/2023] [Indexed: 03/10/2024] Open
Affiliation(s)
- Na-Young Kim
- Central Disease Control Headquarters, Korea Centers for Disease Control and Prevention Agency (KDCA), Cheongju, Republic of Korea
| | - Seonhee Ahn
- Central Disease Control Headquarters, Korea Centers for Disease Control and Prevention Agency (KDCA), Cheongju, Republic of Korea
| | - GwangJin Kim
- Homicide, Gwangju Nambu Police Station, Gwangju, Republic of Korea
| | - Donghyok Kwon
- Central Disease Control Headquarters, Korea Centers for Disease Control and Prevention Agency (KDCA), Cheongju, Republic of Korea
| | - Young-Joon Park
- Central Disease Control Headquarters, Korea Centers for Disease Control and Prevention Agency (KDCA), Cheongju, Republic of Korea
| | - Sang-Eun Lee
- Central Disease Control Headquarters, Korea Centers for Disease Control and Prevention Agency (KDCA), Cheongju, Republic of Korea
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Schuh L, Markov PV, Veliov VM, Stilianakis NI. A mathematical model for the within-host (re)infection dynamics of SARS-CoV-2. Math Biosci 2024; 371:109178. [PMID: 38490360 DOI: 10.1016/j.mbs.2024.109178] [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: 12/12/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
Interactions between SARS-CoV-2 and the immune system during infection are complex. However, understanding the within-host SARS-CoV-2 dynamics is of enormous importance for clinical and public health outcomes. Current mathematical models focus on describing the within-host SARS-CoV-2 dynamics during the acute infection phase. Thereby they ignore important long-term post-acute infection effects. We present a mathematical model, which not only describes the SARS-CoV-2 infection dynamics during the acute infection phase, but extends current approaches by also recapitulating clinically observed long-term post-acute infection effects, such as the recovery of the number of susceptible epithelial cells to an initial pre-infection homeostatic level, a permanent and full clearance of the infection within the individual, immune waning, and the formation of long-term immune capacity levels after infection. Finally, we used our model and its description of the long-term post-acute infection dynamics to explore reinfection scenarios differentiating between distinct variant-specific properties of the reinfecting virus. Together, the model's ability to describe not only the acute but also the long-term post-acute infection dynamics provides a more realistic description of key outcomes and allows for its application in clinical and public health scenarios.
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Affiliation(s)
- Lea Schuh
- Joint Research Centre (JRC), European Commission, Via Enrico Fermi 2749, Ispra, 21027, Italy.
| | - Peter V Markov
- Joint Research Centre (JRC), European Commission, Via Enrico Fermi 2749, Ispra, 21027, Italy; London School of Hygiene & Tropical Medicine, University of London, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Vladimir M Veliov
- Institute of Statistics and Mathematical Methods in Economics, Vienna University of Technology, Wiedner Hauptstraße 8-10, Vienna, 1040, Austria
| | - Nikolaos I Stilianakis
- Joint Research Centre (JRC), European Commission, Via Enrico Fermi 2749, Ispra, 21027, Italy; Department of Biometry and Epidemiology, University of Erlangen-Nuremberg, Waldstraße 6, Erlangen, 91054, Germany.
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Høeg TB, Haslam A, Prasad V. An Analysis of Studies Pertaining to Masks in Morbidity and Mortality Weekly Report: Characteristics and Quality of Studies through 2023. Am J Med 2024; 137:154-162.e1. [PMID: 37777144 DOI: 10.1016/j.amjmed.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The purpose of this study was to describe and evaluate the nature and methodology of reports and appropriateness of conclusions in The Morbidity and Mortality Weekly Report (MMWR) pertaining to masks. Because MMWR has substantial influence on United States health policy and is not externally peer-reviewed, it is critical to understand the scientific process within the journal. Mask policies have been highly influenced by data published in the MMWR. METHODS Retrospective cross-sectional study of MMWR publications pertaining to masks through 2023. Outcomes included study design, whether the study was able to assess mask effectiveness, if results were statistically significant, if masks were concluded to be effective, if randomized evidence or conflicting data were mentioned or cited, and appropriateness of causal statements. RESULTS There were 77 studies, all published after 2019, that met our inclusion criteria. The most common study design was observational without a comparator group: 22/77 (28.6%); 0/77 were randomized; 23/77 (29.9%) assessed mask effectiveness; 11/77 (14.3%) were statistically significant, but 58/77 (75.3%) stated that masks were effective. Of these, 41/58 (70.7%) used causal language. One mannequin study used causal language appropriately (1.3%). None cited randomized data; 1/77 (1.3%) cited conflicting evidence. CONCLUSIONS MMWR publications pertaining to masks drew positive conclusions about mask effectiveness >75% of the time despite only 30% testing masks and <15% having statistically significant results. No studies were randomized, yet over half drew causal conclusions. The level of evidence generated was low and the conclusions were most often unsupported by the data. Our findings raise concern about the reliability of the journal for informing health policy.
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Affiliation(s)
- Tracy Beth Høeg
- Department of Epidemiology and Biostatistics, University of California San Francisco; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Alyson Haslam
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco.
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Huang W, Gao CX, Luo D, Wang Y, Zheng X, Liu C, Wang Y, Li Y, Qian H. Risk evaluation of venue types and human behaviors of COVID-19 outbreaks in public indoor environments: A systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 341:122970. [PMID: 37979645 DOI: 10.1016/j.envpol.2023.122970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
Despite increasing vaccination rates, the incidence of breakthrough infections with COVID-19 has increased due to the continued emergence of new variants of the SARS-CoV-2 coronavirus. Therefore, Non-pharmaceutical interventions remain the most effective measures for coping with the ever-changing pandemic. The lifting of compulsory interventions has made individuals primary responsibility for their own health, which highlights the importance of increasing awareness of the infection risk from the environment in which they live and their individual behaviors. We systematically searched PubMed, Web of Science, ScienceDirect, and Scopus on April 17, 2023, for all studies reporting COVID-19 outbreaks in public indoor venues. The study outcome was the attack rate. A total of 42 studies, which included cross-sectional studies, cohort studies, and case studies, reporting data on 1951 confirmed cases in 64 COVID-19 outbreaks satisfied the meta-analysis and were included in the review. A random-effect model was used in the meta-analysis, and subgroup analyses were conducted to investigate factors affecting attack rates. We found a strong level of evidence (p < 0.01) supporting a higher pooled attack rate in recreation-related venues (0.44, 95% CI: 0.30 to 0.60) than in work-related venues (0.21, 95% CI: 0.16 to 0.27). Compared to those outbreaks without that, outbreaks with high-intensity exercise, vocalization, contact behavior, or close body proximity had a higher attack rate of 0.51, 0.55, 0.33, and 0.39, respectively. Further studies suggest that different attack rates across different types of settings may be the result of heterogeneity in exposed people's behaviors. There were significant heterogeneities that may limit the interpretation of connections between influencing factors and outbreak outcomes. The identification of key behaviors that may contribute to transmission risk, and their correlation with venue type, has important implications for the development of future public health interventions and individual prevention strategies for respiratory infectious diseases such as COVID-19.
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Affiliation(s)
- Weiwei Huang
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia; Orygen, Parkville, VIC 3052, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Danting Luo
- School of Energy and Environment, Southeast University, Nanjing, China; Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Yong Wang
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Cong Liu
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Ying Wang
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China; Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong, China; School of Public Health, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China; Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China.
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Weiss T, Reuter T, Dowell E, Singstock M, Smith K, Schlaudecker J. Evaluation of an infection control protocol to limit COVID-19 at residential summer camps in 2021. PLoS One 2023; 18:e0282560. [PMID: 38011154 PMCID: PMC10681214 DOI: 10.1371/journal.pone.0282560] [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] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
AIM To assess the effectiveness of an infection control protocol developed to mitigate the spread of COVID-19 at two multi-week residential summer camps in 2021. SUBJECT AND METHODS Data were collected from 595 camp attendees and staff members at two wilderness camps in Northern Minnesota. Testing was undertaken in all unvaccinated campers before arrival at camp, on day 4 of camp, and in the event of respiratory symptoms. Campers were limited to cohorts during the first 4 days of camp and wore masks indoors. The number of positive COVID-19 cases measured the efficacy of the protocol. RESULTS The testing and cohorting protocol successfully prevented the spread of COVID-19 among campers and staff. During the first summer session, there were zero positive cases of COVID-19 among 257 campers and 127 staff. During the second summer session, compliance with the protocol limited the spread of COVID-19 to just three individuals of 266 campers and 129 staff. Maintaining cohorts at arrival limited spread from a single positive case to only two tent companions. CONCLUSION The testing and cohorting protocol limited the spread of COVID-19 among residential summer wilderness campers and staff. Post-arrival testing ensured newly acquired virus was limited in spread before COVID-19 precautions were relaxed on camp day 5. A strict evidence-based cohorting protocol limited in-camp spread and allowed for a successful summer camp season. The usefulness of this protocol with an evolving pandemic, increasing vaccination rates, and virus variants could have implications for future practice.
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Affiliation(s)
- Tirzah Weiss
- Department of Community and Family Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Tate Reuter
- Department of Community and Family Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Evan Dowell
- Department of Community and Family Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Mitchell Singstock
- Department of Community and Family Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Katherine Smith
- Department of Community and Family Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Jeffrey Schlaudecker
- Department of Community and Family Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
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Hart R, Feygin Y, Kluthe T, Quinn K, Rao S, Baumer-Mouradian SH. Emergency Departments: An Underutilized Resource for Expanding COVID-19 Vaccine Coverage in Children. Vaccines (Basel) 2023; 11:1445. [PMID: 37766122 PMCID: PMC10536917 DOI: 10.3390/vaccines11091445] [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: 07/11/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
COVID-19 vaccine (CV) acceptance rates remain suboptimal in children. Emergency departments (EDs) represent a unique opportunity to improve vaccination rates, particularly in underserved children. Little is known about the presence or reach of CV programs in US EDs. We assessed, via a cross-sectional survey of pediatric ED physicians, the number of EDs offering CVs to children, the approximate numbers of vaccines administered annually, and the perceived facilitators/barriers to vaccination. The proportion of EDs offering CVs is reported. Chi-square tests compared facilitators and barriers among frequent vaccinators (≥50 CVs/year), infrequent vaccinators (<50 CVs/year), and non-vaccinators. Among 492 physicians from 166 EDs, 142 responded (representing 61 (37.3%) EDs). Most EDs were in large, urban, academic, freestanding children's hospitals. Only 11 EDs (18.0%) offer ≥1 CV/year, and only two (18.2%) of these gave ≥50 CVs. Common facilitators of vaccination included the electronic health record facilitation of vaccination, a strong provider/staff buy-in, storage/accessibility, and having a leadership team or champion. Barriers included patient/caregiver refusal, forgetting to offer vaccines, and, less commonly, a lack of buy-in/support and the inaccessibility of vaccines. Many (28/47, 59.6%) EDs expressed interest in establishing a CV program.
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Affiliation(s)
- Rebecca Hart
- Department of Pediatrics, Norton Children’s and the University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Yana Feygin
- Department of Pediatrics, Norton Children’s and the University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Theresa Kluthe
- Department of Pediatrics, Norton Children’s and the University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Katherine Quinn
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Suchitra Rao
- Department of Pediatrics (Infectious Diseases and Hospital Medicine), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Shannon H. Baumer-Mouradian
- Department of Pediatrics, Medical College of Wisconsin/Children’s Hospital of Wisconsin, Milwaukee, WI 53226, USA
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Wen J, Du X, Li A, Zhang S, Shen S, Zhang Z, Yang L, Sun C, Li J, Zhu S. Dilemmas and options for COVID-19 vaccination in children. Ital J Pediatr 2023; 49:103. [PMID: 37620892 PMCID: PMC10464401 DOI: 10.1186/s13052-023-01513-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
Over 16 million children have been detected positive for the coronavirus disease 2019 (COVID-19) in the United States since the outbreak of the pandemic. In general, children infected with severe acute respiratory syndrome coronavirus type 2 tend to have lighter symptoms than adults. However, in some cases, the infection can develop into severe forms, such as multisystem inflammatory syndrome in children. Moreover, long-term public health preventive interventions have had some negative effects on the physical and mental health of children. Given the important role that vaccination plays in reducing severe illness and mortality, it is essential for the efficient implementation of vaccination in the pediatric population. Nevertheless, parental distrust of vaccination, especially with regard to its safety and efficacy, hinders this process. Herein, we comprehensively summarize the available data on the safety and effectiveness of COVID-19 vaccine in children. The results show that the currently approved COVID-19 vaccine is safe and effective for children. Although two doses of vaccine in children seem insufficient to prevent Omicron infection, the booster dose provides enhanced protection against infection and severe illness. Most importantly, the bivalent vaccine has been approved for use in the pediatric population to extend the immune response to currently circulating Omicron variant. And the immune protection afforded to newborns after maternal vaccination appears to last only 6 months. Therefore, in the current situation where the rate of virus mutation is accelerating and the COVID-19 pandemic is still severe, it is crucial to extend vaccine protection to children over 6 months of age to weave a tighter safety net.
