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Rankin DA, Katz SE, Amarin JZ, Hayek H, Stewart LS, Slaughter JC, Deppen S, Yanis A, Romero YH, Chappell JD, Khankari NK, Halasa NB. Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee. Antimicrob Steward Healthc Epidemiol 2024; 4:e29. [PMID: 38500720 PMCID: PMC10945942 DOI: 10.1017/ash.2024.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
Objective Evaluate the association between provider-ordered viral testing and antibiotic treatment practices among children discharged from an ED or hospitalized with an acute respiratory infection (ARI). Design Active, prospective ARI surveillance study from November 2017 to February 2020. Setting Pediatric hospital and emergency department in Nashville, Tennessee. Participants Children 30 days to 17 years old seeking medical care for fever and/or respiratory symptoms. Methods Antibiotics prescribed during the child's ED visit or administered during hospitalization were categorized into (1) None administered; (2) Narrow-spectrum; and (3) Broad-spectrum. Setting-specific models were built using unconditional polytomous logistic regression with robust sandwich estimators to estimate the adjusted odds ratios and 95% confidence intervals between provider-ordered viral testing (ie, tested versus not tested) and viral test result (ie, positive test versus not tested and negative test versus not tested) and three-level antibiotic administration. Results 4,107 children were enrolled and tested, of which 2,616 (64%) were seen in the ED and 1,491 (36%) were hospitalized. In the ED, children who received a provider-ordered viral test had 25% decreased odds (aOR: 0.75; 95% CI: 0.54, 0.98) of receiving a narrow-spectrum antibiotic during their visit than those without testing. In the inpatient setting, children with a negative provider-ordered viral test had 57% increased odds (aOR: 1.57; 95% CI: 1.01, 2.44) of being administered a broad-spectrum antibiotic compared to children without testing. Conclusions In our study, the impact of provider-ordered viral testing on antibiotic practices differed by setting. Additional studies evaluating the influence of viral testing on antibiotic stewardship and antibiotic prescribing practices are needed.
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Affiliation(s)
- Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sophie E. Katz
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Z. Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Haya Hayek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C. Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen Deppen
- Department of Thoracic Surgery and Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nikhil K. Khankari
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Rankin DA, Stewart LS, Slaughter JC, Deppen S, Katz SE, Stahl AL, Stopczynski T, Yanis A, McHenry R, Guevara Pulido C, Herazo Romero Y, Chappell JD, Halasa NB, Khankari NK. Principal Component Patterns of Pediatric Respiratory Viral Testing Across Health Care Settings. Hosp Pediatr 2024; 14:126-136. [PMID: 38225919 PMCID: PMC10823184 DOI: 10.1542/hpeds.2023-007389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Factors prompting clinicians to request viral testing in children are unclear. We assessed patterns prompting clinicians to perform viral testing in children discharged from an emergency department (ED) or hospitalized with an acute respiratory infection (ARI). METHODS Using active ARI surveillance data collected from November 2017 through February 2020, children aged between 30 days and 17 years with fever or respiratory symptoms who had a research respiratory specimen tested were included. Children's presentation patterns from their initial evaluation at each health care setting were analyzed using principal components (PCs) analysis. PC-specific models using logistic regression with robust sandwich estimators were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between PCs and provider-ordered viral testing. PCs were assigned respiratory virus/viruses names a priori based on the patterns represented. RESULTS In total, 4107 children were enrolled and tested, with 2616 (64%) discharged from the ED and 1491 (36%) hospitalized. In the ED, children with a coviral presentation pattern had a 1.44-fold (95% CI, 1.24-1.68) increased odds of receiving a provider-ordered viral test than children showing clinical symptoms less representative of coviral-like infection. Whereas children in the ED and hospitalized with rhinovirus-like symptoms had 71% (OR, 0.29; 95% CI, 0.24-0.34) and 39% (OR, 0.61; 95% CI, 0.49-0.76) decreased odds, respectively, of receiving a provider-ordered viral test during their medical encounter. CONCLUSIONS Viral tests are frequently ordered by clinicians, but presentation patterns vary by setting and influence the initiation of testing. Additional assessments of factors affecting provider decisions to use viral testing in pediatric ARI management are needed to maximize patient benefits of testing.
