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Kanungo S, Bhattacharjee U, Prabhakaran AO, Kumar R, Rajkumar P, Bhardwaj SD, Chakrabarti AK, Kumar C. P. G, Potdar V, Manna B, Amarchand R, Choudekar A, Gopal G, Sarda K, Lafond KE, Azziz-Baumgartner E, Saha S, Dar L, Krishnan A. Adverse outcomes in patients hospitalized with pneumonia at age 60 or more: A prospective multi-centric hospital-based study in India. PLoS One 2024; 19:e0297452. [PMID: 38696397 PMCID: PMC11065220 DOI: 10.1371/journal.pone.0297452] [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] [Received: 10/06/2023] [Accepted: 01/04/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Limited data exists regarding risk factors for adverse outcomes in older adults hospitalized with Community-Acquired Pneumonia (CAP) in low- and middle-income countries such as India. This multisite study aimed to assess outcomes and associated risk factors among adults aged ≥60 years hospitalized with pneumonia. METHODS Between December 2018 and March 2020, we enrolled ≥60-year-old adults admitted within 48 hours for CAP treatment across 16 public and private facilities in four sites. Clinical data and nasal/oropharyngeal specimens were collected by trained nurses and tested for influenza, respiratory syncytial virus (RSV), and other respiratory viruses (ORV) using the qPCR. Participants were evaluated regularly until discharge, as well as on the 7th and 30th days post-discharge. Outcomes included ICU admission and in-hospital or 30-day post-discharge mortality. A hierarchical framework for multivariable logistic regression and Cox proportional hazard models identified risk factors (e.g., demographics, clinical features, etiologic agents) associated with critical care or death. FINDINGS Of 1,090 CAP patients, the median age was 69 years; 38.4% were female. Influenza viruses were detected in 12.3%, RSV in 2.2%, and ORV in 6.3% of participants. Critical care was required for 39.4%, with 9.9% in-hospital mortality and 5% 30-day post-discharge mortality. Only 41% of influenza CAP patients received antiviral treatment. Admission factors independently associated with ICU admission included respiratory rate >30/min, blood urea nitrogen>19mg/dl, altered sensorium, anemia, oxygen saturation <90%, prior cardiovascular diseases, chronic respiratory diseases, and private hospital admission. Diabetes, anemia, low oxygen saturation at admission, ICU admission, and mechanical ventilation were associated with 30-day mortality. CONCLUSION High ICU admission and 30-day mortality rates were observed among older adults with pneumonia, with a significant proportion linked to influenza and RSV infections. Comprehensive guidelines for CAP prevention and management in older adults are needed, especially with the co-circulation of SARS-CoV-2.
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Affiliation(s)
- Suman Kanungo
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Byomkesh Manna
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Choudekar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Giridara Gopal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Krishna Sarda
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Kathryn E. Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Siddhartha Saha
- Influenza program, US Centers for Disease Control and Prevention, New Delhi, India
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Chard AN, Machingaidze C, Loayza S, Gharpure R, Nogareda F, González R, Domínguez R, Tinoco YO, Dawood FS, Carreon JD, Lafond KE, Jara J, Azziz-Baumgartner E, Cozza V, Couto P, Rolfes MA, Tempia S. Estimating averted illnesses from influenza vaccination for children and pregnant women - El Salvador, Panama, and Peru, 2011-2018. Vaccine 2024:S0264-410X(24)00419-5. [PMID: 38584055 DOI: 10.1016/j.vaccine.2024.04.007] [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: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Estimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011-2017 among two influenza vaccine target populations: children aged 6-23 months and pregnant women. METHODS We derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries' vaccine coverage was achieved using four different vaccine deployment strategies. RESULTS Among children aged 6-23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March-June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women). DISCUSSION Influenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.
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Affiliation(s)
- Anna N Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Chiedza Machingaidze
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Sergio Loayza
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Radhika Gharpure
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Francisco Nogareda
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Rosalba González
- Gorgas Memorial Institute of Health Studies, Ave. Justo Arosemena, Calle 35, Panama City, Panama
| | - Rhina Domínguez
- National Institute of Health of El Salvador, C. Gabriela Mistral 211, San Salvador, El Salvador
| | - Yeny O Tinoco
- U.S. Naval Medical Research Unit SOUTH, Av. Venezuela. Cuadra 36 s/n. Bellavista. Callao, Lima, Peru
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Joseph Daniel Carreon
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Jorge Jara
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Vanessa Cozza
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Paula Couto
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States; Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Stefano Tempia
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
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Acevedo-Rodriguez JG, Zamudio C, Kojima N, Krapp F, Tsukayama P, Sal Y Rosas Celi VG, Baldeon D, Neciosup-Vera CS, Medina C, Gonzalez-Lagos E, Castro L, Fowlkes A, Azziz-Baumgartner E, Gotuzzo E. Influenza incidence, lineages, and vaccine effectiveness estimates in Lima, Peru, 2023. Lancet Microbe 2024; 5:e308-e309. [PMID: 38219756 DOI: 10.1016/s2666-5247(23)00392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024]
Affiliation(s)
| | - Carlos Zamudio
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Noah Kojima
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fiorella Krapp
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Pablo Tsukayama
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | | | - Dante Baldeon
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | | | - Carlos Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Elsa Gonzalez-Lagos
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Laura Castro
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Fowlkes
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru.
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Zhang Y, Romieu-Hernandez A, Boehmer TK, Azziz-Baumgartner E, Carton TW, Gundlapalli AV, Fearrington J, Nagavedu K, Dea K, Moyneur E, Cowell LG, Kaushal R, Mayer KH, Puro J, Rasmussen SA, Thacker D, Weiner MG, Saydah S, Block JP. Association between SARS-CoV-2 infection and select symptoms and conditions 31 to 150 days after testing among children and adults. BMC Infect Dis 2024; 24:181. [PMID: 38341566 PMCID: PMC10859007 DOI: 10.1186/s12879-024-09076-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31- to 150-day following a SARS-CoV-2 test among adults and children with positive and negative test results. METHODS We conducted a retrospective cohort study using electronic health record (EHR) data from 43 PCORnet sites participating in a national COVID-19 surveillance program. This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test during March 1, 2020-May 31, 2021 documented in their EHR. We used logistic regression to calculate the odds of having a symptom and Cox models to calculate the risk of having a newly diagnosed condition associated with a SARS-CoV-2 positive test. RESULTS After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥ 1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11-1.23]; children: aOR, 1.18[95% CI, 1.08-1.28]) or shortness of breath (adults: aOR, 1.50[95% CI, 1.38-1.63]; children: aOR, 1.40[95% CI, 1.15-1.70]) 31-150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥ 3 symptoms or fatigue compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (adjusted hazard ratio[aHR], 1.25[95% CI, 1.17-1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11-1.28]), or respiratory disease (aHR, 1.44[95% CI, 1.30-1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive test also had higher odds or increased risk of being diagnosed with certain symptoms or conditions. CONCLUSIONS Patients with SARS-CoV-2 infection, especially those who were hospitalized, were at higher risk of being diagnosed with certain symptoms and conditions after acute infection.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | | | - Tegan K Boehmer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Adi V Gundlapalli
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia Fearrington
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA
| | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA
| | | | | | - Lindsay G Cowell
- Peter O-Donnell Jr. School of Public Health, Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health, Harvard Medical School, Boston, MA, USA
| | | | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sharon Saydah
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA.
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Gharpure R, Chard AN, Cabrera Escobar M, Zhou W, Valleau MM, Yau TS, Bresee JS, Azziz-Baumgartner E, Pallas SW, Lafond KE. Costs and cost-effectiveness of influenza illness and vaccination in low- and middle-income countries: A systematic review from 2012 to 2022. PLoS Med 2024; 21:e1004333. [PMID: 38181066 PMCID: PMC10802964 DOI: 10.1371/journal.pmed.1004333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/22/2024] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. METHODS AND FINDINGS We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. CONCLUSIONS The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs.