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Affiliation(s)
- Jingzhi Wen
- Department of Paediatrics, Yantai Yeda Hospital, Yantai, Shandong, 264006, China
| | - Xiaoan Du
- Jining Medical University, Jining, Shandong, 272067, China
| | - Adan Li
- Jining Medical University, Jining, Shandong, 272067, China
| | - Shungeng Zhang
- Jining Medical University, Jining, Shandong, 272067, China
| | - Shengyun Shen
- Jining Medical University, Jining, Shandong, 272067, China
| | - Ziteng Zhang
- Jining Medical University, Jining, Shandong, 272067, China
| | - Liyuan Yang
- Jining Medical University, Jining, Shandong, 272067, China
| | - Changqing Sun
- Department of Paediatrics, Yantai Yeda Hospital, Yantai, Shandong, 264006, China
| | - Jianing Li
- Department of Paediatrics, Yantai Yeda Hospital, Yantai, Shandong, 264006, China.
| | - Shiheng Zhu
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
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Falender RA, Mitchell PG, Guzman-Cottrill JA, Cieslak PR, Sutton M. Pediatric SARS-CoV-2 Seroprevalence, Oregon, USA, November 1, 2020-June 30, 2022. Emerg Infect Dis 2023; 29:1672-1675. [PMID: 37486347 PMCID: PMC10370852 DOI: 10.3201/eid2908.230471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
We estimated SARS-CoV-2 seroprevalence in children in Oregon, USA, at 6 time points. Seroprevalence increased linearly during November 2020-December 2021 and peaked in February 2022 at 38.8% (95% CI 32.8%-46.5%). We observed no increase in the seroprevalence trend after widespread school reopening. Seroprevalence estimates complement case-based cumulative incidence.
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Alhuzaimi AN, Alrasheed AA, Al-Eyadhy A, Aljamaan F, Alhasan K, Batais MA, Jamal A, Alshahrani FS, Alenezi S, Alhaboob A, AlZamil F, Bashumeel YY, Banaeem AM, Aldawood A, Halwani R, Barry M, Al-Tawfiq JA, Temsah MH. Exploring Determinants of COVID-19 Vaccine Acceptance, Uptake, and Hesitancy in the Pediatric Population: A Study of Parents and Caregivers in Saudi Arabia during the Initial Vaccination Phase. Healthcare (Basel) 2023; 11:972. [PMID: 37046901 PMCID: PMC10094388 DOI: 10.3390/healthcare11070972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES This study aims to assess COVID-19 vaccine acceptance, uptake, and hesitancy among parents and caregivers of children in Saudi Arabia during the initial rollout of pediatric COVID-19 vaccination. METHODS An electronic survey was used to collect data from participants who visited a COVID-19 vaccine center. The survey included demographic data, COVID-19 vaccine status among participants and their children, and reasons for vaccine acceptance or rejection. The Vaccine Hesitancy Scale (VHS) tool was also employed to assess vaccine hesitancy and attitudes toward the COVID-19 vaccine and routine childhood vaccination. Multivariate binary regression analysis was used to identify predictors of actual COVID-19 vaccine uptake among children. RESULTS Of the 873 respondents included in the analysis, 61.5% were parents and 38.5% were other caregivers. Of the participants, 96.9% had received the COVID-19 vaccine. Six hundred and ninety-four participants accepted the vaccine for their children, with the main reasons being an endorsement by the Saudi Ministry of Health (60%) and the importance of going back to school (55%). One hundred and seventy-nine participants would not vaccinate their children, with the most common reasons being fear of adverse effects (49%) and inadequate data about vaccine safety (48%). Factors such as age, COVID-19 vaccination status, self-rated family commitment level, attitudes toward routine children's vaccines, and participants' generalized anxiety disorder (GAD7) score did not significantly correlate with children's COVID-19 vaccination status. Parents were less likely to vaccinate their children compared to other caregivers, and participants with a higher socioeconomic status were more likely to vaccinate their children. CONCLUSION Vaccine acceptance and uptake were high during the initial pediatric COVID-19 vaccination rollout in Saudi Arabia. Still, the ongoing endorsement of the Ministry of Health and healthcare authorities should continue to advocate for better vaccine uptake in children.
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Affiliation(s)
- Abdullah N. Alhuzaimi
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Division of Pediatric Cardiology, Cardiac Science Department, College of Medicine, King Saud University Medical City, Riyadh 11362, Saudi Arabia
- Pediatric Cardiology Section, Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
| | - Abdullah A. Alrasheed
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh 11362, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
| | - Fadi Aljamaan
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Critical Care Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
| | - Khalid Alhasan
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
- Solid Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia
| | - Mohammed A. Batais
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh 11362, Saudi Arabia
- Family Medicine Center, King Saud University Medical City, Riyadh 11362, Saudi Arabia
| | - Amr Jamal
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh 11362, Saudi Arabia
- Evidence-Based Health Care & Knowledge Translation Research Chair, Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Fatimah S. Alshahrani
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University Medical City, Riyadh 11362, Saudi Arabia
| | - Shuliweeh Alenezi
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Department of Psychiatry, King Saud University, Riyadh 11362, Saudi Arabia
| | - Ali Alhaboob
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
| | - Fahad AlZamil
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
| | - Yaser Y. Bashumeel
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukayriah 51941, Saudi Arabia
| | - Ahmad M. Banaeem
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Abdulrahman Aldawood
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Rabih Halwani
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Mazin Barry
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Evidence-Based Health Care & Knowledge Translation Research Chair, Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
- Department of Internal Medicine, College of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia (M.-H.T.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
- Prince Abdullah bin Khaled Coeliac Disease Research Chair, King Saud University, Riyadh 11362, Saudi Arabia
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Follow-Up of Side Effects throughout the Entire Course of Coronavirus Vaccination. Vaccines (Basel) 2023; 11:vaccines11030704. [PMID: 36992288 DOI: 10.3390/vaccines11030704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/22/2023] Open
Abstract
Vaccines are considered the best protective means against coronavirus infection. There is increasing interest in reporting the side effects of vaccines, especially for individuals younger than 18 years old. Accordingly, this analytical cohort study aims to report on the side effects of adult and young individuals who received vaccination within 24 h, 72 h, 5 days, and 1 week through the entire course of vaccination (ECoV). A validated online survey was used to collect information. In total, 1069 individuals were completely followed. Most individuals received the Pfizer vaccine (59.6%). Most individuals had received two doses (69.4%). Very strong and statistically significant associations with side effects (p < 0.05, Phi (Φ) > 0.25) throughout the ECoV were reported for the type of vaccine and female gender. Non-smokers reported weak statistically significant associations. Fatigue and localized pain were the most commonly reported side effect, with onset within 24 h and duration of less than 72 h. The prevalence of reported side effects was statistically significantly higher among young individuals (<18 years old) than among adults (X2 (1) =7.6, p = 0.006. Phi φ = 0.11).
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Ahmed AK, Sijercic VC, Sayad R, Ruthig GR, Abdelwahab SF, El-Mokhtar MA, Sayed IM. Risks and Preventions for Pregnant Women and Their Preterm Infants in a World with COVID-19: A Narrative Review. Vaccines (Basel) 2023; 11:vaccines11030640. [PMID: 36992224 DOI: 10.3390/vaccines11030640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/05/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
(1) Background and Aim: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is linked to increasing cases of coronavirus disease 2019 (COVID-19) around the world. COVID-19 infections have an important impact on pregnancy, preterm birth (PTB) and delivery. Although several complications have been reported in infected pregnant women, the effect of infection on PTB is controversial. The purpose of this study was to summarize the existing literature on the effects and complications of COVID-19 on the health of pregnant women and preterm babies and its impact on the incidence of PTB. We also discuss the effect of current COVID-19 vaccines during pregnancy. (2) Methods: We carried out a systematic search of MEDLINE, Embase, and PubMed for studies on preterm births associated with COVID-19. (3) Results and Conclusions: We discovered contradictory results regarding the prevalence of PTB during the pandemic compared to earlier years. While most studies indicated an increase in PTBs with COVID-19, some indicated a decline in the preterm delivery rate during this time. During pregnancy, COVID-19 infection can increase the incidence of cesarean section, stillbirth, ICU admission, preeclampsia/eclampsia, and mortality rates. In the treatment of pregnant women with severe COVID-19, methylprednisolone was favored over prednisolone, and a brief course of dexamethasone is advised for pregnant women with anticipated PTB to accelerate the development of the fetal lung. Generally, vaccination for COVID-19 in pregnant and lactating women stimulates anti-SARS-CoV2 immune responses, and it does not result in any noteworthy negative reactions or outcomes for the mother or baby.
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Affiliation(s)
| | | | - Reem Sayad
- Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Gregory R Ruthig
- Department of Biology, North Central College, Naperville, IL 60540, USA
| | - Sayed F Abdelwahab
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Mohamed A El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Microbiology and Immunology Department, Faculty of Pharmacy, Sphinx University, Assiut 71515, Egypt
| | - Ibrahim M Sayed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
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12
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Brainard J, Jones NR, Harrison FC, Hammer CC, Lake IR. Super-spreaders of novel coronaviruses that cause SARS, MERS and COVID-19: A systematic review. Ann Epidemiol 2023:S1047-2797(23)00058-3. [PMID: 37001627 DOI: 10.1016/j.annepidem.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 01/12/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Most index cases with novel coronavirus infections transmit disease to just one or two other individuals, but some individuals "super-spread"-they infect many secondary cases. Understanding common factors that super-spreaders may share could inform outbreak models, and be used to guide contact tracing during outbreaks. METHODS We searched in MEDLINE, Scopus, and preprints to identify studies about people documented as transmitting pathogens that cause SARS, MERS, or COVID-19 to at least nine other people. We extracted data to describe them by age, sex, location, occupation, activities, symptom severity, any underlying conditions, disease outcome and undertook quality assessment for outbreaks published by June 2021. RESULTS The most typical super-spreader was a male age 40+. Most SARS or MERS super-spreaders were very symptomatic, the super-spreading occurred in hospital settings and frequently the individual died. In contrast, COVID-19 super-spreaders often had very mild disease and most COVID-19 super-spreading happened in community settings. CONCLUSIONS SARS and MERS super-spreaders were often symptomatic, middle- or older-age adults who had a high mortality rate. In contrast, COVID-19 super-spreaders tended to have mild disease and were any adult age. More outbreak reports should be published with anonymized but useful demographic information to improve understanding of super-spreading, super-spreaders, and the settings in which super-spreading happens.