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Affiliation(s)
| | | | | | - Stephen Deppen
- Department of Thoracic Surgery and Division of Epidemiology
| | | | | | | | | | | | | | | | | | | | - Nikhil K. Khankari
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Halasa/Chappell Research Investigators
- Address correspondence to Danielle A. Rankin, PhD, MPH, Vanderbilt University School of Medicine, Vanderbilt Epidemiology PhD Program, 1161 21st Ave South, D7232 MCN, Nashville, TN 37232. E-mail:
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Amarin JZ, Potter M, Thota J, Rankin DA, Probst V, Haddadin Z, Stewart LS, Yanis A, Talj R, Rahman H, Markus TM, Chappell J, Lindegren ML, Schaffner W, Spieker AJ, Halasa NB. Clinical characteristics and outcomes of children with single or co-detected rhinovirus-associated acute respiratory infection in Middle Tennessee. BMC Infect Dis 2023; 23:136. [PMID: 36882755 PMCID: PMC9990557 DOI: 10.1186/s12879-023-08084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/15/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Rhinovirus (RV) is one of the most common etiologic agents of acute respiratory infection (ARI), which is a leading cause of morbidity and mortality in young children. The clinical significance of RV co-detection with other respiratory viruses, including respiratory syncytial virus (RSV), remains unclear. We aimed to compare the clinical characteristics and outcomes of children with ARI-associated RV-only detection and those with RV co-detection-with an emphasis on RV/RSV co-detection. METHODS We conducted a prospective viral surveillance study (11/2015-7/2016) in Nashville, Tennessee. Children < 18 years old who presented to the emergency department (ED) or were hospitalized with fever and/or respiratory symptoms of < 14 days duration were eligible if they resided in one of nine counties in Middle Tennessee. Demographics and clinical characteristics were collected by parental interviews and medical chart abstractions. Nasal and/or throat specimens were collected and tested for RV, RSV, metapneumovirus, adenovirus, parainfluenza 1-4, and influenza A-C using reverse transcription quantitative polymerase chain reaction assays. We compared the clinical characteristics and outcomes of children with RV-only detection and those with RV co-detection using Pearson's χ2 test for categorical variables and the two-sample t-test with unequal variances for continuous variables. RESULTS Of 1250 children, 904 (72.3%) were virus-positive. RV was the most common virus (n = 406; 44.9%), followed by RSV (n = 207; 19.3%). Of 406 children with RV, 289 (71.2%) had RV-only detection, and 117 (28.8%) had RV co-detection. The most common virus co-detected with RV was RSV (n = 43; 36.8%). Children with RV co-detection were less likely than those with RV-only detection to be diagnosed with asthma or reactive airway disease both in the ED and in-hospital. We did not identify differences in hospitalization, intensive care unit admission, supplemental oxygen use, or length of stay between children with RV-only detection and those with RV co-detection. CONCLUSION We found no evidence that RV co-detection was associated with poorer outcomes. However, the clinical significance of RV co-detection is heterogeneous and varies by virus pair and age group. Future studies of RV co-detection should incorporate analyses of RV/non-RV pairs and include age as a key covariate of RV contribution to clinical manifestations and infection outcomes.
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Affiliation(s)
- Justin Z Amarin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA.
| | - Molly Potter
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Jyotsna Thota
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Danielle A Rankin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA.,Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Varvara Probst
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Zaid Haddadin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Laura S Stewart
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Ahmad Yanis
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Rana Talj
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Herdi Rahman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Tiffanie M Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Chappell
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Mary Lou Lindegren
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
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Rankin DA, Yanis A, Talj R, Howe HL, Bloos SM, Fernandez KN, Amarin JZ, Bruce M, Salib S, Hargrave S, Chappell JD, Spieker AJ, Halasa NB, Howard LM. Clinical presentations of adult and pediatric SARS-CoV-2-positive cases in a community cohort, Nashville, Tennessee. J Med Virol 2022; 94:5560-5566. [PMID: 35815457 PMCID: PMC9350274 DOI: 10.1002/jmv.27988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Compared to adults, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness in children has been lower and less severe. However, reports comparing SARS-CoV-2 infection among children and adults are limited. As part of our longitudinal cohort study of adults and children with SARS-CoV-2 infection and their household contacts in Nashville, Tennessee, we compared the clinical characteristics and outcomes of SARS-CoV-2 infections between children and adults. Children were more likely to be asymptomatically infected and had a shorter illness duration compared to adults. The differences observed in clinical presentation across ages may inform symptom-specific testing, screening, and management algorithms.