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Affiliation(s)
- Radhika Gharpure
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna N. Chard
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Weigong Zhou
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Molly M. Valleau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tat S. Yau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph S. Bresee
- Task Force for Global Health, Atlanta, Georgia, United States of America
| | | | - Sarah W. Pallas
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn E. Lafond
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Kubale J, Kujawski S, Chen I, Wu Z, Khader IA, Hasibra I, Whitaker B, Gresh L, Simaku A, Simões EAF, Al-Gazo M, Rogers S, Gerber SI, Balmaseda A, Tallo VL, Al-Sanouri TM, Porter R, Bino S, Azziz-Baumgartner E, McMorrow M, Hunt D, Thompson M, Biggs HM, Gordon A. Etiology of Acute Lower Respiratory Illness Hospitalizations Among Infants in 4 Countries. Open Forum Infect Dis 2023; 10:ofad580. [PMID: 38130597 PMCID: PMC10733183 DOI: 10.1093/ofid/ofad580] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background Recent studies explored which pathogens drive the global burden of pneumonia hospitalizations among young children. However, the etiology of broader acute lower respiratory tract infections (ALRIs) remains unclear. Methods Using a multicountry study (Albania, Jordan, Nicaragua, and the Philippines) of hospitalized infants and non-ill community controls between 2015 and 2017, we assessed the prevalence and severity of viral infections and coinfections. We also estimated the proportion of ALRI hospitalizations caused by 21 respiratory pathogens identified via multiplex real-time reverse transcription polymerase chain reaction with bayesian nested partially latent class models. Results An overall 3632 hospitalized infants and 1068 non-ill community controls participated in the study and had specimens tested. Among hospitalized infants, 1743 (48.0%) met the ALRI case definition for the etiology analysis. After accounting for the prevalence in non-ill controls, respiratory syncytial virus (RSV) was responsible for the largest proportion of ALRI hospitalizations, although the magnitude varied across sites-ranging from 65.2% (95% credible interval, 46.3%-79.6%) in Albania to 34.9% (95% credible interval, 20.0%-49.0%) in the Philippines. While the fraction of ALRI hospitalizations caused by RSV decreased as age increased, it remained the greatest driver. After RSV, rhinovirus/enterovirus (range, 13.4%-27.1%) and human metapneumovirus (range, 6.3%-12.0%) were the next-highest contributors to ALRI hospitalizations. Conclusions We observed substantial numbers of ALRI hospitalizations, with RSV as the largest source, particularly in infants aged <3 months. This underscores the potential for vaccines and long-lasting monoclonal antibodies on the horizon to reduce the burden of ALRI in infants worldwide.
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Affiliation(s)
- John Kubale
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephanie Kujawski
- Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Irena Chen
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Iris Hasibra
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Brett Whitaker
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Artan Simaku
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Eric A F Simões
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Mahmoud Al-Gazo
- The Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Shannon Rogers
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan I Gerber
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Veronica L Tallo
- Department of Health, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
| | | | - Rachael Porter
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Bino
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Eduardo Azziz-Baumgartner
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mark Thompson
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly M Biggs
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Nogareda F, Regan AK, Couto P, Fowlkes AL, Gharpure R, Loayza S, Leite JA, Rodríguez A, Vicari A, Azziz-Baumgartner E, Salas D. Effectiveness of COVID-19 vaccines against hospitalisation in Latin America during three pandemic waves, 2021-2022: a test-negative case-control design. Lancet Reg Health Am 2023; 27:100626. [PMID: 38035125 PMCID: PMC10682274 DOI: 10.1016/j.lana.2023.100626] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023]
Abstract
Background Vaccine effectiveness (VE) is essential to monitor the performance of vaccines and generate strategic information to guide decision making. We pooled data from six Latin American countries to estimate the effectiveness of COVID-19 vaccines in preventing laboratory-confirmed SARS-CoV-2 hospitalisation during three different pandemic waves from February 2021 to September 2022. Methods We used a test-negative case-control design in hospitalised adults in Chile, Costa Rica, Ecuador, Guatemala, Paraguay, and Uruguay. We estimated adjusted VE by age group (18-64 and ≥65 years), vaccine type and product for primary series vaccination and booster vaccination and by time since last dose during the Omicron variant dominant period. We used mixed effects logistic regression models adjusting for sex, age, week of onset of symptom onset and pre-existing conditions with country fit as a random effect term. Findings We included 15,241 severe acute respiratory infection (SARI) patients in the analysis. Among adults 18-64 years, VE estimates for primary series vaccination during pre-Delta and Delta periods ranged by product from 66.5% to 95.1% and from 33.5% to 88.2% for older adults. During the Omicron period, VE estimates for primary series were lower and decreased by time since last vaccination, but VE increased to between 26.4% and 57.4% when a booster was administered. Interpretation mRNA and viral vector vaccines presented higher VE for both primary series and booster. While VE decreased over time, protection against severe COVID-19-associated hospitalisation increased when booster doses were administered. Vaccination with additional doses should be recommended, particularly for persons at increased risk of developing severe COVID-19. Funding This work was supported by a grant from the U.S. Centers for Disease Control and Prevention (CDC) through cooperative agreements with the Pan American Health Organization/World Health Organization.
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Affiliation(s)
| | - Annette K. Regan
- Pan American Health Organization, Washington, DC, USA
- School of Nursing and Health Professions, University of San Francisco, USA
- Fielding School of Public Health, University of California Los Angeles, USA
| | - Paula Couto
- Pan American Health Organization, Washington, DC, USA
| | - Ashley L. Fowlkes
- National Center for Immunization and Respiratory Diseases, U.S. CDC, USA
| | - Radhika Gharpure
- National Center for Immunization and Respiratory Diseases, U.S. CDC, USA
| | - Sergio Loayza
- Pan American Health Organization, Washington, DC, USA
| | | | | | - Andrea Vicari
- Pan American Health Organization, Washington, DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Washington, DC, USA
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Hassan MZ, Sturm-Ramirez K, Islam MS, Afreen S, Rahman MZ, Kafi MAH, Chowdhury S, Khan SU, Rahman M, Nasreen S, Davis CT, Levine MZ, Rahman M, Luby SP, Azziz-Baumgartner E, Iuliano AD, Uyeki TM, Gurley ES. Interpretation of molecular detection of avian influenza A virus in respiratory specimens collected from live bird market workers in Dhaka, Bangladesh: infection or contamination? Int J Infect Dis 2023; 136:22-28. [PMID: 37652093 DOI: 10.1016/j.ijid.2023.08.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Interpreting real-time reverse transcription-polymerase chain reaction (rRT-PCR) results for human avian influenza A virus (AIV) detection in contaminated settings like live bird markets (LBMs) without serology or viral culture poses a challenge. METHODS During February-March 2012 and November 2012-February 2013, we screened workers at nine LBMs in Dhaka, Bangladesh, to confirm molecular detections of AIV RNA in respiratory specimens with serology. We tested nasopharyngeal (NP) and throat swabs from workers with influenza-like illness (ILI) and NP, throat, and arm swabs from asymptomatic workers for influenza virus by rRT-PCR and sera for seroconversion and antibodies against HPAI A(H5N1) and A(H9N2) viruses. RESULTS Among 1273 ILI cases, 34 (2.6%) had A(H5), 56 (4%) had A(H9), and six (0.4%) had both A(H5) and A(H9) detected by rRT-PCR. Of 192 asymptomatic workers, A(H5) was detected in eight (4%) NP and 38 (20%) arm swabs. Of 28 ILI cases with A(H5) or A(H9) detected, none had evidence of seroconversion, but one (3.5%) and 12 (43%) were seropositive for A(H5) and A(H9), respectively. CONCLUSION Detection of AIV RNA in respiratory specimens from symptomatic and asymptomatic LBM workers without evidence of seroconversion or virus isolation suggests environmental contamination, emphasizing caution in interpreting rRT-PCR results in high viral load settings.
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Affiliation(s)
- Md Zakiul Hassan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | | | | | - Sadia Afreen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Sukanta Chowdhury
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Salah Uddin Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sharifa Nasreen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; University of British Columbia, Vancouver, Canada
| | - C Todd Davis
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Min Z Levine
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | - A D Iuliano
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Krishnan A, Shekhawat K, Ortega-Sanchez IR, Kanungo S, Rajkumar P, Bhardwaj SD, Kumar R, Prabhakaran AO, Gopal G, Chakrabarti AK, Purushothaman GKC, Potdar V, Manna B, Gharpure R, Amarchand R, Choudekar A, Lafond KE, Dar L, Bhattacharjee U, Azziz-Baumgartner E, Saha S. Cost of acute respiratory illness episode and its determinants among community-dwelling older adults: a four-site cohort study from India. BMJ Public Health 2023; 1:e000103. [PMID: 38116390 PMCID: PMC10728158 DOI: 10.1136/bmjph-2023-000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Introduction Advocacy for the provision of public health resources, including vaccine for the prevention of acute respiratory illnesses (ARIs) among older adults in India, needs evidence on costs and benefits. Using a cohort of community-dwelling adults aged 60 years and older in India, we estimated the cost of ARI episode and its determinants. Methods We enrolled 6016 participants in Ballabgarh, Chennai, Kolkata and Pune from July 2018 to March 2020. They were followed up weekly to identify ARI and classified them as acute upper respiratory illness (AURI) or pneumonia based on clinical features based on British Thoracic Society guidelines. All pneumonia and 20% of AURI cases were asked about the cost incurred on medical consultation, investigation, medications, transportation, food and lodging. The cost of services at public facilities was supplemented by WHO-Choosing Interventions that are Cost-Effective(CHOICE) estimates for 2019. Indirect costs incurred by the affected participant and their caregivers were estimated using human capital approach. We used generalised linear model with log link and gamma family to identify the average marginal effect of key determinants of the total cost of ARI. Results We included 2648 AURI and 1081 pneumonia episodes. Only 47% (range 36%-60%) of the participants with pneumonia sought care. The mean cost of AURI episode was US$13.9, while that of pneumonia episode was US$25.6, with indirect costs comprising three-fourths of the total. The cost was higher among older men by US$3.4 (95% CI: 1.4 to 5.3), those with comorbidities by US$4.3 (95% CI: 2.8 to 5.7) and those who sought care by US$17.2 (95% CI: 15.1 to 19.2) but not by influenza status. The mean per capita annual cost of respiratory illness was US$29.5. Conclusion Given the high community disease and cost burden of ARI, intensifying public health interventions to prevent and mitigate ARI among this fast-growing older adult population in India is warranted.