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13
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Wilkinson K, Ata A, Neaton S, Woll C. Evaluation of Safety Measures at a Medical Summer Camp During the SARS-CoV-2 Pandemic. Wilderness Environ Med 2023; 34:77-81. [PMID: 36517390 PMCID: PMC9688782 DOI: 10.1016/j.wem.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION SARS-CoV-2 poses challenges for the safe delivery of a camp experience with a medically complex camper population. Multiple studies have investigated the effect of nonpharmaceutical interventions for preventing SARS-CoV-2 transmission in traditional summer camp settings, but none in the medical summer camp settings. Our objective was to describe and evaluate the nonpharmaceutical interventions on SARS-CoV-2 transmission rate in a medical summer camp setting. METHODS This was a single-institution cross-sectional study conducted between June 2021 and August 2021 in a rural summer camp setting in upstate New York. Nonpharmaceutical interventions consisted of prearrival guidance on low-risk activities, obtaining negative SARS-CoV-2 polymerase chain reaction results within 72 h prior to arrival, adult SARS-CoV-2 vaccine mandate, universal masking mandate, small cohorts, daily symptom screening, and rapid testing on site. Primary cases were defined as an individual with a positive SARS-CoV-2 test result of any type while at camp or 2 wk after departure from camp without any known exposure at camp; secondary cases were defined as cases from potential exposures within camp. RESULTS Two hundred and ninety-three campers were included. Nine individuals were tested owing to potentially infectious symptoms while at camp. Thirty-four campers were tested because they arrived from a county with an a priori intermediate level of SARS-CoV-2 community spread. Zero on-site rapid tests were positive for SARS-CoV-2. CONCLUSIONS We describe the implementation of multilayered nonpharmaceutical interventions at a medical summer camp during the SARS-CoV-2 pandemic.
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Affiliation(s)
| | - Ashar Ata
- Departments of Surgery and Emergency Medicine, Albany Medical Center, Albany, NY
| | | | - Christopher Woll
- Double H Hole-in-the-Woods Ranch, Lake Luzerne, NY; Departments of Pediatrics and Emergency Medicine, Albany Medical Center, Albany, NY.
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14
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Baker JM, Shah MM, O’Hegarty M, Pomeroy M, Keiser P, Ren P, Weaver SC, Maknojia S, Machado RRG, Mitchell BM, McConnell A, Tate JE, Kirking HL. Primary and Secondary Attack Rates by Vaccination Status after a SARS-CoV-2 B.1.617.2 (Delta) Variant Outbreak at a Youth Summer Camp-Texas, June 2021. J Pediatric Infect Dis Soc 2022; 11:550-556. [PMID: 36043454 PMCID: PMC9452135 DOI: 10.1093/jpids/piac086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/05/2022] [Indexed: 01/01/2023]
Abstract
Children are capable of initiating COVID-19 transmission into households, but many questions remain about the impact of vaccination on transmission. Data from a COVID-19 Delta variant outbreak at an overnight camp in Texas during June 23-27, 2021, were analyzed. The camp had 451 attendees, including 364 youths aged < 18 years and 87 adults. Detailed interviews were conducted with 92 (20.4%) of consenting attendees and 117 household members of interviewed attendees with COVID-19. Among 450 attendees with known case status, the attack rate was 41%, including 42% among youths; attack rates were lower among vaccinated (13%) than among unvaccinated youths (48%). The secondary attack rate was 51% among 115 household contacts of 55 interviewed index patients. Secondary infections occurred in 67% of unvaccinated household members and 33% of fully or partially vaccinated household members. Analyses suggested that household member vaccination and camp attendee masking at home protected against household transmission.
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Affiliation(s)
- Julia M Baker
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
- Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Melisa M Shah
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
- Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | | | - Mary Pomeroy
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
| | - Philip Keiser
- Galveston County Health District, Galveston, Texas, USA
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Ping Ren
- Department of Pathology, University of Texas Medical Branch atGalveston, Texas, USA
| | - Scott C Weaver
- World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Sara Maknojia
- Galveston County Health District, Galveston, Texas, USA
| | - Rafael R G Machado
- World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Brooke M Mitchell
- World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Allan McConnell
- World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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15
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Garst BA, Dubin A, Gaslin T, Schultz B, Ambrose M, Hashikawa A, Dehudy A. Camp health care practices and adaptations associated with COVID-19. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2156513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Barry A. Garst
- Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA
| | - Alexsandra Dubin
- Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA
| | | | - Beth Schultz
- Department of Nursing, Manchester University, North Manchester, IN
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16
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Xu C, Ma M, Yi Y, Yi C, Dai H. Clinical features and high-resolution chest computerized tomography findings of children infected by the B.1.617.2 variant of coronavirus disease 2019. Ann Med 2022; 54:2391-2401. [PMID: 36039499 PMCID: PMC9448437 DOI: 10.1080/07853890.2022.2114608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To analyse the clinical symptoms, laboratory examinations and chest CT findings of children infected by the B.1.617.2 variant of COVID-19 and to compare the differences between clinical subtypes. METHODS Fifty-three children (28 males, 25 females; age ranging from 4 months to 17 years) were included with B.1.617.2 variant infection in Nanjing, China, from July 21 to August 12 2021. Clinical data from patients were collected and analysed in groups of mild and common types. Imaging data were divided into three stages for evaluation: early, intermediate and late stages. RESULTS In our study, fever (53%), cough (34%) and pharyngeal discomfort (28%) were the main symptoms. There were no differences in clinical symptoms between the mild and common type. The most common laboratory test items outside the normal range were decreased mean corpuscular volume (68%), lymphocyte percentage (64% elevated and 2% decreased) and decreased serum alkaline phosphatase concentration (66%). The differences in haemoglobin and monocyte percentages between the mild and common types were statistically significant (p = .037 and .033, respectively). No influencing factor was statistically significant in the regression analysis of both symptoms and clinical subtypes. The main CT findings were ground-glass opacity and consolidation located in the periphery and bilateral multilobed involvement. The mean CT score was 1.6. CT score correlated with packet cell volume, haemoglobin, mean erythrocyte volume, mean platelet volume and platelet distribution width. CONCLUSION The pathogenetic condition of children with B.1.617.2 variant infection is mild. Although there were intergroup differences in some blood cell analyses, T-lymphocyte counts, and comprehensive biochemical indicators, no factors had a significant effect on clinical typing and the presence or absence of symptoms. CT findings and CT scores reflect disease stage and pathological changes and correlate moderately with laboratory tests, making them of good value for disease diagnosis and monitoring.Key MessagesPaediatric patients infected with B.1.617.2 variant have a milder clinical and imaging presentation than adults and are similar to the prototype infection.CT findings and scores which reflect disease stages and pathological changes.There is a correlation between chest CT and laboratory tests, which can be useful for the diagnosis and follow-up of the disease.
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Affiliation(s)
- Chuanjun Xu
- Department of Radiology, The Second Hospital of Nanjing Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Mengya Ma
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Institute of Medical Imaging, Soochow University, Suzhou, P.R. China
| | - Yongxiang Yi
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Changhua Yi
- Nanjing Infectious Diseases Clinical Medical Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Institute of Medical Imaging, Soochow University, Suzhou, P.R. China
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17
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Tinker SC, Prince-Guerra JL, Vermandere K, Gettings J, Drenzik C, Voccio G, Parrott T, Drobeniuc J, Hayden T, Briggs S, Heida D, Thornburg N, Barrios LC, Neatherlin JC, Madni S, Rasberry CN, Swanson KD, Tamin A, Harcourt JL, Lester S, Atherton L, Honein MA. Evaluation of self-administered antigen testing in a college setting. Virol J 2022; 19:202. [PMID: 36457114 PMCID: PMC9713151 DOI: 10.1186/s12985-022-01927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The objective of our investigation was to better understand barriers to implementation of self-administered antigen screening testing for SARS-CoV-2 at institutions of higher education (IHE). METHODS Using the Quidel QuickVue At-Home COVID-19 Test, 1347 IHE students and staff were asked to test twice weekly for seven weeks. We assessed seroconversion using baseline and endline serum specimens. Online surveys assessed acceptability. RESULTS Participants reported 9971 self-administered antigen test results. Among participants who were not antibody positive at baseline, the median number of tests reported was eight. Among 324 participants seronegative at baseline, with endline antibody results and ≥ 1 self-administered antigen test results, there were five COVID-19 infections; only one was detected by self-administered antigen test (sensitivity = 20%). Acceptability of self-administered antigen tests was high. CONCLUSIONS Twice-weekly serial self-administered antigen testing in a low prevalence period had low utility in this investigation. Issues of testing fatigue will be important to address in future testing strategies.
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Affiliation(s)
- Sarah C. Tinker
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Jessica L. Prince-Guerra
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA ,grid.416738.f0000 0001 2163 0069Laboratory Leadership Service, CDC, Atlanta, GA USA
| | - Kelly Vermandere
- grid.420388.50000 0004 4692 4364Georgia Department of Public Health, Atlanta, GA USA
| | - Jenna Gettings
- grid.420388.50000 0004 4692 4364Georgia Department of Public Health, Atlanta, GA USA ,grid.416738.f0000 0001 2163 0069Epidemic Intelligence Service, CDC, Atlanta, GA USA
| | - Cherie Drenzik
- grid.420388.50000 0004 4692 4364Georgia Department of Public Health, Atlanta, GA USA
| | - Gary Voccio
- grid.420388.50000 0004 4692 4364Georgia Department of Public Health, Atlanta, GA USA
| | | | - Jan Drobeniuc
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Tonya Hayden
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Stephen Briggs
- grid.423400.10000 0000 9002 0195Berry College, Rome, GA USA
| | - Debbie Heida
- grid.423400.10000 0000 9002 0195Berry College, Rome, GA USA
| | - Natalie Thornburg
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Lisa C. Barrios
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - John C. Neatherlin
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Sabrina Madni
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Catherine N. Rasberry
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Kenneth D. Swanson
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Azaibi Tamin
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Jennifer L. Harcourt
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Sandra Lester
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Lydia Atherton
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
| | - Margaret A. Honein
- grid.416738.f0000 0001 2163 0069COVID-19 Response Team, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333 USA
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18
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Ng NBH, Appleby GF, Thong XY, Ong SKA, Hii SZW, Tan IKZ, Mohite S, Kao PT. COVID-19 vaccination-related attendance at a pediatric emergency department in Singapore among 12- to 18-year old adolescents. Pediatr Neonatol 2022; 63:633-641. [PMID: 35989181 PMCID: PMC9356755 DOI: 10.1016/j.pedneo.2022.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Singapore was one of the first countries to begin COVID-19 vaccination with the BNT162b2 vaccine for adolescents aged 12-18 years. This study evaluates the incidence of COVID-19 vaccine related attendances to a Pediatric Emergency Department (PED) to understand post-vaccination health behaviors among adolescents. METHODS This was a retrospective review of electronic medical records over a 4 month period, from the start of the adolescent vaccination drive to when more than 85% of this group had been fully vaccinated. RESULTS The incidence of COVID-19 vaccination-related presentations to our PED was 3.1% over 4 months (291 of 9387 PED attendances), with a peak daily incidence of 15.4% (14 of 91 attendances). Presentations were characterized by severity into: severe (3.4%), moderate (7.9%) or mild (88.7%) based on predefined criteria. The most common presenting complaints were chest pain (58.8%), dyspnea (28.2%) and palpitations (22.6%). Hospitalization was required in only 6.2% of attendances. Patients with moderate-severe presentations were 0.7 years older (p = 0.030), more likely to have underlying drug allergies (p = 0.048) and had higher rates of hospitalization (p < 0.005) compared to mild presentations. Despite concerns of cardiac inflammation, chest pain related attendances were less likely to be severe (p < 0.005) with reduced hospitalization need (p = 0.043) compared to other presentations. Investigations beyond clinical assessment comprised 91% of attendances, but abnormalities were only found in 6.4% cases. CONCLUSION Our study supports current evidence that COVID-19 vaccination is safe amongst adolescents. We highlight the health behaviors among adolescents post-vaccination, which is partly driven by media reports on vaccine side effects and an element of anxiety. While most of the presentations were mild, these can have implications on health resource utilization, particularly in an ongoing pandemic. As healthcare workers, we have an ongoing role to ensure accurate information on vaccine safety is communicated effectively to the public.
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Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore.