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Affiliation(s)
- Danielle A. Rankin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Epidemiology PhD ProgramVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Ahmad Yanis
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Rana Talj
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Harrison L. Howe
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sean M. Bloos
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Tulane University School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Kailee N. Fernandez
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Justin Z. Amarin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Mercedes Bruce
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Seifein Salib
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Samarian Hargrave
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - James D. Chappell
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Andrew J. Spieker
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Natasha B. Halasa
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Leigh M. Howard
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
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5
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Haddadin Z, Spieker AJ, Rahman H, Rankin DA, Talj R, Yanis A, Amarin JZ, Schmitz J, Chappell J, Halasa NB. Respiratory pathogens during the COVID-19 pandemic: Alterations in detection and seasonality in Nashville, Tennessee. PLoS One 2022; 17:e0270469. [PMID: 35921608 PMCID: PMC9348857 DOI: 10.1371/journal.pone.0270469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
Shortly after the implementation of community mitigation measures in response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), sharp declines in respiratory syncytial virus and influenza circulation were noted; post-mitigation circulation of other respiratory pathogens has gone unexplored. We retrospectively analyzed all records of a provider-ordered multiplex test between April 1, 2018, and July 31, 2021, in Nashville, Tennessee, and we noted disrupted historical seasonal patterns for common respiratory pathogens during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Justin Z. Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Jonathan Schmitz
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail:
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6
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Rankin DA, Yanis A, Haddadin Z, Talj R, Fernandez KN, Bloos SM, Stahl A, Gu W, Nicotera J, Howe HL, Salib S, Chappell J, Howard LM, Khankari NK, Halasa NB. The impact of community closures among nonessential and essential workers, Nashville, Tennessee: A cross-sectional study. Health Sci Rep 2022; 5:e658. [PMID: 35620536 PMCID: PMC9128158 DOI: 10.1002/hsr2.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Aims The effects of community closures and relaxing social distancing restrictions on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by occupational risk remain unclear. Therefore, we evaluated the impact of community closures and reopening phases with the prevalence of testing SARS-CoV-2-positive among nonessential and essential workers. Methods We constructed a cross-sectional cohort from March 20 to July 31, 2020, of 344 adults from Metropolitan Nashville, Tennessee. We performed an unconditional logistic regression model to evaluate the impact of community closures and phase implementation on testing SARS-CoV-2 positive by occupation to estimate adjusted prevalence odds ratios (aPORs) and 95% confidence intervals (CIs). Results During a stay-at-home/Phase I order, those with non-essential occupations had 59% decreased prevalence odds (aPOR:0.41; 95% CI: 0.20-0.84) of testing SARS-CoV-2-positive compared to when no restrictions were in place. Persons with essential occupations had four times the prevalence odds of testing SARS-CoV-2-positive (aPOR:4.19; 95% CI:1.57-11.18) compared with nonessential occupations when no community restrictions were established. Conclusion Stay-at-home restrictions were associated with a lower risk of SARS-CoV-2 infection in the community for nonessential workers. Essential employees remained at increased risk for SARS-CoV-2, including when no community restrictions were in place and vaccines were not available. This study supports targeting prevention measures for these high-risk occupations.
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Affiliation(s)
- Danielle A. Rankin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Epidemiology PhD ProgramVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Ahmad Yanis
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zaid Haddadin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Rana Talj
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Kailee N. Fernandez
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sean M. Bloos
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Anna Stahl
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Wenying Gu
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Janet Nicotera
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Harrison L. Howe
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Seifein Salib
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - James Chappell
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Leigh M. Howard
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Nikhil K. Khankari
- Division of Genetic Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Natasha B. Halasa
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
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Probst V, Rankin DA, Haddadin Z, Hamdan L, Rahman HK, Yanis A, Talj R, Spieker AJ, Howard L, Stewart LS, Guevara C, Yepsen E, Faouri S, Shehabi A, Williams JV, Chappell J, Khuri-Bulos N, Halasa NB. Adenovirus Infection in Hospitalized Children with Acute Respiratory Infection in Jordan. Pediatr Infect Dis J 2022; 41:277-283. [PMID: 35315822 PMCID: PMC8943843 DOI: 10.1097/inf.0000000000003423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The most common clinical manifestation of adenovirus (AdV) infection is acute respiratory illness (ARI). Specific AdV species associated with ARI hospitalizations are not well defined in the Middle East. METHODS A viral surveillance study was conducted among children <2 years hospitalized in Amman, Jordan, from March 2010 to March 2013. Nasal and throat respiratory specimens were obtained from enrolled children and tested for viruses using a real-time reverse-transcription quantitative polymerase chain reaction. AdV-positive specimens were typed by partial hexon gene sequencing. Demographic and clinical features were compared between AdV detected as single pathogen versus co-detected with other respiratory viruses, and between AdV-B and AdV-C species. RESULTS AdV was detected in 475/3168 (15%) children hospitalized with ARI; of these, 216 (45%) specimens were successfully typed with AdV-C as the most common species detected (140/216; 65%). Children with AdV-single detection (88/475; 19%) had a higher frequency of fever (71% vs. 56%; P=0.015), diarrhea (18% vs. 11%; p=0.048), and/or seizures/abnormal movements (14% vs. 5%; p=0.003). Children with AdV co-detected with other viruses more likely required oxygen support [adjusted odds ratio (aOR) 1.91 (95% CI: 1.08, 3.39), P = 0.027] than those with AdV-single detection. Children with AdV-C had higher odds of co-detections with other viruses compared with those with AdV-B [aOR 4.00 (95% CI: 1.91, 8.44), P < 0.001]. CONCLUSION Clinical differences were identified between AdV-single and AdV co-detected with other viruses, and between AdV-B and AdV-C. Larger studies with AdV typing are needed to determine additional epidemiological and clinical differences between specific AdV species and types.