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Affiliation(s)
- Anand Krishnan
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kusum Shekhawat
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suman Kanungo
- Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Prabu Rajkumar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Sumit Dutt Bhardwaj
- Indian Council of Medical Research,National Institute of Virology, Pune, India
| | - Rakesh Kumar
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Giridara Gopal
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Kumar Chakrabarti
- Virology, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | | | - Varsha Potdar
- Indian Council of Medical Research,National Institute of Virology, Pune, India
| | - Byomkesh Manna
- Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Radhika Gharpure
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ritvik Amarchand
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Choudekar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kathryn E Lafond
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Uttaran Bhattacharjee
- Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Eduardo Azziz-Baumgartner
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Siddhartha Saha
- Influenza Program, Centers for Disease Control and Prevention, New Delhi, Delhi, India
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10
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Fowlkes AL, Nogareda F, Regan A, Loayza S, Mancio JM, Duca LM, Couto P, Leite J, Rodriguez A, Salas D, Azziz-Baumgartner E. Interim Effectiveness Estimates of 2023 Southern Hemisphere Influenza Vaccines in Preventing Influenza-Associated Hospitalizations - REVELAC-i Network, March-July 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1010-1015. [PMID: 37708084 PMCID: PMC10511266 DOI: 10.15585/mmwr.mm7237e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - REVELAC–i Network
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; Pan American Health Organization, Washington, DC; School of Nursing and Health Professions, University of San Francisco, San Francisco, California; Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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11
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Chard AN, Nogareda F, Regan AK, Barraza MFO, Fasce RA, Vergara N, Avendaño M, Penayo E, Vázquez C, Von Horoch M, Michel F, Alfonso A, Mogdasy C, Chiparelli H, Goñi N, Alegretti M, Loayza S, Couto P, Rodriguez A, Salas D, Fowlkes AL, Azziz-Baumgartner E. End-of-season influenza vaccine effectiveness during the Southern Hemisphere 2022 influenza season - Chile, Paraguay, and Uruguay. Int J Infect Dis 2023; 134:39-44. [PMID: 37201863 PMCID: PMC10404161 DOI: 10.1016/j.ijid.2023.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES This study estimated the 2022 end-of-season influenza vaccine effectiveness (VE) against severe acute respiratory illness (SARI) hospitalization in Chile, Paraguay, and Uruguay. METHODS We pooled surveillance data from SARI cases in 18 sentinel surveillance hospitals in Chile (n = 9), Paraguay (n = 2), and Uruguay (n = 7) from March 16-November 30, 2022. VE was estimated using a test-negative design and logistic regression models adjusted for country, age, sex, presence of ≥1 comorbidity, and week of illness onset. VE estimates were stratified by influenza virus type and subtype (when available) and influenza vaccine target population, categorized as children, individuals with comorbidities, and older adults, defined per countries' national immunization policies. RESULTS Among the 3147 SARI cases, there were 382 (12.1%) influenza test-positive case patients; 328 (85.9%) influenza case patients were in Chile, 33 (8.6%) were in Paraguay, and 21 (5.5%) were in Uruguay. In all countries, the predominant subtype was influenza A(H3N2) (92.6% of influenza cases). Adjusted VE against any influenza-associated SARI hospitalization was 33.8% (95% confidence interval: 15.3%, 48.2%); VE against influenza A(H3N2)-associated SARI hospitalization was 30.4% (95% confidence interval: 10.1%, 46.0%). VE estimates were similar across target populations. CONCLUSION During the 2022 influenza season, influenza vaccination reduced the odds of hospitalization among those vaccinated by one-third. Health officials should encourage influenza vaccination in accordance with national recommendations.
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Affiliation(s)
- Anna N Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA.
| | | | - Annette K Regan
- Pan American Health Organization, Washington DC, USA; School of Nursing and Health Professions, University of San Francisco, San Francisco, USA; Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | | | - Rodrigo A Fasce
- Virology Department, Public Health Institute of Chile, Santiago, Chile
| | | | | | - Elena Penayo
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Cynthia Vázquez
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Marta Von Horoch
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | | | | | | | | | | | | | - Sergio Loayza
- Pan American Health Organization, Washington DC, USA
| | - Paula Couto
- Pan American Health Organization, Washington DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Washington DC, USA
| | - Ashley L Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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12
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Szablewski CM, Iwamoto C, Olsen SJ, Greene CM, Duca LM, Davis CT, Coggeshall KC, Davis WW, Emukule GO, Gould PL, Fry AM, Wentworth DE, Dugan VG, Kile JC, Azziz-Baumgartner E. Reported Global Avian Influenza Detections Among Humans and Animals During 2013-2022: Comprehensive Review and Analysis of Available Surveillance Data. JMIR Public Health Surveill 2023; 9:e46383. [PMID: 37651182 PMCID: PMC10502594 DOI: 10.2196/46383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Avian influenza (AI) virus detections occurred frequently in 2022 and continue to pose a health, economic, and food security risk. The most recent global analysis of official reports of animal outbreaks and human infections with all reportable AI viruses was published almost a decade ago. Increased or renewed reports of AI viruses, especially high pathogenicity H5N8 and H5N1 in birds and H5N1, H5N8, and H5N6 in humans globally, have established the need for a comprehensive review of current global AI virus surveillance data to assess the pandemic risk of AI viruses. OBJECTIVE This study aims to provide an analysis of global AI animal outbreak and human case surveillance information from the last decade by describing the circulating virus subtypes, regions and temporal trends in reporting, and country characteristics associated with AI virus outbreak reporting in animals; surveillance and reporting gaps for animals and humans are identified. METHODS We analyzed AI virus infection reports among animals and humans submitted to animal and public health authorities from January 2013 to June 2022 and compared them with reports from January 2005 to December 2012. A multivariable regression analysis was used to evaluate associations between variables of interest and reported AI virus animal outbreaks. RESULTS From 2013 to 2022, 52.2% (95/182) of World Organisation for Animal Health (WOAH) Member Countries identified 34 AI virus subtypes during 21,249 outbreaks. The most frequently reported subtypes were high pathogenicity AI H5N1 (10,079/21,249, 47.43%) and H5N8 (6722/21,249, 31.63%). A total of 10 high pathogenicity AI and 6 low pathogenicity AI virus subtypes were reported to the WOAH for the first time during 2013-2022. AI outbreaks in animals occurred in 26 more Member Countries than reported in the previous 8 years. Decreasing World Bank income classification was significantly associated with decreases in reported AI outbreaks (P<.001-.02). Between January 2013 and June 2022, 17/194 (8.8%) World Health Organization (WHO) Member States reported 2000 human AI virus infections of 10 virus subtypes. H7N9 (1568/2000, 78.40%) and H5N1 (254/2000, 12.70%) viruses accounted for the most human infections. As many as 8 of these 17 Member States did not report a human case prior to 2013. Of 1953 human cases with available information, 74.81% (n=1461) had a known animal exposure before onset of illness. The median time from illness onset to the notification posted on the WHO event information site was 15 days (IQR 9-30 days; mean 24 days). Seasonality patterns of animal outbreaks and human infections with AI viruses were very similar, occurred year-round, and peaked during November through May. CONCLUSIONS Our analysis suggests that AI outbreaks are more frequently reported and geographically widespread than in the past. Global surveillance gaps include inconsistent reporting from all regions and human infection reporting delays. Continued monitoring for AI virus outbreaks in animals and human infections with AI viruses is crucial for pandemic preparedness.