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19
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Abstract
BACKGROUND We aimed to elucidate variables associated with coronavirus disease 2019 (COVID-19) vaccine compliance in adolescents and devise targeted interventions. Our secondary aim was to compare the rates of severe acute respiratory syndrome coronavirus 2 infection, hospitalizations and deaths between vaccinated and unvaccinated adolescents. METHODS A retrospective review of electronic medical records was performed on all adolescents 12-17 years of age registered at Clalit Health District in Israel during January 1, 2021, to November 18, 2021, with characterization by vaccination status against COVID-19. Univariate and multivariable analyses were employed to identify predictors of vaccination. RESULTS Of the 43,919 subjects included in the study, 28,207 (64.2%) were vaccinated. Non-ultraorthodox Jewish adolescents had a higher vaccination rate than the minorities Arabs or ultraorthodox Jews (72.5%, 66.2% and 40.5%, respectively, P < 0.001). Adolescents of high socioeconomic status had nearly 2-fold higher vaccination rates than those of low socioeconomic status (80.4% vs 42.3%; P < 0.0001). Adolescents 16-17 years old had a higher rate of COVID-19 vaccination than those 12-15 years old (72.5% vs 60.6%, P < 0.001), as were girls versus boys (64.7% vs 63.8%, P = 0.047). Multivariate analysis identified 3 independent variables that were significantly ( P < 0.001) associated with low vaccination: ultraorthodox sector, Arab population, and underlying obesity (hazard rations 0.42, 0.72 and 0.84, respectively). Vaccination was significantly associated with reduced severe acute respiratory syndrome coronavirus 2 infection, hospitalization and death ( P < 0.001). CONCLUSION This study highlights several pediatric populations with low COVID-19 vaccine compliance. Targeted interventions aimed at these populations are suggested with consideration of their special cultural, social and societal characteristics.
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20
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Garst BA, Dubin A, Gaslin T. Application of non-pharmaceutical interventions in camps following the onset of COVID-19. Child Care Health Dev 2022; 48:956-962. [PMID: 34994409 DOI: 10.1111/cch.12957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the COVID-19 pandemic emerged in the United States in the spring and summer of 2020, many organizations serving children and youth immediately faced significant operational and healthcare challenges. Centers for Disease Control and Prevention guidance for the safe operation of youth programmes emphasized the importance of non-pharmaceutical interventions (NPIs), yet few studies have examined NPI usage in summer programmes such as camps. METHOD This sequential explanatory mixed-methods study explored the utilization of NPIs among camp healthcare providers who completed an online questionnaire followed by one-on-one interviews. RESULTS The study findings indicated that camps consistently used a core set of NPIs to maintain and protect the health of camp participants, including screening, cohorting, hand hygiene, sanitizing practices, ventilation and physical distancing. The study findings further identified specific practices of camp healthcare providers that made NPI utilization possible, as exemplified in the emergent themes of wellness promotion; health awareness and modelling; and camp health service mobilization. CONCLUSION NPI usage benchmarks from this study, as well as effective practices for NPI utilization, can inform the application of NPIs and other health-promoting practices across diverse formal and informal youth settings.
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Affiliation(s)
| | | | - Tracey Gaslin
- Association of Camp Nursing, Louisville, Kentucky, USA
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21
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Molassiotis A, Xie YJ, Leung AYM, Ho GWK, Li Y, Leung PHM, Wang HL, Chen CXR, Tong DWK, Siu JYM, Lau JTF. A Community-Based Participatory Research Approach to Developing and Testing Social and Behavioural Interventions to Reduce the Spread of SARS-CoV-2: A Protocol for the ' COPAR for COVID' Programme of Research with Five Interconnected Studies in the Hong Kong Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13392. [PMID: 36293972 PMCID: PMC9603243 DOI: 10.3390/ijerph192013392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While a number of population preventive measures for COVID-19 exist that help to decrease the spread of the virus in the community, there are still many areas in preventative efforts that need improvement or refinement, particularly as new strains of the virus develop. Some of the key issues currently include incorrect and/or inconsistent use of face masks, low acceptance of early screening or vaccination for COVID-19, vaccine hesitance, and misinformation. This is particularly the case in some vulnerable populations, such as older people with chronic illnesses, ethnic minorities who may not speak the mainstream language well and children. The current protocol introduces a large programme of research through five interrelated studies that all focus on social and behavioural interventions to improve different aspects of community-related preventative indicators. Hence, the specific objectives of the overall programme are to (1) increase early testing for COVID-19 and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase COVID-19-related health literacy and vaccine literacy and promote improved preventative measures in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public's motivation to stay at home and avoid nonessential high-risk activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5). METHODS We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short- and long-term, including, for example, the 8-item self-reported eHealth Literacy Scale (eHEAL) and objective measures such as vaccine uptake. DISCUSSION Theory-driven interventions will address each study's focus (e.g., social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Improvements are expected to be seen in the outcomes of vulnerable and high-risk groups. Decreased infection rates are expected due to improved preventative behaviours and increased vaccine uptake. Long-term sustainability of the approach will be achieved through the CBPR model. The publication of this protocol can assist not only in sharing a large-scale and complex community-based design, but will also allow all to learn from this, so that we will have better insight in the future whether sharing of study designs can elicit timely research initiatives.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Health and Social Care Research Centre, University of Derby, Derby DE22 1GB, UK
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Angela Y. M. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Grace W. K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Polly Hang-Mei Leung
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hua Li Wang
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | | | | | - Judy Yuen-man Siu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joseph T. F. Lau
- Centre for Health Behaviours Research, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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22
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Bhatia R, Sledge I, Baral S. Missing science: A scoping study of COVID-19 epidemiological data in the United States. PLoS One 2022; 17:e0248793. [PMID: 36223335 PMCID: PMC9555641 DOI: 10.1371/journal.pone.0248793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.
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Affiliation(s)
- Rajiv Bhatia
- Primary Care and Population Health, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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Prioritizing interventions for preventing COVID-19 outbreaks in military basic training. PLoS Comput Biol 2022; 18:e1010489. [PMID: 36206315 PMCID: PMC9581358 DOI: 10.1371/journal.pcbi.1010489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/19/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022] Open
Abstract
Like other congregate living settings, military basic training has been subject to outbreaks of COVID-19. We sought to identify improved strategies for preventing outbreaks in this setting using an agent-based model of a hypothetical cohort of trainees on a U.S. Army post. Our analysis revealed unique aspects of basic training that require customized approaches to outbreak prevention, which draws attention to the possibility that customized approaches may be necessary in other settings, too. In particular, we showed that introductions by trainers and support staff may be a major vulnerability, given that those individuals remain at risk of community exposure throughout the training period. We also found that increased testing of trainees upon arrival could actually increase the risk of outbreaks, given the potential for false-positive test results to lead to susceptible individuals becoming infected in group isolation and seeding outbreaks in training units upon release. Until an effective transmission-blocking vaccine is adopted at high coverage by individuals involved with basic training, need will persist for non-pharmaceutical interventions to prevent outbreaks in military basic training. Ongoing uncertainties about virus variants and breakthrough infections necessitate continued vigilance in this setting, even as vaccination coverage increases.
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24
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Zhai W, Yue H, Deng Y. Examining the association between urban green space and viral transmission of COVID-19 during the early outbreak. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2022; 147:102768. [PMID: 35936827 PMCID: PMC9340055 DOI: 10.1016/j.apgeog.2022.102768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 05/03/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
Even though exposure to urban green spaces (UGS) has physical and mental health benefits during COVID-19, whether visiting UGS will exacerbate viral transmission and what types of counties would be more impacted remain to be answered. In this research, we adopted mobile phone data to measure the county-level UGS visitation across the United States. We developed a Bayesian model to estimate the effective production number of the pandemic. To consider the spatial dependency, we applied the geographically weighted panel regression to estimate the association between UGS visitation and viral transmission. We found that visitations to UGS may be positively correlated with the viral spread in Florida, Idaho, New Mexico, Texas, New York, Ohio, and Pennsylvania. Especially noteworthy is that the spread of COVID-19 in the majority of counties is not associated with green space visitation. Further, we found that when people visit UGS, there may be a positive association between median age and viral transmission in New Mexico, Colorado, and Missouri; a positive association between concentration of blacks and viral transmission in North Dakota, Minnesota, Wisconsin, Michigan, and Florida; and a positive association between poverty rate and viral transmission in Iowa, Missouri, Colorado, New Mexico, and the Northeast United States.
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Affiliation(s)
- Wei Zhai
- School of Architecture and Planning, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Haoyu Yue
- Department of Urban Design and Planning, University of Washington, Seattle, Washington, USA
| | - Yihan Deng
- Department of Information Systems, City University of Hong Kong, Hong Kong, China
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25
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Bai J(H, Phinney S, Angell K, Grimm B, Tegomoh B, Figliomeni J, Abdalhamid B, Khan AS, Donahue M, Brett-Major DM, McDougall L. Outbreak of SARS-CoV-2 B.1.617.2 (Delta Variant) in a Youth Camp Associated With Community Spread, Nebraska, June-July 2021. Public Health Rep 2022; 138:157-163. [PMID: 36113162 PMCID: PMC9482873 DOI: 10.1177/00333549221123582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES During June-July 2021, an outbreak of SARS-CoV-2 occurred among attendees of a summer youth camp in Nebraska. We assessed the factors that contributed to onward transmission of disease. METHODS The Four Corners Health Department conducted an outbreak investigation and recorded both laboratory-confirmed and self-reported cases of SARS-CoV-2 and mitigation measures employed. We generated sequences on positive specimens, created an epidemic curve to assist with outbreak visualization, and examined epidemiologic, genomic, and laboratory outcomes. RESULTS Evaluation of 3 index cases led to the identification of 25 people with COVID-19 who interacted directly with the camp. Contact tracing revealed an additional 18 cases consistent with onward community transmission. Most (24 of 35, 68.5%) vaccine-eligible community cases were not vaccinated. We sequenced 8 positive specimens; all were identified as the Delta variant. Precamp planning incorporated local health officials who recommended wearing face masks, practicing social distancing, and using attendee cohorts to limit mixing of people involved in various activities. CONCLUSION Low vaccination levels and poor face mask-wearing habits among attendees resulted in secondary and tertiary spread of SARS-CoV-2 and severe outcomes among young adults. This outbreak of COVID-19 at a youth camp highlights the importance of vaccination and use of other measures to interrupt opportunities for SARS-CoV-2 spread in the community and shows that vaccinated people remain vulnerable to infection when in an environment of high exposure to SARS-CoV-2. Proactive case identification and interruption of chains of transmission can help decrease the number of cases and avoid further severe outcomes.
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Affiliation(s)
- Julia (He) Bai
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA,Julia (He) Bai, MPH, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Ste 3036F, Omaha, NE 68198-4395, USA.
| | | | - Kathleen Angell
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brandon Grimm
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryan Tegomoh
- Nebraska Department of Health and Human Services, Lincoln, NE, USA,CDC Foundation, Atlanta, GA, USA
| | | | - Baha Abdalhamid
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ali S. Khan
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew Donahue
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
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26
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Endo (遠藤彰) A, Uchida (内田満夫) M, Liu (刘扬) Y, Atkins KE, Kucharski AJ, Funk S. Simulating respiratory disease transmission within and between classrooms to assess pandemic management strategies at schools. Proc Natl Acad Sci U S A 2022; 119:e2203019119. [PMID: 36074818 PMCID: PMC9478679 DOI: 10.1073/pnas.2203019119] [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: 02/28/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
The global spread of coronavirus disease 2019 (COVID-19) has emphasized the need for evidence-based strategies for the safe operation of schools during pandemics that balance infection risk with the society's responsibility of allowing children to attend school. Due to limited empirical data, existing analyses assessing school-based interventions in pandemic situations often impose strong assumptions, for example, on the relationship between class size and transmission risk, which could bias the estimated effect of interventions, such as split classes and staggered attendance. To fill this gap in school outbreak studies, we parameterized an individual-based model that accounts for heterogeneous contact rates within and between classes and grades to a multischool outbreak data of influenza. We then simulated school outbreaks of respiratory infectious diseases of ongoing threat (i.e., COVID-19) and potential threat (i.e., pandemic influenza) under a variety of interventions (changing class structures, symptom screening, regular testing, cohorting, and responsive class closures). Our results suggest that interventions changing class structures (e.g., reduced class sizes) may not be effective in reducing the risk of major school outbreaks upon introduction of a case and that other precautionary measures (e.g., screening and isolation) need to be employed. Class-level closures in response to detection of a case were also suggested to be effective in reducing the size of an outbreak.