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Affiliation(s)
- Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Lubna Hamdan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Herdi K. Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leigh Howard
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Claudia Guevara
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Erin Yepsen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan
| | - Asem Shehabi
- Department of Pediatrics, Jordan University, Amman, Jordan
| | - John V. Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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8
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Siddiqui SM, Bowman KA, Zhu AL, Fischinger S, Beger S, Maron JS, Bartsch YC, Atyeo C, Gorman MJ, Yanis A, Hultquist JF, Lorenzo-Redondo R, Ozer EA, Simons LM, Talj R, Rankin DA, Chapman L, Meade K, Steinhart J, Mullane S, Siebert S, Streeck H, Sabeti P, Halasa N, Musk ER, Barouch DH, Menon AS, Nilles EJ, Lauffenburger DA, Alter G. Serological Markers of SARS-CoV-2 Reinfection. mBio 2022; 13:e0214121. [PMID: 35073738 PMCID: PMC8787477 DOI: 10.1128/mbio.02141-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
As public health guidelines throughout the world have relaxed in response to vaccination campaigns against SARS-CoV-2, it is likely that SARS-CoV-2 will remain endemic, fueled by the rise of more infectious SARS-CoV-2 variants. Moreover, in the setting of waning natural and vaccine immunity, reinfections have emerged across the globe, even among previously infected and vaccinated individuals. As such, the ability to detect reexposure to and reinfection by SARS-CoV-2 is a key component for global protection against this virus and, more importantly, against the potential emergence of vaccine escape mutations. Accordingly, there is a strong and continued need for the development and deployment of simple methods to detect emerging hot spots of reinfection to inform targeted pandemic response and containment, including targeted and specific deployment of vaccine booster campaigns. In this study, we identify simple, rapid immune biomarkers of reinfection in rhesus macaques, including IgG3 antibody levels against nucleocapsid and FcγR2A receptor binding activity of anti-RBD antibodies, that are recapitulated in human reinfection cases. As such, this cross-species analysis underscores the potential utility of simple antibody titers and function as price-effective and scalable markers of reinfection to provide increased resolution and resilience against new outbreaks. IMPORTANCE As public health and social distancing guidelines loosen in the setting of waning global natural and vaccine immunity, a deeper understanding of the immunological response to reexposure and reinfection to this highly contagious pathogen is necessary to maintain public health. Viral sequencing analysis provides a robust but unrealistic means to monitor reinfection globally. The identification of scalable pathogen-specific biomarkers of reexposure and reinfection, however, could significantly accelerate our capacity to monitor the spread of the virus through naive and experienced hosts, providing key insights into mechanisms of disease attenuation. Using a nonhuman primate model of controlled SARS-CoV-2 reexposure, we deeply probed the humoral immune response following rechallenge with various doses of viral inocula. We identified virus-specific humoral biomarkers of reinfection, with significant increases in antibody titer and function upon rechallenge across a range of humoral features, including IgG1 to the receptor binding domain of the spike protein of SARS-CoV-2 (RBD), IgG3 to the nucleocapsid protein (N), and FcγR2A receptor binding to anti-RBD antibodies. These features not only differentiated primary infection from reexposure and reinfection in monkeys but also were recapitulated in a sequencing-confirmed reinfection patient and in a cohort of putatively reinfected humans that evolved a PCR-positive test in spite of preexisting seropositivity. As such, this cross-species analysis using a controlled primate model and human cohorts reveals increases in antibody titers as promising cross-validated serological markers of reinfection and reexposure.
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Affiliation(s)
- Sameed M. Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Kathryn A. Bowman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Alex L. Zhu
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Immunology and Virology, University of Duisburg-Essen, Essen, Germany
| | - Samuel Beger
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Jenny S. Maron
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Virology, Division of Medical Sciences, Harvard University, Boston, Massachusetts, USA
| | - Yannic C. Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Virology, Division of Medical Sciences, Harvard University, Boston, Massachusetts, USA
| | - Matthew J. Gorman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Judd F. Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Egon A. Ozer
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lacy M. Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lindsay Chapman
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Kyle Meade
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Jordan Steinhart
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Sean Mullane
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Suzanne Siebert
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Hendrik Streeck
- Institute of Virology, University Hospital, University of Bonn, and German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Pardis Sabeti
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, Massachusetts, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elon R. Musk
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Dan H. Barouch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Anil S. Menon
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Eric J. Nilles
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
- Harvard Humanitarian Initiative, Boston, Massachusetts, USA
| | - Douglas A. Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, Massachusetts, USA
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9
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Yanis A, Haddadin Z, Spieker AJ, Waqfi D, Rankin DA, Talj R, Thomas L, Birdwell KA, Ezzell L, Blair M, Eason J, Varjabedian R, Warren CM, Nochowicz CH, Olson EC, Simmons JD, Yoder S, Guy M, Thomsen I, Chappell JD, Kalams SA, Halasa NB. Humoral and cellular immune responses to the SARS-CoV-2 BNT162b2 vaccine among a cohort of solid organ transplant recipients and healthy controls. Transpl Infect Dis 2022; 24:e13772. [PMID: 34905653 DOI: 10.1111/tid.13772] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased morbidity and mortality in solid organ transplant (SOT) recipients. Despite exclusion from SARS-CoV-2 vaccine clinical trials, these individuals were identified as high-risk and prioritized for vaccination in public health guidelines. METHODS We prospectively evaluated humoral and cellular immune responses to two doses of the SARS-CoV-2 mRNA vaccine, BNT162b2, in 56 SOT recipients and 26 healthy controls (HCs). Blood specimens collected from participants prior to each dose and following the second dose were tested for SARS-CoV-2-specific antibodies, as well as CD4+ and CD8+ T-cell responses. RESULTS SOT recipients demonstrated lower mean anti-SARS-CoV-2 antibody levels compared to HCs after each dose, and only 21.6% achieved an antibody response after the second dose within the range of HC responses. Similarly, the percentage of responsive CD4+ and CD8+ T cells in SOT recipients was lower than in HCs. While most HCs showed notable humoral and cellular responses, responses were less concordant in SOT recipients, with some showing evidence of either humoral or cellular response, but not both. CONCLUSION Humoral and cellular immune responses to the BNT162b2 vaccine are markedly reduced in SOT recipients as compared to HCs, suggesting that SOT recipients may benefit from more tailored regimens such as higher dose and/or additional vaccinations.