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Affiliation(s)
- Christine M Szablewski
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Chelsea Iwamoto
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sonja J Olsen
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carolyn M Greene
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lindsey M Duca
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - C Todd Davis
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kira C Coggeshall
- Division of Global Health Protection, Global Health Center, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - William W Davis
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gideon O Emukule
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Philip L Gould
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David E Wentworth
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Vivien G Dugan
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James C Kile
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, United States
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13
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Sumner KM, Duca LM, Arriola CS, Neyra J, Soto G, Romero C, Tinoco Y, Nogareda F, Matos E, Chavez V, Castillo M, Bravo E, Castro J, Thompson M, Azziz-Baumgartner E. Knowledge, attitudes, and practices associated with frequent influenza vaccination among healthcare personnel in Peru, 2016─2018. Vaccine X 2023; 14:100314. [PMID: 37234596 PMCID: PMC10205539 DOI: 10.1016/j.jvacx.2023.100314] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction Despite a government-subsidized vaccination program, healthcare personnel (HCP) influenza vaccination uptake remains low in Peru. Using three years of cross-sectional surveys and an additional five years of prior vaccination history of HCP in Peru, we explored HCP knowledge, attitudes, and practices (KAP) of influenza illness and its impact on vaccination frequency. Methods In 2016, the Estudio Vacuna de Influenza Peru (VIP) cohort was initiated in Lima, Peru, which collected information about HCP KAP and influenza vaccination history from 2011─2018. HCP were classified by their 8-year influenza vaccination history as never (0 years), infrequently (1─4 years), or frequently (5─8 years) vaccinated. Logistic regression models were used to describe KAP associated with frequent compared to infrequent influenza vaccination, adjusted for each HCP's healthcare workplace, age, sex, preexisting medical conditions, occupation, and length of time providing direct patient care. Results From 2016─2018, 5131 HCP were recruited and 3120 fully enrolled in VIP; 2782 consistently reported influenza vaccination status and became our analytic sample. From 2011─2018, 14.3% of HCP never, 61.4% infrequently, and 24.4% frequently received influenza vaccines. Compared to HCP who were infrequently vaccinated, frequently vaccinated HCP were more likely to believe they were susceptible to influenza (adjusted odds ratio [aOR]:1.49, 95% confidence interval [CI]:1.22─1.82), perceived vaccination to be effective (aOR:1.92, 95%CI:1.59─2.32), were knowledgeable about influenza and vaccination (aOR:1.37, 95%CI:1.06─1.77), and believed vaccination had emotional benefits like reduced regret or anger if they became ill with influenza (aOR:1.96, 95%CI:1.60─2.42). HCP who reported vaccination barriers like not having time or a convenient place to receive vaccines had reduced odds of frequent vaccination (aOR:0.74, 95%CI:0.61─0.89) compared to those without reported barriers. Conclusion Few HCP frequently received influenza vaccines during an eight-year period. To increase HCP influenza vaccination in middle-income settings like Peru, campaigns could strengthen influenza risk perception, vaccine knowledge, and accessibility.
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Affiliation(s)
- Kelsey M. Sumner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lindsey M. Duca
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carmen Sofia Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joan Neyra
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Candice Romero
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Yeny Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Francisco Nogareda
- Consultant to the Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, USA
| | | | | | - Maria Castillo
- Hospital Nacional de Salud del Niño, Lima, Peru
- Medical School, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduar Bravo
- Medical School, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Castro
- Hospital Nacional Daniel Alcides Carrion, Lima, Peru
| | - Mark Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Lafond KE, Gharpure R, Dugan VG, Azziz-Baumgartner E. Estimating the full health and economic benefits of current and future influenza vaccines. BMC Med 2023; 21:273. [PMID: 37501176 PMCID: PMC10373290 DOI: 10.1186/s12916-023-02995-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
In the dynamic landscape of respiratory virus vaccines, it is crucial to assess the value of novel mRNA and combination influenza/COVID-19 vaccines in low- and middle-income countries. Modeling studies, such as the one conducted by Waterlow et al., provide vital information about the cost-benefit potential of these products compared to currently licensed vaccines. However, this approach only accounts for directly measured medically attended influenza-associated illnesses and has two major limitations. First, this method fails to capture the full disease burden of influenza (including non-respiratory and non-medically attended influenza illnesses), which are particularly important drivers of disease burden in infants and older adults. Second, the model does not describe the ancillary benefits of influenza vaccination such as the attenuation of severe disease, prevention of severe non-respiratory outcomes (e.g., myocardial infarctions), or reduced antibiotic use. To obtain a comprehensive understanding of the benefits of influenza vaccines, we must strive to improve the inputs for future modeling-based evaluations.
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Affiliation(s)
- K E Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA.
| | - R Gharpure
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA
| | - V G Dugan
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA
| | - E Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA
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15
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Biggs HM, Simões EAF, Abu Khader I, Thompson MG, Gordon A, Hunt DR, DeGroote NP, Porter RM, Bino S, Marar BI, Gresh L, de Jesus-Cornejo J, Langley G, Thornburg NJ, Peret TCT, Whitaker B, Zhang Y, Wang L, Patel MC, McMorrow M, Campbell W, Hasibra I, Duka E, Al-Gazo M, Kubale J, Sanchez F, Lucero MG, Tallo VL, Azziz-Baumgartner E, Simaku A, Gerber SI. Respiratory Syncytial Virus Infection among Hospitalized Infants in Four Middle-Income Countries. J Pediatric Infect Dis Soc 2023:piad042. [PMID: 37313727 DOI: 10.1093/jpids/piad042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Understanding respiratory syncytial virus (RSV) global epidemiology is important to inform future prevention strategies. METHODS Hospitalized infants <1-year-old with acute illness were enrolled prospectively in Albania, Jordan, Nicaragua, and Philippines during respiratory seasons in 2015-2017. Medical chart review, parental interview, and post-discharge follow up were conducted. Respiratory specimens were tested using real-time RT-PCR for RSV. Infant characteristics associated with very severe illness (intensive care unit [ICU] admission or receipt of supplemental oxygen) were assessed using logistic regression to adjust for potential confounders (age, sex, study site, preterm birth). RESULTS Of 3,634 enrolled hospitalized infants, 1,129 (31%) tested positive for RSV. The median age of RSV-positive infants was 2.7 (IQR: 1.4 to 6.1) months and 665 (59%) were male. Very severe illness in 583 (52%) RSV-positive infants was associated with younger age (aOR 4.1, 95% CI: 2.6-6.5 for 0-2 compared to 9-11-months; p<0.01), , low weight-for-age z-score (aOR 1.9, 95%CI: 1.2-2.8; p<0.01), ICU care after birth (aOR 1.6, 95%CI: 1.0-2.5; p=0.48), and cesarean delivery (aOR 1.4, 95% CI: 1.0-1.8; p=.03). RSV subgroups A and B co-circulated at all sites with alternating predominance by year; subgroup was not associated with severity (aOR 1.0, 95% CI: 0.8-1.4). Nine (0.8%) RSV-positive infants died during admission or within ≤30 days of discharge, of which 7 (78%) were <6-months-old. CONCLUSIONS RSV was associated with nearly a third of infant acute illness hospitalizations in four middle-income countries during the respiratory season, where, in addition to young age, factors including low weight-for-age might be important predictors of severity. RSV prevention strategies targeting young infants could substantially reduce RSV-associated hospitalizations in middle-income countries.
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Affiliation(s)
- Holly M Biggs
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric A F Simões
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ilham Abu Khader
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Mark G Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Nicholas P DeGroote
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Bino
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | | | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Joanne de Jesus-Cornejo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Gayle Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teresa C T Peret
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yange Zhang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lijuan Wang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mira C Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Iris Hasibra
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Enkeleda Duka
- Pediatric Department, Mother Theresa University Hospital Center, Tirana, Albania
| | - Mahmoud Al-Gazo
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Felix Sanchez
- Hospital Infantil Manuel de Jesus Rivera, Ministry of Health, Managua, Nicaragua
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Veronica L Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Artan Simaku
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nogareda F, Gharpure R, Contreras M, Velandia M, Lucia Pacis C, Elena Chevez A, Azziz-Baumgartner E, Salas D. Seasonal influenza vaccination in the Americas: Progress and challenges during the COVID-19 pandemic. Vaccine 2023:S0264-410X(23)00689-8. [PMID: 37328348 PMCID: PMC10247885 DOI: 10.1016/j.vaccine.2023.06.024] [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: 02/23/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Vaccination is one of the most effective measures to prevent influenza illness and its complications; influenza vaccination remained important during the COVID-19 pandemic to prevent additional burden on health systems strained by COVID-19 demand. OBJECTIVES We describe policies, coverage, and progress of seasonal influenza vaccination programs in the Americas during 2019-2021 and discuss challenges in monitoring and maintaining influenza vaccination coverage among target groups during the COVID-19 pandemic. METHODS We used data on influenza vaccination policies and vaccination coverage reported by countries/territories via the electronic Joint Reporting Form on Immunization (eJRF) for 2019-2021. We also summarized country vaccination strategies shared with PAHO. RESULTS As of 2021, 39 (89 %) out of 44 reporting countries/territories in the Americas had policies for seasonal influenza vaccination. Countries/territories adapted health services and immunization delivery strategies using innovative approaches, such as new vaccination sites and expanded schedules, to ensure continuation of influenza vaccination during the COVID-19 pandemic. However, among countries/territories that reported data to eJRF in both 2019 and 2021, median coverage decreased; the percentage point decrease was 21 % (IQR = 0-38 %; n = 13) for healthcare workers, 10 % (IQR = -1.5-38 %; n = 12) for older adults, 21 % (IQR = 5-31 %; n = 13) for pregnant women, 13 % (IQR = 4.8-20.8 %; n = 8) for persons with chronic diseases, and 9 % (IQR = 3-27 %; n = 15) for children. CONCLUSIONS Countries/territories in the Americas successfully adapted influenza vaccination delivery to continue vaccination services during the COVID-19 pandemic; however, reported influenza vaccination coverage decreased from 2019 to 2021. Reversing declines in vaccination will necessitate strategic approaches that prioritize sustainable vaccination programs across the life course. Efforts should be made to improve the completeness and quality of administrative coverage data. Lessons learned from COVID-19 vaccination, such as the rapid development of electronic vaccination registries and digital certificates, might facilitate advances in coverage estimation.