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Affiliation(s)
- Akira Endo (遠藤彰)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Alan Turing Institute, London NW1 2DB, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan
- Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - CMMID COVID-19 Working Group
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | | | - Yang Liu (刘扬)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Katherine E. Atkins
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, United Kingdom
| | - Adam J. Kucharski
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
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Bozzola E, Caffarelli C, Santamaria F, Corsello G. The year 2021 in COVID-19 pandemic in children. Ital J Pediatr 2022; 48:161. [PMID: 36064605 PMCID: PMC9444079 DOI: 10.1186/s13052-022-01360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/30/2022] [Indexed: 01/08/2023] Open
Abstract
In this article, the developments in the field of COVID-19 pandemic published in the Italian Journal of Pediatrics in 2021 are reflected. We describe progresses in SARS-CoV-2 transmission route, clinical presentation, diagnosis, treatment, and access to health care facilities in children. They led to substantial changes in the clinical approach.
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Affiliation(s)
- Elena Bozzola
- Department of Pediatric, IRCCS Bambino Gesù Children's Hospital, Pediatric Diseases Unit, Rome, Italy.
| | - Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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Intent among Parents to Vaccinate Children before Pediatric COVID-19 Vaccine Recommendations, Minnesota and Los Angeles County, California-May-September 2021. Vaccines (Basel) 2022; 10:vaccines10091441. [PMID: 36146519 PMCID: PMC9504557 DOI: 10.3390/vaccines10091441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: This study assessed the associations between parent intent to have their child receive the COVID-19 vaccination, and demographic factors and various child activities, including attendance at in-person education or childcare. Methods: Persons undergoing COVID-19 testing residing in Minnesota and Los Angeles County, California with children aged <12 years completed anonymous internet-based surveys between 10 May and 6 September 2021 to assess factors associated with intention to vaccinate their child. Factors influencing the parents’ decision to have their child attend in-person school or childcare were examined. Estimated adjusted odds rations (AORs, 95% CI) were computed between parents’ intentions regarding children’s COVID-19 vaccination and participation in school and extra-curricular activities using multinomial logistic regression. Results: Compared to parents intending to vaccinate their children (n = 4686 [77.2%]), those undecided (n = 874 [14.4%]) or without intention to vaccinate (n = 508 [8.4%]) tended to be younger, non-White, less educated, and themselves not vaccinated against COVID-19. Their children more commonly participated in sports (aOR:1.51 1.17−1.95) and in-person faith or community activities (aOR:4.71 3.62−6.11). A greater proportion of parents without intention to vaccinate (52.5%) indicated that they required no more information to make their decision in comparison to undecided parents (13.2%). They further indicated that additional information regarding vaccine safety and effectiveness would influence their decision. COVID-19 mitigation measures were the most common factors influencing parents’ decision to have their child attend in-person class or childcare. Conclusions: Several demographic and socioeconomic factors are associated with parents’ decision whether to vaccinate their <12-year-old children for COVID-19. Child participation in in-person activities was associated with parents’ intentions not to vaccinate. Tailored communications may be useful to inform parents’ decisions regarding the safety and effectiveness of vaccination.
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胡 亚, 姚 开. Clinical characteristics and epidemiological significance of coronavirus disease 2019 in children and adolescents. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:846-852. [PMID: 36036120 PMCID: PMC9425860 DOI: 10.7499/j.issn.1008-8830.2205026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
Abstract
The epidemic of coronavirus disease 2019 (COVID-19) started in late December 2019, and spread rapidly throughout the world. In March 2020, the World Health Organization (WHO) declared global epidemic of COVID-19. According to the American Academy of Pediatrics, nearly 13 million children have been diagnosed with COVID-19 since the outbreak. In general, children and teens have milder symptoms and fewer deaths from COVID-19 than adults. Understanding the symptoms, infectivity, and transmission patterns of COVID-19 in children and adolescents is of great significance for timely identifying suspected patients and developing effective control measures. Considering that some children will not be vaccinated for quite some time in the future, it is more important to improve the understanding of the clinical and epidemiological significance of COVID-19 in children and adolescents. This article summarizes the current understanding of the clinical manifestations and epidemiological significance of COVID-19 in children and adolescents to provide a reference for clinical diagnosis and treatment and the formulation of epidemic prevention and control strategies in children's gathering institutions such as kindergartens and schools.
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30
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Blaisdell L, Rising J, van Zyl A, Finn J, Vergales J. Testing and Nonpharmaceutical Interventions for Prevention of SARS-CoV-2 in 20 US Overnight Camps in Summer 2021. Public Health Rep 2022; 137:1007-1012. [PMID: 35856437 PMCID: PMC9357653 DOI: 10.1177/00333549221110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: Overnight camps are a setting where COVID-19 can easily spread without the
diligent use of layered public health interventions. We evaluated 20 camps
in the United States to examine COVID-19 transmission and mitigation
strategies during summer 2021. Methods: For this descriptive cross-sectional study, we examined self-reported
information from 20 camps in 6 predominantly northeastern states on
geographic information, tests and testing cadences, vaccination rates, and
number of COVID-19 cases during summer 2021. Because the camps had hired
public health consultants to guide them on reducing COVID-19 introduction
and spread, all camps implemented similar interventions, including
encouraging behaviors that lower the risk of COVID-19 transmission prior to
camp arrival, use of cohorts, testing before and after arrival, and strong
encouragement of vaccination among eligible campers and staff members. Results: A total of 9474 attendees at the 20 camps came from geographically diverse
regions. Camps generally tested before and at arrival, as well as once or
twice after arrival. Rates of vaccination were high among staff members
(84.6%) and campers (76.2%). Camps identified 27 COVID-19 cases, with 17
(63.0%) detected after arrival, 3 (7.4%) detected on arrival, and 8 (29.6%)
detected prior to arrival. Conclusions: The spread of cases detected after arrival to overnight camps was limited by
the use of 3 key interventions: (1) high vaccination rates, (2) a rigorous
and responsive testing strategy, and (3) ongoing use of public health
interventions. These findings have implications for successful operation of
overnight camps, residential schools and colleges, and other similar
settings.
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Affiliation(s)
- Laura Blaisdell
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Josh Rising
- Rising Health Strategies, LLC, Washington DC, USA
| | | | - Julia Finn
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jeff Vergales
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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31
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Spira B. The Impact of the Highly Virulent SARS-CoV-2 Gamma Variant on Young Adults in the State of São Paulo: Was It Inevitable? Cureus 2022; 14:e26486. [PMID: 35919213 PMCID: PMC9339207 DOI: 10.7759/cureus.26486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic had and is still having a tremendous impact on people all over the world, but it has been particularly harsh in South America. Nine out of 13 South American countries are among the 50 countries with the highest COVID-19 death rates. The gamma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant that emerged by the end of 2020 in the Brazilian Amazon quickly spread throughout the country causing the harsh COVID-19 second wave. This variant displayed high viral loads, high transmissibility, and increased virulence as compared to previous variants. Aims The aim of this retrospective study is to revisit and analyse the epidemiology of the COVID-19 second wave in the state of São Paulo, the most populous Brazilian state. In addition to examining the possible factors that led to the emergence and propagation of the gamma variant, measures that could have prevented its spread and that of other highly virulent variants were also investigated. Materials and methods Data from São Paulo's official sources on morbidity, mortality, age distribution, and testing prior to and during the COVID-19 second wave (February - June 2021) and data regarding the distribution of SARS-CoV-2 variants in the country were parsed, analyzed, and compared to the period that anteceded the eruption of the second COVID-19 wave. Results In the state of São Paulo, the toll of the COVID-19 second wave surpassed that of the first 11 months of the pandemic (from March 2020 to January 2021), as 56% of the deaths occurred in the five months of the second wave between February and June 2021. The mean age of COVID-19 victims, which was already below life expectancy in the state dropped even further in the pandemic's second wave, reaching an average of 60 years of age. The years of life lost per death per month doubled and the case-fatality rate (CFR) of young adults (20-39 years old) more than trebled during this period. A number of hypotheses have been raised that might explain the emergence and spread of the gamma variant and the measures that could have been taken to prevent it and minimise its impact on the population. Conclusions Over 142,000 people died as a result of the SARS-CoV-2 gamma variant sweep in São Paulo in the first semester of 2021. Due to its high viral load, the gamma variant displayed high transmissibility and a high degree of virulence resulting in increased case fatality rates across most age tiers. Notably, this second wave was marked by a very significant increase in deaths among young adults. This increase was at least partially due to a deterioration in general health provoked by non-pharmaceutical interventions. In hindsight, a safer and more effective measure might have been to allow the free spread of the virus among the young and healthy in the first wave, thus conferring immunity against more virulent variants that emerged later on.
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Affiliation(s)
- Claire Johnston
- Infectious Diseases, Public Health Wales, Cardiff, UK
- Department of Microbiology, Morriston Hospital, Swansea, UK
| | | | - Sion Lingard
- Health Protection Team, Public Health Wales, Swansea
| | - Stephen Hailey
- Medical Directorate - General Practice & Revalidation, NHS Wales Health Education and Improvement Wales, Nantgarw, Rhondda Cynon Taff, UK
| | - Brendan Healy
- Cardiff and Vale University Health Board, Public Health Wales, Cardiff
- Department of Microbiology, Morriston Hospital, Swansea, UK
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33
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Villers J, Henriques A, Calarco S, Rognlien M, Mounet N, Devine J, Azzopardi G, Elson P, Andreini M, Tarocco N, Vassella C, Keiser O. SARS-CoV-2 aerosol transmission in schools: the effectiveness of different interventions. Swiss Med Wkly 2022; 152:w30178. [PMID: 35704941 DOI: 10.4414/smw.2022.w30178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Indoor aerosol transmission of SARS-CoV-2 has been widely recognised, especially in schools where children remain in closed indoor spaces and largely unvaccinated. Measures such as strategic natural ventilation and high efficiency particulate air (HEPA) filtration remain poorly implemented and mask mandates are often progressively lifted as vaccination rollout is enhanced. METHODS We adapted a previously developed aerosol transmission model to study the effect of interventions (natural ventilation, face masks, HEPA filtration and their combinations) on the concentration of virus particles in a classroom of 160 m3 containing one infectious individual. The cumulative dose of viruses absorbed by exposed occupants was calculated. RESULTS In the absence of interventions, the cumulative dose absorbed was 1.5 times higher in winter than in spring/summer, increasing chances of indoor airborne transmission in winter. However, natural ventilation was more effective in winter, leading to up to a 20-fold decrease in cumulative dose when six windows were fully open at all times. In winter, partly opening two windows all day or fully opening six windows at the end of each class was effective as well (2.7- to 3-fold decrease). In summer, good ventilation levels could be achieved through the opening of windows all day long (2- to 7-fold decrease depending on the number of windows open). Opening windows only during yard and lunch breaks had minimal effect (≤1.5-fold decrease). One HEPA filter was as effective as two windows partly open all day in winter (3-fold decrease) whereas two filters were more effective (5-fold decrease). Surgical face masks were very effective independently of the season (8-fold decrease). Combined interventions (i.e., natural ventilation, masks, and HEPA filtration) were the most effective (≥25-fold decrease) and remained highly effective in the presence of a super-spreader. INTERPRETATION Natural ventilation, face masks, and HEPA filtration are effective interventions to reduce SARS-CoV-2 aerosol transmission. These measures should be combined and complemented by additional interventions (e.g., physical distancing, hygiene, testing, contact tracing and vaccination) to maximise benefit.