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Affiliation(s)
- Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Danya Waqfi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lora Thomas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly A Birdwell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren Ezzell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marcia Blair
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joan Eason
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekkah Varjabedian
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christian M Warren
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia H Nochowicz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C Olson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua D Simmons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra Yoder
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madeline Guy
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isaac Thomsen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spyros A Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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10
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Howe HL, Rankin DA, Bloos SM, Fernandez KN, Salib S, Talj R, Waqfi D, Villarreal J, Yanis A, Chappell J, Howard L, Halasa NB, Halasa NB. 290. Persistence of Long COVID in SARS-CoV-2 Confirmed Cases One-Year Post Infection. Open Forum Infect Dis 2021. [PMCID: PMC8690477 DOI: 10.1093/ofid/ofab466.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Regardless of severity of acute SARS-CoV-2 illness, adults infected with SARS-CoV-2 are at risk for post-acute sequelae of COVID-19. Long COVID is typically classified as symptoms lasting greater than four weeks post-infection. We aimed to evaluate the frequency of resolved and unresolved long COVID symptoms in adults residing in greater Nashville, TN. Methods We conducted a longitudinal cohort study of SARS-CoV-2-positive and exposed individuals from March 20 to May 15, 2020. Participants for this analysis were included if: 1) ≥18 years; 2) SARS-CoV-2 positive by molecular or antibody testing; and 3) completed a one-year visit. Demographic and illness information were collected at enrollment, and long COVID symptoms were systematically collected at the one-year survey. Long COVID symptoms are defined as an adult experiencing at least one of the following symptoms four weeks post-infection: fatigue, confusion, loss of smell or taste, shortness of breath, chest pain, cough, muscle aches, inability to exercise, or heart palpitations. Unresolved symptoms are defined as an individual with long COVID still experiencing symptoms at the one-year visit. Results A total of 115 adults enrolled and completed the one-year survey, of which 63 (54.8%) were SARS-CoV-2-positive, with one asymptomatic individual. Of SARS-CoV-2-positive symptomatic adults, 32 (51%) were female, 5 (88%) were of Hispanic ethnicity, and 58 (92%) were white. At the one-year visit, 33 (52%) reported having long COVID, of which 17 (52%) reported having unresolved symptoms. Fatigue (89%), headache (89%), muscle aches (79%), and cough (77%) were the most common symptoms reported at illness onset (Figure 1). Among 33 adults with long COVID, fatigue (42%), loss of smell (39%), and loss of taste (33%) were most common (Figure 2A). In the 17 individuals with unresolved symptoms, loss of smell (29%) and loss of taste (24%) were commonly reported (Figure 2B). Figure 1. COVID-19 symptoms reported at enrollment (n=62) ![]()
Figure 2. Long COVID (symptoms lasting ≥ 4 weeks) (n=33) (A) and unresolved long COVID symptoms one-year post-infection (n=17) (B) reported on the one-year survey ![]()
Conclusion Half of the adults in our cohort reported long COVID symptoms, with more than quarter of symptoms persisting one-year post-illness. Our findings support that prolonged symptoms up to year after SARS-CoV-2 exposure occur, and future studies should investigate the residual impacts of long COVID symptoms and conditions. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support
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Affiliation(s)
- Harrison L Howe
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, TN
| | - Sean M Bloos
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Kailee N Fernandez
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, TN
| | - Seifein Salib
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Rana Talj
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Danya Waqfi
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | | | - Ahmad Yanis
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - James Chappell
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Leigh Howard
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
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11