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Affiliation(s)
- Francisco Nogareda
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA.
| | - Radhika Gharpure
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcela Contreras
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Martha Velandia
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Carmelita Lucia Pacis
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Ana Elena Chevez
- Pan American Health Organization, Revolving Fund, Washington, DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
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17
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Rojop N, Calvimontes DM, Barrios E, Lamb MM, Paniagua-Avila A, Monzon J, Duca LM, Iwamoto C, Chard AN, Gomez M, Arias K, Roell Y, Bolanos GA, Zielinski-Gutierrez E, Azziz-Baumgartner E, Lopez MR, Cordon-Rosales C, Asturias EJ, Olson D. COVID-19 Attitudes and Vaccine Hesitancy among an Agricultural Community in Southwest Guatemala: A Cross-Sectional Survey. Vaccines (Basel) 2023; 11:1059. [PMID: 37376448 DOI: 10.3390/vaccines11061059] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Despite offering free-of-charge COVID-19 vaccines starting July 2021, Guatemala has one of the lowest vaccination rates in Latin America. From 28 September 2021 to 11 April 2022, we conducted a cross-sectional survey of community members, adapting a CDC questionnaire to evaluate COVID-19 vaccine access and hesitancy. Of 233 participants ≥ 12 years, 127 (55%) received ≥1 dose of COVID-19 and 4 (2%) reported prior COVID-19 illness. Persons ≥ 12 years old who were unvaccinated (n = 106) were more likely to be female (73% vs. 41%, p < 0.001) and homemakers (69% vs. 24%, p < 0.01) compared with vaccinated participants (n = 127). Among those ≥18 years, the main reported motivation for vaccination among vaccinated participants was to protect the health of family/friends (101/117, 86%); on the other hand, 40 (55%) unvaccinated persons reported little/no confidence in public health institutions recommending COVID-19 vaccination. Community- and/or home-based vaccination programs, including vaccination of families through the workplace, may better reach female homemakers and reduce inequities and hesitancy.
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Affiliation(s)
- Neudy Rojop
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
| | - Diva M Calvimontes
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Edgar Barrios
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
| | - Molly M Lamb
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Alejandra Paniagua-Avila
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 11032, USA
| | - Jose Monzon
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
| | - Lindsey M Duca
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
| | - Chelsea Iwamoto
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
| | - Anna N Chard
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
| | - Melissa Gomez
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
| | - Kareen Arias
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
| | - Yannik Roell
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Guillermo Antonio Bolanos
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
| | | | | | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Edwin J Asturias
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Daniel Olson
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu 11010, Guatemala
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
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18
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Igboh LS, Roguski K, Marcenac P, Emukule GO, Charles MD, Tempia S, Herring B, Vandemaele K, Moen A, Olsen SJ, Wentworth DE, Kondor R, Mott JA, Hirve S, Bresee JS, Mangtani P, Nguipdop-Djomo P, Azziz-Baumgartner E. Timing of seasonal influenza epidemics for 25 countries in Africa during 2010-19: a retrospective analysis. Lancet Glob Health 2023; 11:e729-e739. [PMID: 37061311 PMCID: PMC10126228 DOI: 10.1016/s2214-109x(23)00109-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 07/24/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Using country-specific surveillance data to describe influenza epidemic activity could inform decisions on the timing of influenza vaccination. We analysed surveillance data from African countries to characterise the timing of seasonal influenza epidemics to inform national vaccination strategies. METHODS We used publicly available sentinel data from African countries reporting to the WHO Global Influenza Surveillance and Response FluNet platform that had 3-10 years of data collected during 2010-19. We calculated a 3-week moving proportion of samples positive for influenza virus and assessed epidemic timing using an aggregate average method. The start and end of each epidemic were defined as the first week when the proportion of positive samples exceeded or went below the annual mean, respectively, for at least 3 consecutive weeks. We categorised countries into five epidemic patterns: northern hemisphere-dominant, with epidemics occurring in October-March; southern hemisphere-dominant, with epidemics occurring in April-September; primarily northern hemisphere with some epidemic activity in southern hemisphere months; primarily southern hemisphere with some epidemic activity in northern hemisphere months; and year-round influenza transmission without a discernible northern hemisphere or southern hemisphere predominance (no clear pattern). FINDINGS Of the 34 countries reporting data to FluNet, 25 had at least 3 years of data, representing 46% of the countries in Africa and 89% of Africa's population. Study countries reported RT-PCR respiratory virus results for a total of 503 609 specimens (median 12 971 [IQR 9607-20 960] per country-year), of which 74 001 (15%; median 2078 [IQR 1087-3008] per country-year) were positive for influenza viruses. 248 epidemics occurred across 236 country-years of data (median 10 [range 7-10] per country). Six (24%) countries had a northern hemisphere pattern (Algeria, Burkina Faso, Egypt, Morocco, Niger, and Tunisia). Eight (32%) had a primarily northern hemisphere pattern with some southern hemisphere epidemics (Cameroon, Ethiopia, Mali, Mozambique, Nigeria, Senegal, Tanzania, and Togo). Three (12%) had a primarily southern hemisphere pattern with some northern hemisphere epidemics (Ghana, Kenya, and Uganda). Three (12%) had a southern hemisphere pattern (Central African Republic, South Africa, and Zambia). Five (20%) had no clear pattern (Côte d'Ivoire, DR Congo, Madagascar, Mauritius, and Rwanda). INTERPRETATION Most countries had identifiable influenza epidemic periods that could be used to inform authorities of non-seasonal and seasonal influenza activity, guide vaccine timing, and promote timely interventions. FUNDING None. TRANSLATIONS For the Berber, Luganda, Xhosa, Chewa, Yoruba, Igbo, Hausa and Afan Oromo translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ledor S Igboh
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Immunization Systems Branch, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Katherine Roguski
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Perrine Marcenac
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Myrna D Charles
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefano Tempia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Belinda Herring
- World Health Organization-Regional Office for Africa, Brazzaville, Congo
| | - Katelijn Vandemaele
- Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Ann Moen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sonja J Olsen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David E Wentworth
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Kondor
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Josh A Mott
- Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Siddhivinayak Hirve
- Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | | | - Punam Mangtani
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Nguipdop-Djomo
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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19
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Groom HC, Crawford P, Azziz-Baumgartner E, Henninger ML, Smith N, Salas B, Donald J, Naleway AL. Care trajectories for patients utilizing electronic visits for COVID-like symptoms in a large healthcare delivery system: May 2020-December 2021. J Telemed Telecare 2023:1357633X231162874. [PMID: 36945878 DOI: 10.1177/1357633x231162874] [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] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is limited information about how on-line screening tools developed by integrated systems facilitated management of COVID-like illness patients. METHODS Using the Kaiser Permanente Northwest (KPNW) Electronic Health Record, we identified adult plan members who accessed online COVID-19 screening e-visits and enumerated their subsequent medical encounters, tests for SARS-CoV-2, and test outcomes. RESULTS Between May 2020 and December 2021, members completed 55,139 e-visits, with disproportionate representation among females (65% vs. 53% in the overall membership) and members aged <45 years (61% vs. 39%). Thirty percent of patients (16,953) were managed entirely through e-visits and 70% received subsequent in-person care. The percent of SARS-CoV-2 positive individuals was highest among the 1055 individuals triaged to inpatient care (17.9%), compared to 9.5% among those escalated to additional ambulatory care. CONCLUSIONS The e-visit on-line screening tool helped KPNW assist thousands of patients with COVID-19 symptoms, avoid unnecessary in-person patient encounters, and preserved KPNW infection control and pandemic surge capacity.