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Affiliation(s)
| | - Andre Henriques
- European Organization for Nuclear Research (CERN), Geneva, Switzerland
| | - Serafina Calarco
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Markus Rognlien
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nicolas Mounet
- European Organization for Nuclear Research (CERN), Geneva, Switzerland
| | - James Devine
- European Organization for Nuclear Research (CERN), Geneva, Switzerland
| | | | - Philip Elson
- European Organization for Nuclear Research (CERN), Geneva, Switzerland
| | - Marco Andreini
- European Organization for Nuclear Research (CERN), Geneva, Switzerland
| | - Nicola Tarocco
- European Organization for Nuclear Research (CERN), Geneva, Switzerland
| | - Claudia Vassella
- Federal Office of Public Health, Consumer Protection Directorate, Indoor Pollutants Unit, Berne, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Switzerland
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta variant transmits much more rapidly than prior SARS-CoV-2 viruses. The primary mode of transmission is via short range aerosols that are emitted from the respiratory tract of an index case. There is marked heterogeneity in the spread of this virus, with 10% to 20% of index cases contributing to 80% of secondary cases, while most index cases have no subsequent transmissions. Vaccination, ventilation, masking, eye protection, and rapid case identification with contact tracing and isolation can all decrease the transmission of this virus.
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Affiliation(s)
- Eric A Meyerowitz
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Aaron Richterman
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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35
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Zauche LH, Pomeroy M, Demeke HB, Mettee Zarecki SL, Williams JL, Newsome K, Hill L, Dooyema CA. Answering the Call: The Response of Centers for Disease Control and Prevention's Federal Public Health Nursing Workforce to the COVID-19 Pandemic. Am J Public Health 2022; 112:S226-S230. [PMID: 35679561 PMCID: PMC9184916 DOI: 10.2105/ajph.2021.306703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Lauren Head Zauche
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Mary Pomeroy
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Hanna B Demeke
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Shauna L Mettee Zarecki
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Jennifer L Williams
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kimberly Newsome
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Laura Hill
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Carrie A Dooyema
- Lauren Head Zauche, Kimberly Newsome, and Jennifer L. Williams are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mary Pomeroy and Laura Hill are with the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Hanna B. Demeke is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Shauna L. Mettee Zarecki is with the Center for Preparedness and Response, CDC. Carrie A. Dooyema is with the National Center for Chronic Disease Prevention and Health Promotion, CDC
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Ke R, Martinez PP, Smith RL, Gibson LL, Mirza A, Conte M, Gallagher N, Luo CH, Jarrett J, Zhou R, Conte A, Liu T, Farjo M, Walden KKO, Rendon G, Fields CJ, Wang L, Fredrickson R, Edmonson DC, Baughman ME, Chiu KK, Choi H, Scardina KR, Bradley S, Gloss SL, Reinhart C, Yedetore J, Quicksall J, Owens AN, Broach J, Barton B, Lazar P, Heetderks WJ, Robinson ML, Mostafa HH, Manabe YC, Pekosz A, McManus DD, Brooke CB. Daily longitudinal sampling of SARS-CoV-2 infection reveals substantial heterogeneity in infectiousness. Nat Microbiol 2022; 7:640-652. [PMID: 35484231 PMCID: PMC9084242 DOI: 10.1038/s41564-022-01105-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
The dynamics of SARS-CoV-2 replication and shedding in humans remain poorly understood. We captured the dynamics of infectious virus and viral RNA shedding during acute infection through daily longitudinal sampling of 60 individuals for up to 14 days. By fitting mechanistic models, we directly estimated viral expansion and clearance rates and overall infectiousness for each individual. Significant person-to-person variation in infectious virus shedding suggests that individual-level heterogeneity in viral dynamics contributes to 'superspreading'. Viral genome loads often peaked days earlier in saliva than in nasal swabs, indicating strong tissue compartmentalization and suggesting that saliva may serve as a superior sampling site for early detection of infection. Viral loads and clearance kinetics of Alpha (B.1.1.7) and previously circulating non-variant-of-concern viruses were mostly indistinguishable, indicating that the enhanced transmissibility of this variant cannot be explained simply by higher viral loads or delayed clearance. These results provide a high-resolution portrait of SARS-CoV-2 infection dynamics and implicate individual-level heterogeneity in infectiousness in superspreading.
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Affiliation(s)
- Ruian Ke
- T-6, Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Pamela P Martinez
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rebecca L Smith
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura L Gibson
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Agha Mirza
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Madison Conte
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas Gallagher
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chun Huai Luo
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Junko Jarrett
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruifeng Zhou
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abigail Conte
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tongyu Liu
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Mireille Farjo
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kimberly K O Walden
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gloria Rendon
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Christopher J Fields
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Leyi Wang
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Richard Fredrickson
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Darci C Edmonson
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Melinda E Baughman
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Karen K Chiu
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Hannah Choi
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kevin R Scardina
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shannon Bradley
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Stacy L Gloss
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Crystal Reinhart
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jagadeesh Yedetore
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jessica Quicksall
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alyssa N Owens
- Center for Clinical and Translational Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - John Broach
- UMass Memorial Medical Center, Worcester, MA, USA
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bruce Barton
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Peter Lazar
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - William J Heetderks
- National Institute for Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Matthew L Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heba H Mostafa
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David D McManus
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christopher B Brooke
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Wiens KE, Smith CP, Badillo-Goicoechea E, Grantz KH, Grabowski MK, Azman AS, Stuart EA, Lessler J. In-person schooling and associated COVID-19 risk in the United States over spring semester 2021. SCIENCE ADVANCES 2022; 8:eabm9128. [PMID: 35442740 PMCID: PMC9020776 DOI: 10.1126/sciadv.abm9128] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Because of the importance of schools to childhood development, the relationship between in-person schooling and COVID-19 risk has been one of the most important questions of this pandemic. Previous work in the United States during winter 2020-2021 showed that in-person schooling carried some risk for household members and that mitigation measures reduced this risk. Schooling and the COVID-19 landscape changed radically over spring semester 2021. Here, we use data from a massive online survey to characterize changes in in-person schooling behavior and associated risks over that period. We find increases in in-person schooling and reductions in mitigations over time. In-person schooling is associated with increased reporting of COVID-19 outcomes even among vaccinated individuals (although the absolute risk among the vaccinated is greatly reduced). Vaccinated teachers working outside the home were less likely to report COVID-19-related outcomes than unvaccinated teachers working exclusively from home. Adequate mitigation measures appear to eliminate the excess risk associated with in-person schooling.
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Affiliation(s)
- Kirsten E. Wiens
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire P. Smith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elena Badillo-Goicoechea
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kyra H. Grantz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M. Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elizabeth A. Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Corresponding author.
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38
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Clough IM, Drozdova AD, Cavanagh C, Gile Thomas A. Adolescents' adherence to Centers for Disease Control and Prevention guidelines during the COVID-19 pandemic. Child Care Health Dev 2022; 48:1052-1061. [PMID: 35388542 PMCID: PMC9111765 DOI: 10.1111/cch.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The outbreak of the coronavirus (COVID-19) pandemic in the United States resulted in safety guidelines from the Centers for Disease Control and Prevention (CDC) intended to curb the spread of the virus. Adolescents are potentially at risk for disregarding these guidelines due to their reduced psychosocial maturity compared with adults. The current study examined the relationship between adolescents' psychosocial maturity, perceived importance of the CDC guidelines and adherence to the CDC guidelines within some of the highest risk groups for contracting COVID-19 in a county particularly impacted by the pandemic (i.e., Hispanic and low-SES youth in El Paso, Texas). METHODS Participants completed a phone interview with a research assistant regarding their thoughts and behaviours in the initial months of the COVID-19 pandemic. Adolescents (N = 68) were 15.38 years old on average (SD = 1.05, range = 13, 17), predominantly male (60.3%) and nearly exclusively Hispanic/Latino (94.1%). RESULTS Results indicated that although more psychosocially mature adolescents reported greater adherence to the CDC guidelines than less psychosocially mature adolescents, the association between psychosocial maturity and adherence was fully mediated by how important adolescents felt it was to follow the guidelines. Specifically, greater perceived importance was associated with greater adherence to the guidelines. CONCLUSIONS The current study found that more psychosocially mature adolescents adhere to CDC's safety guidelines better than less psychosocially mature adolescents because they are more likely to view the guidelines as important. Information that attempts to increase adolescent adherence to the guidelines should therefore emphasize not only that following the guidelines is important, but why following the guidelines is so important. Less psychosocially mature adolescents may benefit most from interventions efforts and targeted messages regarding the importance of following the CDC's guidelines, as more psychosocially mature adolescents already recognize this importance.
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Affiliation(s)
- Isabelle M. Clough
- Department of PsychologyThe University of Texas at El PasoEl PasoTexasUSA
| | - Anna D. Drozdova
- Department of PsychologyThe University of Texas at El PasoEl PasoTexasUSA
| | - Caitlin Cavanagh
- School of Criminal JusticeMichigan State UniversityEast LansingMichiganUSA
| | - April Gile Thomas
- Department of PsychologyThe University of Texas at El PasoEl PasoTexasUSA
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39
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Kong M, Li L, Eilts SM, Li L, Hogan CJ, Pope ZC. Localized and Whole-Room Effects of Portable Air Filtration Units on Aerosol Particle Deposition and Concentration in a Classroom Environment. ACS ES&T ENGINEERING 2022; 2:653-669. [PMID: 37552723 PMCID: PMC8864773 DOI: 10.1021/acsestengg.1c00321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 05/14/2023]
Abstract
In indoor environments with limited ventilation, recirculating portable air filtration (PAF) units may reduce COVID-19 infection risk via not only the direct aerosol route (i.e., inhalation) but also via an indirect aerosol route (i.e., contact with the surface where aerosol particles deposited). We systematically investigated the impact of PAF units in a mock classroom, as a supplement to background ventilation, on localized and whole-room surface deposition and particle concentration. Fluorescently tagged particles with a volumetric mean diameter near 2 μm were continuously introduced into the classroom environment via a breathing simulator with a prescribed inhalation-exhalation waveform. Deposition velocities were inferred on >50 horizontal and vertical surfaces throughout the classroom, while aerosol concentrations were spatially monitored via optical particle spectrometry. Results revealed a particle decay rate consistent with expectations based upon the reported clean air delivery rates of the PAF units. Additionally, the PAF units reduced peak concentrations by a factor of around 2.5 compared to the highest concentrations observed and led to a statistically significant reduction in deposition velocities for horizontal surfaces >2.5 m from the aerosol source. Our results not only confirm that PAF units can reduce particle concentrations but also demonstrate that they may lead to reduced particle deposition throughout an indoor environment when properly positioned with respect to the location of the particle source(s) within the room (e.g., where the largest group of students sit) and the predominant air distribution profile of the room.
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Affiliation(s)
- Meng Kong
- Well Living Lab, Rochester,
Minnesota 55902, United States
| | - Linhao Li
- Well Living Lab, Rochester,
Minnesota 55902, United States
| | - Stephanie M. Eilts
- Department of Mechanical Engineering,
University of Minnesota, Minneapolis, Minnesota 55455,
United States
| | - Li Li
- Department of Mechanical Engineering,
University of Minnesota, Minneapolis, Minnesota 55455,
United States
| | - Christopher J. Hogan
- Department of Mechanical Engineering,
University of Minnesota, Minneapolis, Minnesota 55455,
United States
| | - Zachary C. Pope
- Well Living Lab, Rochester,
Minnesota 55902, United States
- Mayo Clinic, Department of Physiology and
Biomedical Engineering, Rochester, Minnesota 55905, United
States
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40
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Nakashita M, Takagi Y, Tanaka H, Nakamura H, Serizawa Y, Ukai T, Azuma K, Chiba H, Terada K, Nakanishi K, Fujikawa T, Saito K, Yamaguchi R, Mitsuhashi Y, Yano K, Shibuma T, Kuzuma A, Tsuda S, Sadamoto T, Ishii Y, Ohara T, Hitomi Y, Hiroshima T, Yamagishi T, Kamiya H, Anita S, Yahata Y, Shimada T, Arima Y, Suzuki M, Sekizuka T, Kuroda M, Sunagawa T. Singing Is a Risk Factor for SARS-CoV-2 Infection: A Case-control Study of Karaoke-related COVID-19 Outbreaks in Two Cities in Hokkaido, Japan, Linked by Whole Genome Analysis. Open Forum Infect Dis 2022; 9:ofac158. [PMID: 35531379 PMCID: PMC8992236 DOI: 10.1093/ofid/ofac158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Singing in an indoor space may increase the risk of SARS-CoV-2 infection. We conducted a case-control study of karaoke-related COVID-19 outbreaks to reveal the risk factors for SARS-CoV-2 infection among individuals who participate in karaoke.