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Fernandez KN, Rankin DA, Howe HL, Bloos SM, Salib S, Talj R, Rahman HK, Waqfi D, Villarreal J, Yanis A, Howard L, Chappell J, Halasa NB, Halasa NB. 581. COVID-19 Vaccine Perceptions in Adults from Greater Nashville Tennessee. Open Forum Infect Dis 2021. [PMCID: PMC8644308 DOI: 10.1093/ofid/ofab466.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In December 2020, SARS-CoV-2 vaccines were made available to healthcare workers and soon thereafter offered to the general public according to age and risk of severe illness. Despite widespread access, vaccination rates vary by region, with Tennessee ranking lower than the national average. Therefore, we aimed to survey adults in greater Nashville, TN regarding SARS-CoV-2 vaccine perceptions. Methods We conducted a cross-sectional study of an ongoing longitudinal cohort of individuals with confirmed and/or suspected SARS-CoV-2 infection and their household contacts with enrollment onset in March 2020. For this analysis, individuals were included if they were ≥ 18 years and available for a one-year follow-up visit. At the one-year visit individuals completed a survey about vaccine preferences, beliefs and risks. Demographic and social characteristics were collected at enrollment. Individuals were considered vaccinated if they had received at least one dose of a SARS-CoV-2 vaccine under FDA emergency use authorization. Vaccine perceptions were compared by SARS-CoV-2-infection and vaccination status using Pearson’s chi-squared, alpha=5%. Results Between April-May 2021, 115 individuals completed the one-year follow-up. Table 1 includes sociodemographic characteristics of adults, of which the majority were vaccinated and were unemployed or in non-essential occupations. Most individuals agreed the SARS-CoV-2 vaccine can prevent infection and hospitalization (Figure 1A & B). Unvaccinated participants more often agreed that those who contracted SARS-CoV-2 should not receive the vaccine (30%), whereas vaccinated persons less often agreed (11%, p< 0.001) (Figure 1A). Additionally, 44% of unvaccinated individuals were neutral or disagreed that benefits of SARS-CoV-2 vaccination outweighed the illness risk, compared to 10% in the vaccinated group, p=0.001 (Figure 1A). Minimal differences of vaccine perceptions were observed between SARS-CoV-2 positive and negative adults (Figure 1B). Table 1. Sociodemographic Characteristics of Adults ![]()
Figure 1. Vaccine perceptions of vaccinated and unvaccinated (A) SARS-CoV-2 positive and SARS-CoV-2 negative (B) adults in greater Nashville, TN. Vaccine perceptions were collected through a standardized survey at the one-year visit. ![]()
Conclusion Although some unvaccinated individuals seemingly perceived the SARS-CoV-2 vaccine offered some protection, research should continue to evaluate the implications of vaccine hesitancy on the COVID-19 pandemic response as we prepare for the upcoming respiratory season. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it's a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it's a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support
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Affiliation(s)
- Kailee N Fernandez
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Harrison L Howe
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Sean M Bloos
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Seifein Salib
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Rana Talj
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | | | - Danya Waqfi
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | | | - Ahmad Yanis
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - Leigh Howard
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
| | - James Chappell
- Vanderbilt University Medical Center, Goodlettsville, Tennessee
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12
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Talj R, Yanis A, Rankin DA, Starnes JR, Starnes LS, Clark DE, Parra D, Patrick AE, Katz SE, Halasa NB, Halasa NB. 488. Comparison of Demographics and Clinical Characteristics of Multisystem Inflammatory Syndrome in Children and Kawasaki Disease. Open Forum Infect Dis 2021. [PMCID: PMC8644089 DOI: 10.1093/ofid/ofab466.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is an illness associated with recent SARS-CoV-2 infection or exposure. Kawasaki disease (KD), a vasculitis with an unknown etiology, has overlapping clinical presentation with MIS-C, making it difficult to clinicians for distinguish between them. Therefore, we aimed to compare demographic, laboratory, and clinical characteristics between MIS-C and KD in hospitalized children in Nashville, TN. Methods We conducted a single-center retrospective chart review for hospitalized children under 18 years who met American Heart Association criteria for KD and were treated with intravenous immunoglobulin from May 2000 to December 2019, and children meeting the CDC criteria for MIS-C from July 2020 to May 2021. Data abstraction for patients’ demographics, clinical presentation, laboratory values and imaging results was performed. Pearson’s chi-squared test for categorical variables and Wilcoxon rank sum test for continuous variables, with alpha=5%, were used to compare groups. Results A total of 603 KD and 52 MIS-C hospitalized patients were included. Children with MIS-C were older than those with KD. A higher frequency of male sex was noted in both groups, with no significant differences in race and ethnicity (Table). MIS-C children frequently presented with symptoms similar to KD (63.5% rash, 55.8% conjunctivitis, 28.9% mucous membrane changes); however, only one MIS-C patient met criteria for complete KD (Figure). Both MIS-C and KD children presented with elevated CRP and ESR, but the median value of CRP in MIS-C children was significantly higher (Table). In addition, white cell count was lower in MIS-C children, which is primarily driven by the lower absolute lymphocyte count in this group (0.9 vs 2.7, p< 0.001), and echocardiography was more likely to be abnormal at presentation compared to KD (Table). Table. Comparison of Sociodemographic, Clinical, and Laboratory Characteristics among Children with Kawasaki Disease and Multisystem Inflammatory Syndrome in Nashville ![]()
Figure. Comparison of Kawasaki Criteria Between Children with Multisystem Inflammatory Syndrome and Kawasaki Disease ![]()