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Affiliation(s)
- Holly C Groom
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Phil Crawford
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Eduardo Azziz-Baumgartner
- 1242Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Michelle L Henninger
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Bianca Salas
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Judy Donald
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Allison L Naleway
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
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20
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Owusu D, Dawood FS, Azziz-Baumgartner E, Tinoco Y, Soto G, Gonzalez O, Cabrera S, Florian R, Llajaruna E, Hunt DR, Wesley MG, Yau T, Arriola CS. Effectiveness of Maternal Influenza Vaccination in Peru PRIME Cohort. Open Forum Infect Dis 2023; 10:ofad033. [PMID: 36817741 PMCID: PMC9927556 DOI: 10.1093/ofid/ofad033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Background Few studies have examined influenza vaccine effectiveness (VE) among women during pregnancy in middle-income countries. We used data from a prospective cohort of women who were pregnant in Peru to estimate effectiveness of the 2018 Southern Hemisphere influenza vaccine. Methods Women at <28 weeks gestation were enrolled from 4 tertiary level hospitals in Lima, Peru at the start of the 2018 influenza season and followed until the end of their pregnancies. Participants had mid-turbinate nasal swabs collected and tested for influenza by reverse-transcription polymerase chain reaction (RT-PCR) with onset of ≥1 of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing. Time-varying Cox proportional hazard regression models were used to estimate the risk of RT-PCR-confirmed influenza infection after adjusting for inverse probability treatment weight. Results We followed 1896 women for a median of 127 days (interquartile range [IQR], 86-174). Participants had a median age of 29 years (IQR, 24-34). Among the 1896 women, 49% were vaccinated with the 2018 influenza vaccine and 1039 (55%) developed influenza-like illness, 76 (7%) of whom had RT-PCR-confirmed influenza. Incidence rates of RT-PCR-confirmed influenza were 36.6 and 15.3 per 100 000 person-days among women who were unvaccinated and vaccinated, respectively. Adjusted influenza VE was 22% (95% confidence interval, -64.1% to 62.9%). Conclusions Participants vaccinated against influenza had more than 50% lower incidence of RT-PCR-confirmed influenza illness. Although the VE estimated through propensity weight-adjusted time-varying Cox regression did not reach statistical significance, our findings provide additional evidence about the value of maternal influenza vaccination in middle-income countries.
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Affiliation(s)
- Daniel Owusu
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Yeny Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | | | | | | | | | | | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Abt Associates, Inc., Atlanta, Georgia, USA
| | - Tat Yau
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carmen S Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Regan AK, Arriola CS, Couto P, Duca L, Loayza S, Nogareda F, de Almeida WAF, Antman J, Araya S, Avendaño Vigueras MA, Battaglia Paredes SC, Brstilo IF, Bustos P, Fandiño ME, Fasce R, Giovacchini CM, González Caro CI, von Horoch M, Del Valle Juarez M, Katz N, Olivares MF, da Silva DA, da Silva ET, Sotomayor V, Vergara N, Azziz-Baumgartner E, Ropero AM. Severity of influenza illness by seasonal influenza vaccination status among hospitalised patients in four South American countries, 2013-19: a surveillance-based cohort study. Lancet Infect Dis 2023; 23:222-232. [PMID: 36206790 PMCID: PMC9876808 DOI: 10.1016/s1473-3099(22)00493-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although several studies have reported attenuated influenza illness following influenza vaccination, results have been inconsistent and have focused predominantly on adults in the USA. This study aimed to evaluate the severity of influenza illness by vaccination status in a broad range of influenza vaccine target groups across multiple South American countries. METHODS We analysed data from four South American countries (Argentina, Brazil, Chile, and Paraguay) participating in REVELAC-i, a multicentre, test-negative design, vaccine effectiveness network including 41 sentinel hospitals. Individuals hospitalised at one of these centres with severe acute respiratory infection were tested for influenza by real-time RT-PCR, and were included in the analysis if they had complete information about their vaccination status and outcomes of their hospital stay. We used multivariable logistic regression weighted by inverse probability of vaccination and adjusted for antiviral use, duration of illness before admission, and calendar week, to calculate the adjusted odds ratios (aORs) of intensive care unit (ICU) admission and in-hospital death (and combinations of these outcomes) among influenza-positive patients by vaccination status for three target groups: young children (aged 6-24 months), adults (aged 18-64 years) with pre-existing health conditions, and older adults (aged ≥65 years). Survival curves were used to compare length of hospital stay by vaccination status in each target group. FINDINGS 2747 patients hospitalised with PCR-confirmed influenza virus infection between Jan 1, 2013, and Dec 8, 2019, were included in the study: 649 children (70 [10·8%] fully vaccinated, 193 [29·7%] partially vaccinated) of whom 87 (13·4%) were admitted to ICU and 12 (1·8%) died in hospital; 520 adults with pre-existing medical conditions (118 [22·7%] vaccinated), of whom 139 (26·7%) were admitted to ICU and 55 (10·6%) died in hospital; and 1578 older adults (609 [38·6%] vaccinated), of whom 271 (17·2%) were admitted to ICU and 220 (13·9%) died in hospital. We observed earlier discharge among partially vaccinated children (adjusted hazard ratio 1·14 [95% CI 1·01-1·29]), fully vaccinated children (1·24 [1·04-1·47]), and vaccinated adults with pre-existing medical conditions (1·78 [1·18-2·69]) compared with their unvaccinated counterparts, but not among vaccinated older adults (0·82 [0·65-1·04]). Compared with unvaccinated individuals, lower odds of ICU admission were found for partially vaccinated children (aOR 0·64 [95% CI 0·44-0·92]) and fully vaccinated children (0·52 [0·28-0·98]), but not for adults with pre-existing conditions (1·25 [0·93-1·67]) or older adults (0·88 [0·72-1·08]). Lower odds of in-hospital death (0·62 [0·50-0·78]) were found in vaccinated versus unvaccinated older adults, with or without ICU admission, but did not differ significantly in partially vaccinated (1·35 [0·57-3·20]) or fully vaccinated young children (0·88 [0·16-4·82]) or adults with pre-existing medical conditions (1·09 [0·73-1·63]) compared with the respective unvaccinated patient groups. INTERPRETATION Influenza vaccination was associated with illness attenuation among those hospitalised with influenza, although results differed by vaccine target group. These findings might suggest that attenuation of disease severity might be specific to certain target groups, seasons, or settings. FUNDING US Centers for Disease Control and Prevention. TRANSLATIONS For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, Orange, CA, USA; Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | - Carmen Sofia Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paula Couto
- Health Emergencies Program, Pan American Health Organization, Washington, DC, USA
| | - Lindsey Duca
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sergio Loayza
- Department of Family, Health Promotion, and Life Course, Pan American Health Organization, Washington, DC, USA
| | - Francisco Nogareda
- Department of Family, Health Promotion, and Life Course, Pan American Health Organization, Washington, DC, USA
| | | | - Julian Antman
- Surveillance Area, Directorate of Epidemiology, Ministry of Health, Buenos Aires, Argentina; Consultant to The Task Force for Global Health, Decatur, GA, USA
| | - Soraya Araya
- Expanded Program on Immunizations, Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | | | | | | | - Patricia Bustos
- Public Health Institute, Ministry of Health, Santiago, Chile
| | - Maria Eugenia Fandiño
- Surveillance Area, Directorate of Epidemiology, Ministry of Health, Buenos Aires, Argentina
| | - Rodrigo Fasce
- Public Health Institute, Ministry of Health, Santiago, Chile
| | | | | | - Marta von Horoch
- General Directorate of Health Surveillance, Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Maria Del Valle Juarez
- Directorate for the Control of Immunopreventable Diseases, Ministry of Health, Buenos Aires, Argentina
| | - Nathalia Katz
- Directorate for the Control of Immunopreventable Diseases, Ministry of Health, Buenos Aires, Argentina
| | | | | | | | | | - Natalia Vergara
- Department of Epidemiology, Ministry of Health, Santiago, Chile
| | | | - Alba Maria Ropero
- Department of Family, Health Promotion, and Life Course, Pan American Health Organization, Washington, DC, USA
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22
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Wagner AL, Sanchez N, Kubale J, Kuan G, Gresh L, Lopez R, Ojeda S, Azziz-Baumgartner E, Balmaseda A, Gordon A. Single-Dose Vaccination Among Infants and Toddlers Provides Modest Protection Against Influenza Illness, Which Wanes After 5 Months. J Infect Dis 2022; 227:87-91. [PMID: 35796722 DOI: 10.1093/infdis/jiac288] [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: 03/21/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 01/19/2023] Open
Abstract
In their first season of vaccination, young children are recommended 2 doses of influenza vaccine, but a 2-dose schedule might be difficult to implement in many countries. Within a cohort study of 742 children aged 6 to <24 months in Managua, Nicaragua, this study estimated effectiveness of partial vaccination from 3 to 9 months postvaccination. Vaccine effectiveness was 74% (95% confidence interval [CI], 24%-91%) within 3 months and 55% (95% CI, 10%-77%) within 4 months. There was not significant protection beyond 5 months. Partial vaccination might confer some benefits but should be followed by a second dose.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Guillermina Kuan
- Sustainable Sciences Institute, Managua, Nicaragua.,Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Roger Lopez