Methods
Cases were defined as people who enjoyed karaoke at a bar and who tested positive for SARS-CoV-2 by RT-PCR between May 16 and July 3, 2020. Controls were defined as people who enjoyed karaoke at the same bar during the same period as the cases and tested negative. Odds ratio (OR) and confidence interval (CI) were calculated. ORs were adjusted by variables with significantly high odds ratio (aOR).
Results
We identified 81 cases, the majority of whom were active elderly individuals (median age: 75 years). Six cases died (case fatality ratio: 7%). Among the cases, 68 (84%) were guests, 18 of whom had visited more than two karaoke bars. A genome analysis conducted in 30 cases showed six types of isolates within four single-nucleotide variations difference. The case-control study revealed that singing (aOR 11.0, 95% CI, 1.2-101.0), not wearing a mask (aOR 3.7, 95% CI 1.2-11.2) and time spent per visit (aOR 1.7, 95% CI 1.1-2.7) were associated with COVID-19 infection.
Conclusions
A karaoke-related COVID-19 outbreak that occurred in two different cities was confirmed by the results of genome analysis. Singing in less-ventilated, indoor and crowded environments increases the risk of acquiring SARS-CoV-2 infection. Wearing a mask and staying for only a short time can reduce the risk of infection during karaoke.
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Affiliation(s)
- Manami Nakashita
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuta Takagi
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | - Haruna Nakamura
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yusuke Serizawa
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomohiko Ukai
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kotaro Azuma
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | - Hiroko Chiba
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | | | | | - Kayoko Saito
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | - Ryo Yamaguchi
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | - Koichi Yano
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | - Akemi Kuzuma
- Public Health Office, Otaru City, Hokkaido, Japan
| | | | | | - Yasuhiko Ishii
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Tsukasa Ohara
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Yoshiaki Hitomi
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Takashi Hiroshima
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Takuya Yamagishi
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hajime Kamiya
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Samuel Anita
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuichiro Yahata
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomoe Shimada
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuzo Arima
- Center for Surveillance, Immunization and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Motoi Suzuki
- Center for Surveillance, Immunization and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsuyoshi Sekizuka
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
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Abstract
COVID-19 is a nonspecific viral illness caused by a novel coronavirus, SARS-CoV-2, and led to an ongoing global pandemic. Transmission is primarily human-to-human via contact with respiratory particles containing infectious virus. The risk of transmission to health care personnel is low with proper use of personal protective equipment, including gowns, gloves, N95 or surgical mask, and eye protection. Additional measures affecting the risk of transmission include physical distancing, hand hygiene, routine cleaning and disinfection, appropriate air handling and ventilation, and public health interventions such as universal masking and stay-at-home orders.
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Affiliation(s)
- Patrick Reich
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8116, St Louis, MO 63110-1093, USA.
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42
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Zimmermann P, Pittet LF, Finn A, Pollard AJ, Curtis N. Should children be vaccinated against COVID-19? Arch Dis Child 2022; 107:e1. [PMID: 34732388 DOI: 10.1136/archdischild-2021-323040] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022]
Abstract
Whether all children under 12 years of age should be vaccinated against COVID-19 remains an ongoing debate. The relatively low risk posed by acute COVID-19 in children, and uncertainty about the relative harms from vaccination and disease mean that the balance of risk and benefit of vaccination in this age group is more complex. One of the key arguments for vaccinating healthy children is to protect them from long-term consequences. Other considerations include population-level factors, such as reducing community transmission, vaccine supply, cost, and the avoidance of quarantine, school closures and other lockdown measures. The emergence of new variants of concern necessitates continual re-evaluation of the risks and benefits. In this review, we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider and highlight the complexity of policy decisions on COVID-19 vaccination in this age group.
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Affiliation(s)
- Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland .,Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland.,Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Laure F Pittet
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Adam Finn
- Bristol Vaccine Centre, School of Clinical Sciences and School of Cellular & Molecular Medicine, University of Bristol, Bristol, UK.,Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nigel Curtis
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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Huynh G, Nguyen HTN, Van Tran K, Le An P, Tran TD. Determinants of COVID-19 vaccine hesitancy among parents in Ho Chi Minh City, Vietnam. Postgrad Med 2022; 134:303-308. [DOI: 10.1080/00325481.2022.2044142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Giao Huynh
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Han Thi Ngoc Nguyen
- Infection Control Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khanh Van Tran
- Department of Scientific Research, District 2 Hospital, Ho Chi Minh City, Vietnam
| | - Pham Le An
- Family Medicine Training Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tuan Diep Tran
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Heshin-Bekenstein M, Ziv A, Toplak N, Hagin D, Kadishevich D, Butbul YA, Saiag E, Kaufman A, Shefer G, Sharon O, Pel S, Elkayam O, Uziel Y. Safety and immunogenicity of BNT162b2 mRNA COVID-19 vaccine in adolescents with rheumatic diseases treated with immunomodulatory medications. Rheumatology (Oxford) 2022; 61:4263-4272. [PMID: 35179569 PMCID: PMC9383463 DOI: 10.1093/rheumatology/keac103] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Adolescents with juvenile-onset autoimmune inflammatory rheumatic diseases (AIIRD) could be at-risk for disease flare secondary to SARS-CoV-2 infection or to withholding anti-inflammatory therapy. While vaccination can protect against COVID-19, safety and immunogenicity data regarding anti-SARS-CoV-2 vaccines among adolescents with AIIRD are limited. This international, prospective, multicentre study evaluated the safety and immunogenicity of the BNT162b2 anti-SARS-CoV-2 vaccine among adolescents and young adults with juvenile-onset AIIRD, 80% of whom are on chronic immunomodulatory therapy. METHODS Vaccine side effects, disease activity, and short-term efficacy were evaluated after 3 months in 91 patients. Anti-spike S1/S2 IgG antibody levels were evaluated in 37 patients and 22 controls, 2-9 weeks after the second dose. RESULTS Ninety-one patients and 40 healthy controls were included. Safety profile was good, with 96.7% (n = 88) of patients reporting mild or no side-effects, and no change in disease activity. However, 3 patients had transient acute symptoms: 2 following the first vaccination (renal failure and pulmonary haemorrhage) and 1 following the second dose (mild lupus flare vs viral infection). Seropositivity rate was 97.3% in the AIIRD group compared with 100% among controls. However, anti-S1/S2 antibody titres were significantly lower in the AIIRD group compared with controls (242 ± 136.4 vs 387.8 ± 57.3 BAU/ml, respectively; p< 0.0001). No cases of COVID-19 were documented during the 3-month follow-up. CONCLUSION Vaccination of juvenile-onset AIIRD patients demonstrated good short-term safety and efficacy, high seropositivity rate, but lower anti-S1/S2 antibody titres compared with healthy controls. These results should encourage vaccination of adolescents with juvenile-onset AIIRD, even while on immunomodulation.
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Affiliation(s)
- Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yonatan A Butbul
- Pediatric Rheumatology Unit, Rambam Medical Center, Haifa, Israel
| | - Esther Saiag
- Hospital Management, Information and Operation Branch, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alla Kaufman
- Pediatric Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabi Shefer
- Department of Endocrinology Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orli Sharon
- Department of Endocrinology Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ori Elkayam
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
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45
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Alonso S, Català M, López D, Álvarez-Lacalle E, Jordan I, García-García JJ, Fumadó V, Muñoz-Almagro C, Gratacós E, Balanza N, Varo R, Millat P, Baro B, Ajanovic S, Arias S, Claverol J, de Sevilla MF, Bonet-Carne E, Garcia-Miquel A, Coma E, Medina-Peralta M, Fina F, Prats C, Bassat Q. Individual prevention and containment measures in schools in Catalonia, Spain, and community transmission of SARS-CoV-2 after school re-opening. PLoS One 2022; 17:e0263741. [PMID: 35171936 PMCID: PMC8849486 DOI: 10.1371/journal.pone.0263741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite their clear lesser vulnerability to COVID-19, the extent by which children are susceptible to getting infected by SARS-CoV-2 and their capacity to transmit the infection to other people remains inadequately characterized. We aimed to evaluate the role of school reopening and the preventive strategies in place at schools in terms of overall risk for children and community transmission, by comparing transmission rates in children as detected by a COVID-19 surveillance platform in place in Catalonian Schools to the incidence at the community level. METHODS AND FINDINGS Infections detected in Catalan schools during the entire first trimester of classes (September-December 2020) were analysed and compared with the ongoing community transmission and with the modelled predicted number of infections. There were 30.486 infections (2.12%) documented among the circa 1.5M pupils, with cases detected in 54.0% and 97.5% of the primary and secondary centres, respectively. During the entire first term, the proportion of "bubble groups" (stable groups of children doing activities together) that were forced to undergo confinement ranged between 1 and 5%, with scarce evidence of substantial intraschool transmission in the form of chains of infections, and with ~75% of all detected infections not leading to secondary cases. Mathematical models were also used to evaluate the effect of different parameters related to the defined preventive strategies (size of the bubble group, number of days of confinement required by contacts of an index case). The effective reproduction number inside the bubble groups in schools (R*), defined as the average number of schoolmates infected by each primary case within the bubble, was calculated, yielding a value of 0.35 for primary schools and 0.55 for secondary schools, and compared with the outcomes of the mathematical model, implying decreased transmissibility for children in the context of the applied measures. Relative homogenized monthly cumulative incidence ([Formula: see text]) was assessed to compare the epidemiological dynamics among different age groups and this analysis suggested the limited impact of infections in school-aged children in the context of the overall community incidence. CONCLUSIONS During the fall of 2020, SARS-CoV-2 infections and COVID-19 cases detected in Catalan schools closely mirrored the underlying community transmission from the neighbourhoods where they were set and maintaining schools open appeared to be safe irrespective of underlying community transmission. Preventive measures in place in those schools appeared to be working for the early detection and rapid containment of transmission and should be maintained for the adequate and safe functioning of normal academic and face-to-face school activities.
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Affiliation(s)
- Sergio Alonso
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Martí Català
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Daniel López
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | | | - Iolanda Jordan
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan José García-García
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Victoria Fumadó
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Núria Balanza
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pere Millat
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Bàrbara Baro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Sara Ajanovic
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Sara Arias
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Fundació Sant Joan de Déu, Barcelona, Spain
| | - Mariona Fernández de Sevilla
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Elisenda Bonet-Carne
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Politècnica de Catalunya BarcelonaTech, Barcelona, Spain
| | - Aleix Garcia-Miquel
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Ermengol Coma
- Sistema d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Manuel Medina-Peralta
- Sistema d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Sistema d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Quique Bassat
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
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Racial and Ethnic Diversity in SARS-CoV-2 Vaccine Clinical Trials Conducted in the United States. Vaccines (Basel) 2022; 10:vaccines10020290. [PMID: 35214748 PMCID: PMC8875029 DOI: 10.3390/vaccines10020290] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Evidence shows that White and non-Hispanic individuals are overrepresented in clinical trials. The development of new vaccines and drugs, however, necessitates that clinical research trials include representative participants, particularly in light of evidence showing that underrepresented minorities may have a different response to certain medications and vaccines. Racial and ethnic disparities among clinical trials are multilayered and complex, and this requires action. The results of this study indicate that significant racial and ethnic disparities consistently exist among the most recent early SARS-CoV-2 vaccine clinical trials as compared to the pandemic H1N1 vaccine clinical trials of 2009. New strategies, policies, training programs, and reforms are required to address these disparities among clinical trials.