Conclusion MIS-C and KD present similarly in children; however, age, laboratory and echocardiography findings can help differentiate between them. Different laboratory values suggest different pathophysiology and inflammatory mediators behind these two illnesses, warranting further research. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support
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Affiliation(s)
- Rana Talj
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ahmad Yanis
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, TN
| | | | | | - Daniel E Clark
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Anna E Patrick
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophie E Katz
- Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Yanis A, Haddadin Z, Speaker A, Waqfi D, Talj R, Rankin DA, Ezzell L, Blair M, Eason J, Varjabedian R, Thomas L, Chappell J, Halasa NB, Halasa NB. 568. Comparison of Humoral Immune Response to the SARS-CoV-2 BNT162b2 Vaccine Between Solid Organ Transplant Recipients and Healthy Controls. Open Forum Infect Dis 2021. [PMCID: PMC8644832 DOI: 10.1093/ofid/ofab466.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased morbidity and mortality in immunocompromised individuals, including solid organ transplant recipients (SOTR). Despite being excluded from phase 1-3 SARS-CoV-2 vaccine clinical trials, SOTR were identified as high-risk populations and prioritized for vaccination in public health guidelines. We aimed to evaluate the antibody response to two doses of the BNT162b2 (Pfizer-BioNTech) vaccine in SOTR as compared to healthy controls (HC).
Methods
SOTR and HC scheduled to receive two doses of BNT162b2 vaccine and able to complete required follow-up visits were enrolled. Blood specimens were collected from participants before receiving the first and second doses and 21-42 days after the second dose. Enzyme-linked immunosorbent assay (ELISA) was used to detect immunoglobulin G (IgG) to the SARS-CoV-2 spike receptor-binding domain (RBD). Generalized estimating equations with a working independence correlation structure were used to compare anti-RBD IgG levels between SOTR and HC at each study visit and within each group over time. All models were adjusted for age, sex, and pre-vaccination seroreactivity in the ELISA.
Results
A total of 54 SOTR and 26 HC were enrolled, with mean (SD) ages of 72 (3.6) and 62 (6.7) years, 61% and 35% were male, and 91% and 88% were white, respectively. The most common organ transplant types were kidney (41%) and liver (37%). All SOTR were receiving calcineurin inhibitors. The median time post-transplantation was 7 years. SOTR had markedly lower mean anti-RBD IgG levels when compared to HC with adjusted mean differences of -0.76 (95%CI: [-1.04, -0.47]; p < 0.001) ELISA units (EU) and -1.35 (95%CI [-1.68, -1.01]; p < 0.001) EU after the first and second doses, respectively (Figure 1). Both groups had a significant increase in anti-SARS-CoV-2 IgG levels after the second dose. However, the magnitude was lower in SOTR, 0.49 (95%CI [0.31, 0.69]; p < 0.001) EU than in HCs, 1.08 (95% CI [0.91, 1.24]; p < 0.001) EU.
Figure 1.
Anti-SARS-CoV-2 RBD IgG levels in solid organ transplant recipients and healthy controls before receiving the BNT162b2 vaccine (baseline), post-vaccine dose 1, and post-vaccine dose 2.
Conclusion
Our study showed SOTR mounted weaker humoral immune responses than HC to SARS-CoV-2 vaccines. Given a lower response, SOTR should continue to practice social distancing and masking until data on vaccine efficacy are available in this vulnerable population.
Disclosures
Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it's a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it's a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support
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Affiliation(s)
- Ahmad Yanis
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Andrew Speaker
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Danya Waqfi
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Rana Talj
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Lauren Ezzell
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Marcia Blair
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Joan Eason
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Rebekkah Varjabedian
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Lora Thomas
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - James Chappell
- Vanderbilt University Medical Center, Nashvill, Tennessee
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14
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Ni B, Yanis A, Chappell J, Halasa N. Vaccine protection and how we measure it. Transpl Infect Dis 2021; 23:e13748. [PMID: 34719856 DOI: 10.1111/tid.13748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Bin Ni
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ahmad Yanis
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Chappell
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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Haddadin Z, Rankin DA, Yanis A, Shawareb Y, Hamdan O, Saada M, Hilal S, Alhajajra A, Marar B, Khuri-Bulos N. 772. Respiratory Syncytial Virus Acute Respiratory Infections in Young Children in Jordan: A Prospective Surveillance Study. Open Forum Infect Dis 2020. [PMCID: PMC7777532 DOI: 10.1093/ofid/ofaa439.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections (ARI) hospitalizations in young children and is associated with increased severity compared to other viruses. The aim of this study was to evaluate the utilization of a rapid RSV diagnostic test and clinical characteristics and disease severity of children who were hospitalized during one respiratory season in Amman, Jordan.