- Sustainable Sciences Institute, Managua, Nicaragua.,Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua.,Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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23
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Zhang Y, Romieu-Hernandez A, Boehmer TK, Azziz-Baumgartner E, Carton TW, Gundlapalli AV, Fearrington J, Nagavedu K, Dea K, Moyneur E, Cowell LG, Kaushal R, Mayer KH, Puro J, Rasmussen SA, Thacker D, Weiner MG, Saydeh S, Block JP. Association between SARS-CoV-2 Infection and Select Symptoms and Conditions 31 to 150 Days After Testing among Children and Adults. medRxiv 2022:2022.12.18.22283646. [PMID: 36597540 PMCID: PMC9810226 DOI: 10.1101/2022.12.18.22283646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31 to 150 days following a SARS-CoV-2 test among adults (≥20 years) and children (<20 years) with positive and negative test results documented in the electronic health records (EHRs) of institutions participating in PCORnet, the National Patient-Centered Clinical Research Network. Methods and Findings This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test (nucleic acid amplification or rapid antigen) during March 1, 2020-May 31, 2021 documented in their EHR. We identified hospitalization status in the day prior through the 16 days following the SARS-CoV-2 test as a proxy for the severity of COVID-19. We used logistic regression to calculate the odds of receiving a diagnostic code for each symptom outcome and Cox proportional hazard models to calculate the risk of being newly diagnosed with each condition outcome, comparing those with a SARS-CoV-2 positive test to those with a negative test. After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11-1.23]; children: aOR, 1.18[95% CI, 1.08-1.28]) and shortness of breath (adults: aOR, 1.50[95% CI, 1.38-1.63]; children: aOR, 1.40[95% CI, 1.15-1.70]) 31-150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥3 symptoms (aOR, 1.16[95% CI, 1.08 - 1.26]) and fatigue (aOR, 1.12[95% CI, 1.05 - 1.18]) compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (aHR, 1.25[95% CI, 1.17-1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11-1.28]), and respiratory disease (aHR, 1.44[95% CI, 1.30-1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive SARS-CoV-2 test had higher odds of being diagnosed with fatigue (aOR, 1.11[95% CI, 1.05-1.16]) and shortness of breath (aOR, 1.22[95% CI, 1.15-1.29]), and had an increased risk (aHR, 1.12[95% CI, 1.02-1.23]) of being newly diagnosed with hematologic disorders (i.e., venous thromboembolism and pulmonary embolism) 31-150 days following SARS-CoV-2 test compared with those testing negative. The risk of being newly diagnosed with certain conditions, such as mental health conditions and neurological disorders, was lower among patients with a positive viral test relative to those with a negative viral test. Conclusions Patients with SARS-CoV-2 infection were at higher risk of being diagnosed with certain symptoms and conditions, particularly fatigue, respiratory symptoms, and hematological abnormalities, after acute infection. The risk was highest among adults hospitalized after SARS-CoV-2 infection.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States of America
| | - Alfonso Romieu-Hernandez
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tegan K. Boehmer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas W. Carton
- Louisiana Public Health Institute, New Orleans, Louisiana, United States of America
| | - Adi V. Gundlapalli
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julia Fearrington
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Lindsey G. Cowell
- Peter O-Donnell Jr. School of Public Health, Department of Immunology, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States of America
| | - Kenneth H. Mayer
- Fenway Institute, Fenway Health, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jon Puro
- OCHIN, Inc., Portland, Oregon, United States of America
| | - Sonja A. Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children’s Health, Wilmington, Delaware, United States of America
| | - Mark G. Weiner
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States of America
| | - Sharon Saydeh
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jason P. Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, United States of America
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24
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Olson D, Calvimontes DM, Lamb M, Lesteberg K, Barrios E, Rojop N, Chard A, Iwamoto C, Duca L, Carlos Monzon J, Arias K, Gomez M, Paiz C, Azziz-Baumgartner E, Gutierrez EZ, Mansour H, Kathryn E, Newman LS, Beckham D, Santiago M, Asturias EJ. 1039. Clinical and Economic Impact of COVID-19 and Serologic Protection among Farm Workers: Results from the Guatemala Agricultural Workers and Respiratory Illness Impact (AGRI) Study. Open Forum Infect Dis 2022. [PMCID: PMC9752386 DOI: 10.1093/ofid/ofac492.880] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background In the Guatemala AGricultural workers and Respiratory Impact (AGRI) study, we evaluated the clinical and socioeconomic burdens of respiratory disease in a cohort of Guatemalan banana farm workers. Methods All eligible workers were offered enrollment from June 15–December 30, 2020, and annually, then followed for influenza-like illnesses (ILI) through: 1) self-reporting to study nurses, 2) sentinel surveillance at health posts, and 3) absenteeism. Workers with ILI submitted nasopharyngeal swabs for influenza, RSV, and SARS-CoV-2 testing, then completed surveys at days 0, 7, and 28. Enrollment and acute-illness serum samples were tested for anti-SARS-CoV-2 nucleocapsid IgG (anti-N, Roche Elecsys®), and neutralizing antibodies (NAb) were tested in a subset using a lentivirus-based pseudovirion assay. Results Through October 10, 2021, 1,833 workers were enrolled. The majority were male (84%), young (mean 31 years), and healthy (< 13% had comorbidity). Through October 10, 2021, 1,833 workers developed 169 ILIs (12.0/100 person-years) and 43 (25.4%) of these ILIs were laboratory-confirmed SARS-CoV-2 (3.1/100 person-years). Workers with SARS-CoV-2-positive ILI reported more anosmia (p< 0.01), dysgeusia (p< 0.01), difficulty concentrating (p=0.01), and irritability (p=0.01), and greater clinical and well-being severity scores (Flu-iiQ) than test-negative ILIs (Fig 1); they also had greater absenteeism (p< 0.01) and lost income (median US$127.1, p< 0.01). Among 1334 workers enrolled in 2020, 616 (46.2%) had anti-N IgG suggestive of prior SARS-CoV-2 infection. COVID-19 incidence density for IgG-seropositive workers was 0.4/100 Person – Years (P – Y), lower than those who were seronegative (2.3/100 P – Y) (Fig 2). At enrollment, anti-N IgG titers in serum correlated with neutralizing antibody titers (R2=0.26, p< 0.0001). Notably, in < 6 months from enrollment, most workers with follow-up NAb testing (65/77, 84%) exhibited a 95% decrease in neutralizing antibody titers. Conclusion Guatemalan farm workers suffered a significant burden of COVID-19, including more severe clinical and economic outcomes than other respiratory illnesses. Ongoing vaccination programs and longitudinal serology will provide additional insight into long-term immunity. Disclosures Daniel Olson, MD, Pfizer: Grant/Research Support|Roche: Grant/Research Support Diva M Calvimontes, MD, Pfizer: Grant/Research Support Molly Lamb, PhD, Pfizer: Grant/Research Support Edwards Kathryn, MD, Bionet: Advisor/Consultant|IBM: Advisor/Consultant|Merck: Data Monitoring Committee|Moderna: Data Monitoring Committee|Pfizer: Data Monitoring Committee|Roche: Data Monitoring Committee|Sanofi: Data Monitoring Committee|Seqirus: Data Monitoring Committee|X-4 Pharma: Data Monitoring Committee Edwin J. Asturias, MD, Curevac: DSMB Member|Fundacion para la Salud Integral de los Guatemaltecos: Board Member|Inovio: DSMB Member|Merck: Honoraria|Pfizer: Grant/Research Support.
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Affiliation(s)
| | | | - Molly Lamb
- Colorado School of Public Health, Aurora, Colorado
| | | | - Edgar Barrios
- Fundacion Para La Salud Integral de los Guatemaltecos, Los Encuentros, Retalhuleu, Guatemala
| | - Neudy Rojop
- Fundacion Para La Salud Integral de los Guatemaltecos, Los Encuentros, Retalhuleu, Guatemala
| | - Anna Chard
- Center for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lindsey Duca
- Center for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kareen Arias
- Fundacion Para La Salud Integral de los guatemaltecos, Los Encuentros, Retalhuleu, Guatemala
| | - Melissa Gomez
- Fundacion Para La Salud Integr, Los Encuentros, Retalhuleu, Guatemala
| | - Claudia Paiz
- Fundacion Para La Salud Integral de los Guatemaltecos, Los Encuentros, Retalhuleu, Guatemala
| | | | | | - Hani Mansour
- University of Colorado - Denver, Denver, Colorado
| | | | - Lee S Newman
- Colorado School of Public Health, Aurora, Colorado
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25
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Marcenac P, McCarron M, Davis W, Igboh LS, Mott JA, Lafond KE, Zhou W, Sorrells M, Charles MD, Gould P, Arriola CS, Veguilla V, Guthrie E, Dugan VG, Kondor R, Gogstad E, Uyeki TM, Olsen SJ, Emukule GO, Saha S, Greene C, Bresee JS, Barnes J, Wentworth DE, Fry AM, Jernigan DB, Azziz-Baumgartner E. Leveraging International Influenza Surveillance Systems and Programs during the COVID-19 Pandemic. Emerg Infect Dis 2022; 28:S26-S33. [PMID: 36502434 DOI: 10.3201/eid2813.212248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A network of global respiratory disease surveillance systems and partnerships has been built over decades as a direct response to the persistent threat of seasonal, zoonotic, and pandemic influenza. These efforts have been spearheaded by the World Health Organization, country ministries of health, the US Centers for Disease Control and Prevention, nongovernmental organizations, academic groups, and others. During the COVID-19 pandemic, the US Centers for Disease Control and Prevention worked closely with ministries of health in partner countries and the World Health Organization to leverage influenza surveillance systems and programs to respond to SARS-CoV-2 transmission. Countries used existing surveillance systems for severe acute respiratory infection and influenza-like illness, respiratory virus laboratory resources, pandemic influenza preparedness plans, and ongoing population-based influenza studies to track, study, and respond to SARS-CoV-2 infections. The incorporation of COVID-19 surveillance into existing influenza sentinel surveillance systems can support continued global surveillance for respiratory viruses with pandemic potential.