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Clyne B, Jordan K, Ahern S, Walsh KA, Byrne P, Carty PG, Drummond L, O'Brien KK, Smith SM, Harrington P, Ryan M, O'Neill M. Transmission of SARS-CoV-2 by children: a rapid review, 30 December 2019 to 10 August 2020. Euro Surveill 2022; 27. [PMID: 35115076 PMCID: PMC8815097 DOI: 10.2807/1560-7917.es.2022.27.5.2001651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BackgroundThe role of children in the transmission of SARS-CoV-2 during the early pandemic was unclear.AimWe aimed to review studies on the transmission of SARS-CoV-2 by children during the early pandemic.MethodsWe searched MEDLINE, Embase, the Cochrane Library, Europe PubMed Central and the preprint servers medRxiv and bioRxiv from 30 December 2019 to 10 August 2020. We assessed the quality of included studies using a series of questions adapted from related tools. We provide a narrative synthesis of the results.ResultsWe identified 28 studies from 17 countries. Ten of 19 studies on household and close contact transmission reported low rates of child-to-adult or child-to-child transmission. Six studies investigated transmission of SARS-CoV-2 in educational settings, with three studies reporting 183 cases from 14,003 close contacts who may have contracted COVID-19 from children index cases at their schools. Three mathematical modelling studies estimated that children were less likely to infect others than adults. All studies were of low to moderate quality.ConclusionsDuring the early pandemic, it appeared that children were not substantially contributing to household transmission of SARS-CoV-2. School-based studies indicated that transmission rates in this setting were low. Large-scale studies of transmission chains using data collected from contact tracing and serological studies detecting past evidence of infection would be needed to verify our findings.
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Affiliation(s)
- Barbara Clyne
- Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority, Dublin, Ireland
| | - Susan Ahern
- Health Information and Quality Authority, Dublin, Ireland
| | - Kieran A Walsh
- Health Information and Quality Authority, Dublin, Ireland
| | - Paula Byrne
- Health Information and Quality Authority, Dublin, Ireland
| | - Paul G Carty
- Health Information and Quality Authority, Dublin, Ireland
| | - Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Máirín Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin, Ireland
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Kasi SG, Dhir SK, Shah A, Shivananda S, Verma S, Marathe S, Chatterjee K, Agarwalla S, Srirampur S, Kalyani S, Pemde HK, Balasubramanian S, Basavaraja GV, Parekh BJ, Kumar R, Gupta P. Coronavirus Disease 2019 (COVID-19) Vaccination for Children: Position Statement of Indian Academy of Pediatrics Advisory Committee on Vaccination and Immunization Practices. Indian Pediatr 2022; 59:51-57. [PMID: 34927603 PMCID: PMC8821846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
JUSTIFICATION Data generated after the first wave has revealed that some children with coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected Covid-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2-18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval. OBJECTIVE To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use. PROCESS Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of Covid-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on Covid-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized. RECOMMENDATIONS The IAP supports the Government of India's decision to extend the COVID-19 vaccination program to children between 2-18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out.
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Affiliation(s)
- Srinivas G Kasi
- Kasi Clinic, 2nd Cross, 3rd Block, Jayanagar, Bengaluru, Karnataka. Correspondence to: Dr Srinivas G Kasi, Convener, ACVIP of IAP, Kasi Clinic, 2nd Cross, 3rd Block, Jayanagar, Bengaluru, Karnataka.
| | - Shashi Kant Dhir
- Department of Pediatrics, Guru Gobind Singh Medical College, Faridkot, Punjab
| | - Abhay Shah
- Dr Abhay K Shah Children Hospital, Ahmedabad, Gujarat
| | - S Shivananda
- Department of Pediatrics, Fortis Hospital, Banneraghatta Road, Bengaluru, Karnataka
| | - Sanjay Verma
- Division of Infectious Diseases, Department of Pediatrics, PGIMER, Chandigarh
| | - S Marathe
- Marathe Child Care Hospital, Nagpur, Maharashtra
| | | | - Sunil Agarwalla
- Department of Pediatrics, SCB Medical College and Hospital, Cuttack, Odisha
| | - Sanjay Srirampur
- Department of Pediatrics, Aditya Super Speciality Hospital, Hyderabad, Telangana
| | - Srinivas Kalyani
- Department of Pediatrics, Niloufer Hospital, Osmania Medical College, Hyderabad, Telangana
| | - Harish K Pemde
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi
| | - S Balasubramanian
- Department of Pediatrics, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu
| | | | | | | | - Piyush Gupta
- Department of Pediatrics, University College of Medical Sciences, New Delhi
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Stein M, Ashkenazi-Hoffnung L, Greenberg D, Dalal I, Livni G, Chapnick G, Stein-Zamir C, Ashkenazi S, Hecht-Sagie L, Grossman Z. The Burden of COVID-19 in Children and Its Prevention by Vaccination: A Joint Statement of the Israeli Pediatric Association and the Israeli Society for Pediatric Infectious Diseases. Vaccines (Basel) 2022; 10:81. [PMID: 35062742 PMCID: PMC8781684 DOI: 10.3390/vaccines10010081] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/27/2023] Open
Abstract
As of October 2021, SARS-CoV-2 infections were reported among 512,613 children and adolescents in Israel (~33% of all COVID-19 cases). The 5-11-year age group accounted for about 43% (223,850) of affected children and adolescents. In light of the availability of the Pfizer-BioNTech BNT162b2 vaccine against COVID-19 for children aged 5-11 years, we aimed to write a position paper for pediatricians, policymakers and families regarding the clinical aspects of COVID-19 and the vaccination of children against COVID-19. The first objective of this review was to describe the diverse facets of the burden of COVID-19 in children, including the direct effects of hospitalization during the acute phase of the disease, multisystem inflammatory syndrome in children, long COVID and the indirect effects of social isolation and interruption in education. In addition, we aimed to provide an update regarding the efficacy and safety of childhood mRNA COVID-19 vaccination and to instill confidence in pediatricians regarding the benefits of vaccinating children against COVID-19. We reviewed up-to-date Israeli and international epidemiological data and literature regarding COVID-19 morbidity and its sequelae in children, vaccine efficacy in reducing COVID-19-related morbidity and SARS-CoV-2 transmission and vaccine safety data. We conducted a risk-benefit analysis regarding the vaccination of children and adolescents. We concluded that vaccines are safe and effective and are recommended for all children aged 5 to 11 years to protect them from COVID-19 and its complications and to reduce community transmissions. Based on these data, after weighing the benefits of vaccination versus the harm, the Israeli Ministry of Health decided to recommend vaccination for children aged 5-11 years.
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Affiliation(s)
- Michal Stein
- Infectious Diseases and Infection Control Unit, Hillel Yaffe Medical Center, Hadera 3810101, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Liat Ashkenazi-Hoffnung
- Department of Day Care Hospitalization, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka Medical Center, Be’er Sheva 8458900, Israel;
- The Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Be’er Sheva 8410501, Israel
| | - Ilan Dalal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
- Pediatric Department, E. Wolfson Medical Center, Holon 5822012, Israel
| | - Gilat Livni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva 4920245, Israel
| | - Gil Chapnick
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Jerusalem 9137001, Israel;
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shai Ashkenazi
- Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
- Adelson School of Medicine, Ariel University, Ari’el 4070000, Israel
| | - Lior Hecht-Sagie
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
| | - Zachi Grossman
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
- Adelson School of Medicine, Ariel University, Ari’el 4070000, Israel
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50
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Walter EB, Talaat KR, Sabharwal C, Gurtman A, Lockhart S, Paulsen GC, Barnett ED, Muñoz FM, Maldonado Y, Pahud BA, Domachowske JB, Simões EAF, Sarwar UN, Kitchin N, Cunliffe L, Rojo P, Kuchar E, Rämet M, Munjal I, Perez JL, Frenck RW, Lagkadinou E, Swanson KA, Ma H, Xu X, Koury K, Mather S, Belanger TJ, Cooper D, Türeci Ö, Dormitzer PR, Şahin U, Jansen KU, Gruber WC. Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age. N Engl J Med 2022; 386:35-46. [PMID: 34752019 PMCID: PMC8609605 DOI: 10.1056/nejmoa2116298] [Citation(s) in RCA: 354] [Impact Index Per Article: 177.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Safe, effective vaccines against coronavirus disease 2019 (Covid-19) are urgently needed in children younger than 12 years of age. METHODS A phase 1, dose-finding study and an ongoing phase 2-3 randomized trial are being conducted to investigate the safety, immunogenicity, and efficacy of two doses of the BNT162b2 vaccine administered 21 days apart in children 6 months to 11 years of age. We present results for 5-to-11-year-old children. In the phase 2-3 trial, participants were randomly assigned in a 2:1 ratio to receive two doses of either the BNT162b2 vaccine at the dose level identified during the open-label phase 1 study or placebo. Immune responses 1 month after the second dose of BNT162b2 were immunologically bridged to those in 16-to-25-year-olds from the pivotal trial of two 30-μg doses of BNT162b2. Vaccine efficacy against Covid-19 at 7 days or more after the second dose was assessed. RESULTS During the phase 1 study, a total of 48 children 5 to 11 years of age received 10 μg, 20 μg, or 30 μg of the BNT162b2 vaccine (16 children at each dose level). On the basis of reactogenicity and immunogenicity, a dose level of 10 μg was selected for further study. In the phase 2-3 trial, a total of 2268 children were randomly assigned to receive the BNT162b2 vaccine (1517 children) or placebo (751 children). At data cutoff, the median follow-up was 2.3 months. In the 5-to-11-year-olds, as in other age groups, the BNT162b2 vaccine had a favorable safety profile. No vaccine-related serious adverse events were noted. One month after the second dose, the geometric mean ratio of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing titers in 5-to-11-year-olds to those in 16-to-25-year-olds was 1.04 (95% confidence interval [CI], 0.93 to 1.18), a ratio meeting the prespecified immunogenicity success criterion (lower bound of two-sided 95% CI, >0.67; geometric mean ratio point estimate, ≥0.8). Covid-19 with onset 7 days or more after the second dose was reported in three recipients of the BNT162b2 vaccine and in 16 placebo recipients (vaccine efficacy, 90.7%; 95% CI, 67.7 to 98.3). CONCLUSIONS A Covid-19 vaccination regimen consisting of two 10-μg doses of BNT162b2 administered 21 days apart was found to be safe, immunogenic, and efficacious in children 5 to 11 years of age. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04816643.).
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Affiliation(s)
- Emmanuel B Walter
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Kawsar R Talaat
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Charu Sabharwal
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Alejandra Gurtman
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Stephen Lockhart
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Grant C Paulsen
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Elizabeth D Barnett
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Flor M Muñoz
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Yvonne Maldonado
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Barbara A Pahud
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Joseph B Domachowske
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Eric A F Simões
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Uzma N Sarwar
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Nicholas Kitchin
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Luke Cunliffe
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Pablo Rojo
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Ernest Kuchar
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Mika Rämet
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Iona Munjal
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - John L Perez
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Robert W Frenck
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Eleni Lagkadinou
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Kena A Swanson
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Hua Ma
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Xia Xu
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Kenneth Koury
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Susan Mather
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Todd J Belanger
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - David Cooper
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Özlem Türeci
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Philip R Dormitzer
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Uğur Şahin
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - Kathrin U Jansen
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
| | - William C Gruber
- From Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., B.A.P., U.N.S., I.M., K.A.S., K.K., T.J.B., D.C., P.R.D., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (S.L., N.K., L.C.); the Department of Pediatrics, University of Cincinnati College of Medicine and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P., R.W.F.); Boston Medical Center, Boston University School of Medicine, Boston (E.D.B.); Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.); Stanford University School of Medicine, Palo Alto, CA (Y.M.); Children's Mercy Hospital, Kansas City, MO (B.A.P.); the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (E.A.F.S.); Hospital Universitario 12 de Octubre, Madrid (P.R.); Medical University of Warsaw, Warsaw, Poland (E.K.); Tampere University Vaccine Research Center, Tampere, and PEDEGO Research Unit, University of Oulu, Oulu - both in Finland (M.R.); Vaccine Research and Development (J.L.P., H.M., X.X.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; and BioNTech, Mainz, Germany (E.L., Ö.T., U.Ş.)
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