Methods
Children less than two years hospitalized with fever and/or respiratory symptoms were recruited at Al-Bashir Government Hospital from January 8, 2020, to March 17, 2020. Nasal swabs were collected and tested by Sofia-2 RSV Fluorescent Immunoassay. Demographic information and clinical history were obtained through parental interviews. A validated severity score was used to assess disease severity, and the treating physician prospectively collected the necessary information to calculate the score at admission. Disease severity was categorized based on the total score into 0-5 mild, 6-9 moderate, and ≥ 10 severe. Molecular testing and medical chart reviews are still in process.
Results
A total of 532 subjects were enrolled, and nasal swabs were collected and tested from 458 (86%) of enrollees. The most common admission diagnoses were pneumonia (25%), bronchopneumonia (21%), bronchiolitis (19%) and sepsis (17%). Demographic and clinical characteristics are included in Table 1. Overall, 276 (60%) subjects were RSV-positive. The most common admission diagnoses were pneumonia (33%), sepsis (25%), bronchiolitis (24%) and bronchopneumonia (24%). Compared to RSV-negative children, RSV-positive children were younger (Table 1), and more likely to present with cough, nasal congestion, and appetite loss (Figure 1). There were no differences in severity score or direct intensive care unit admission between the two groups (Table 1).
Figure 1. Symptom Distribution in RSV-Positive and RSV-Negative Subjects
Conclusion
Nearly 2/3 of children enrolled were RSV-positive via rapid diagnostic testing. The majority of RSV-ARI admissions were classified as mild. Further analysis of other clinical parameters, including oxygen use, intravenous fluids administration and length of stay, and molecular testing are needed to support these findings and further evaluate the utility of rapid diagnostic testing.
Disclosures
Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Ahmad Yanis, MD, Quidel Corporation (Grant/Research Support) Yanal Shawareb, MD, Quidel (Grant/Research Support)Quidel (Grant/Research Support, Research Grant or Support, Sanofi) Olla Hamdan, BS, Quidel (Grant/Research Support, Research Grant or Support) Malek Saada, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Sara Hilal, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Ahmad Alhajajra, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Basima Marar, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Najwa Khuri-Bulos, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Ahmad Yanis
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Yanal Shawareb
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Olla Hamdan
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | | | - Sara Hilal
- Al Bashir Hospital, amman, ‘Amman, Jordan
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Ahram M, Farkouh A, Haddad M, Kalaji Z, Yanis A. Knowledge of, attitudes to and participation in clinical trials in Jordan: a population-based survey. East Mediterr Health J 2020; 26:539-546. [PMID: 32538447 DOI: 10.26719/2020.26.5.539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/14/2018] [Indexed: 11/09/2022]
Abstract
Background Clinical trials are important to improve public health care. However, recruiting participants for trials can be difficult. Aims This study assessed public knowledge of and willingness to participate in clinical trials in Jordan and examine the sociodemographic characteristics associated with knowledge and willingness and the reasons behind unwillingness to participate. Methods The questions were part of a representative, population-based survey in 2011 that included 3196 Jordanian individuals. In a home-based interview, participants were asked about: sociodemographic characteristics, and knowledge of and participation in clinical trials. Results Only 21.8% of respondents knew what a clinical trial was and (1.2%) had participated in a trial. About 25% of respondents indicated their willingness to enrol in a trial. Significantly more men (24.1%) than women (19.3%) knew what clinical trials were (P < 0.001), whereas more women (4.3%) than men (2.9%) said they would be very likely to agree to participate in trials. People aged 40-49 years had better knowledge of and greater willingness to participate in trials than other age groups. Income was positively associated with knowledge of trials but negatively associated with willingness to participate. Higher education was positively correlated with knowledge of and willingness to take part in trials. The main reasons for not participating in trials were concern about the risk to own health (61.1%) and not being convinced about the outcome and benefits of clinical trials (29.7%). Conclusion The low level of knowledge of and willingness to participate in clinical trials indicates that strategies are needed to educate the public about the nature and importance of clinical trials.
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Affiliation(s)
- Mamoun Ahram
- Department of Physiology and Biochemistry, The University of Jordan, Amman, Jordan
| | - Ala'a Farkouh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Marah Haddad
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Zeina Kalaji
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad Yanis
- School of Medicine, The University of Jordan, Amman, Jordan
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17
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Sartawi R, Abu-Halimah S, Abdelhamid S, Yanis A. Endovascular Repair of Axillary Artery Transection with a Stent Graft following Blunt Trauma. ACTA ACUST UNITED AC 2019. [DOI: 10.25259/ajir-1-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transection injuries of the axillary artery are rare and typically involve surgical repair. This case describes an emergent endovascular treatment option, using a stent graft, in a patient that was deemed as high risk for open surgery.
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Affiliation(s)
- Rami Sartawi
- Department of Interventional Radiology, OMNY Vein and Cardiovascular, New York
| | | | | | - Ahmad Yanis
- School of Medicine, University of Jordan, Amman, Jordan
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