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26
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Barraza MFO, Fasce RA, Nogareda F, Marcenac P, Mallegas NV, Alister PB, Loayza S, Chard AN, Arriola CS, Couto P, Calavaro CG, Rodriguez A, Wentworth DE, Cuadrado C, Azziz-Baumgartner E. Influenza incidence and vaccine effectiveness during the Southern Hemisphere Influenza season-Chile, 2022. Am J Transplant 2022; 22:3170-3174. [PMID: 36458704 PMCID: PMC9834235 DOI: 10.1111/ajt.16685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
| | - Rodrigo A. Fasce
- Virology Department, Public Health Institute of Chile, Santiago, Chile,Correspondence Rodrigo A. Fasce, Virology Department, Public Health Institute of Chile, Santiago, Chile.
| | | | - Perrine Marcenac
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | | | | | - Sergio Loayza
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Anna N. Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Carmen Sofia Arriola
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Paula Couto
- Pan American Health Organization, Washington, District of Columbia, USA
| | | | - Angel Rodriguez
- Pan American Health Organization, Washington, District of Columbia, USA
| | - David E. Wentworth
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | | | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
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27
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Arriola CS, Soto G, Westercamp M, Bollinger S, Espinoza A, Grogl M, Llanos-Cuentas A, Matos E, Romero C, Silva M, Smith R, Olson N, Prouty M, Azziz-Baumgartner E, Lessa FC. Effectiveness of Whole-Virus COVID-19 Vaccine among Healthcare Personnel, Lima, Peru. Emerg Infect Dis 2022; 28:S238-S243. [PMID: 36502444 DOI: 10.3201/eid2813.212477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In February 2021, Peru launched a COVID-19 vaccination campaign among healthcare personnel using an inactivated whole-virus vaccine. The manufacturer recommended 2 vaccine doses 21 days apart. We evaluated vaccine effectiveness among an existing multiyear influenza vaccine cohort at 2 hospitals in Lima. We analyzed data on 290 participants followed during February-May 2021. Participants completed a baseline questionnaire and provided weekly self-collected nasal swab samples; samples were tested by real-time reverse transcription PCR. Median participant follow-up was 2 (range 1-11) weeks. We performed multivariable logistic regression and adjusted for preselected characteristics. During the study, 25 (9%) participants tested SARS-CoV-2-positive. We estimated adjusted vaccine effectiveness at 95% (95% CI 70%-99%) among fully vaccinated participants and 100% (95% CI 88%-100%) among partially vaccinated participants. These data can inform the use and acceptance of inactivated whole-virus vaccine and support vaccination efforts in the region.
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28
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Olson D, Calvimontes DM, Lamb MM, Guzman G, Barrios E, Chacon A, Rojop N, Arias K, Gomez M, Bolanos GA, Monzon J, Chard AN, Iwamoto C, Duca LM, Vuong N, Fineman M, Lesteberg K, Beckham D, Santiago ML, Quicke K, Ebel G, Gutierrez EZ, Azziz-Baumgartner E, Hayden FG, Mansour H, Edwards K, Newman LS, Asturias EJ. Clinical and Economic Impact of COVID-19 on Agricultural Workers, Guatemala 1. Emerg Infect Dis 2022; 28:S277-S287. [PMID: 36502430 DOI: 10.3201/eid2813.212303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We evaluated clinical and socioeconomic burdens of respiratory disease in banana farm workers in Guatemala. We offered all eligible workers enrollment during June 15-December 30, 2020, and annually, then tracked them for influenza-like illnesses (ILI) through self-reporting to study nurses, sentinel surveillance at health posts, and absenteeism. Workers who had ILI submitted nasopharyngeal swab specimens for testing for influenza virus, respiratory syncytial virus, and SARS-CoV-2, then completed surveys at days 0, 7, and 28. Through October 10, 2021, a total of 1,833 workers reported 169 ILIs (12.0 cases/100 person-years), and 43 (25.4%) were laboratory-confirmed infections with SARS-CoV-2 (3.1 cases/100 person-years). Workers who had SARS-CoV-2‒positive ILIs reported more frequent anosmia, dysgeusia, difficulty concentrating, and irritability and worse clinical and well-being severity scores than workers who had test result‒negative ILIs. Workers who had positive results also had greater absenteeism and lost income. These results support prioritization of farm workers in Guatemala for COVID-19 vaccination.
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29
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Olivares Barraza MF, Fasce RA, Nogareda F, Marcenac P, Vergara Mallegas N, Bustos Alister P, Loayza S, Chard AN, Arriola CS, Couto P, García Calavaro C, Rodriguez A, Wentworth DE, Cuadrado C, Azziz-Baumgartner E. Influenza Incidence and Vaccine Effectiveness During the Southern Hemisphere Influenza Season - Chile, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1353-1358. [PMID: 36301733 PMCID: PMC9620570 DOI: 10.15585/mmwr.mm7143a1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has affected influenza virus transmission, with historically low activity, atypical timing, or altered duration of influenza seasons during 2020-22 (1,2). Community mitigation measures implemented since 2020, including physical distancing and face mask use, have, in part, been credited for low influenza detections globally during the pandemic, compared with those during prepandemic seasons (1). Reduced population exposure to natural influenza infections during 2020-21 and relaxed community mitigation measures after introduction of COVID-19 vaccines could increase the possibility of severe influenza epidemics. Partners in Chile and the United States assessed Southern Hemisphere influenza activity and estimated age-group-specific rates of influenza-attributable hospitalizations and vaccine effectiveness (VE) in Chile in 2022. Chile's most recent influenza season began in January 2022, which was earlier than during prepandemic seasons and was associated predominantly with influenza A(H3N2) virus, clade 3C.2a1b.2a.2. The cumulative incidence of influenza-attributable pneumonia and influenza (P&I) hospitalizations was 5.1 per 100,000 person-years during 2022, which was higher than that during 2020-21 but lower than incidence during the 2017-19 influenza seasons. Adjusted VE against influenza A(H3N2)-associated hospitalization was 49%. These findings indicate that influenza activity continues to be disrupted after emergence of SARS-CoV-2 in 2020. Northern Hemisphere countries might benefit from preparing for an atypical influenza season, which could include early influenza activity with potentially severe disease during the 2022-23 season, especially in the absence of prevention measures, including vaccination. Health authorities should encourage all eligible persons to seek influenza vaccination and take precautions to reduce transmission of influenza (e.g., avoiding close contact with persons who are ill).
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30
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Lewis EL, Smoots AN, Woodworth KR, Olsen EO, Roth NM, Yazdy M, Shephard H, Sizemore L, Wingate H, Dzimira P, Reynolds B, Lush M, Fuchs EL, Ojo K, Siebman S, Hall AJ, Azziz-Baumgartner E, Perrine C, Hsia J, Ellington S, Tong VT, Gilboa SM. Breast Milk Feeding of Infants at Birth Among People With Confirmed SARS-CoV-2 Infection in Pregnancy: SET-NET, 5 States, March 29, 2020-December 31, 2020. Am J Public Health 2022; 112:S787-S796. [PMID: 36288521 PMCID: PMC9612185 DOI: 10.2105/ajph.2022.307023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/01/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To describe prevalence of breast milk feeding among people with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and examine associations between breast milk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods. We performed a retrospective cohort study using data from Massachusetts, Minnesota, Nebraska, Pennsylvania, and Tennessee of whether people with confirmed SARS-CoV-2 infection during pregnancy in 2020 initiated breast milk feeding at birth. Results. Among 11 114 (weighted number) people with SARS-CoV-2 infection in pregnancy, 86.5% (95% confidence interval [CI] = 82.4%, 87.6%) initiated breast milk feeding during birth hospitalization. People with infection within 14 days before delivery had significantly lower prevalence of breast milk feeding (adjusted prevalence ratio [APR] = 0.88; 95% CI = 0.83, 0.94) than did those with infection at least 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breast milk feeding remained only among infants who did not room in with their mother (APR = 0.77; 95% CI = 0.68, 0.88). Conclusions. Pregnant and postpartum people with SARS-CoV-2 infection should have access to lactation support and be advised about the importance of breast milk feeding and how to safely feed their infants in the same room. (Am J Public Health. 2022;112(S8):S787-S796. https://doi.org/10.2105/AJPH.2022.307023).
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Affiliation(s)
- Elizabeth L Lewis
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Ashley N Smoots
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kate R Woodworth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Emily O'Malley Olsen
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Nicole M Roth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mahsa Yazdy
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Hanna Shephard
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Lindsey Sizemore
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Heather Wingate
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Paula Dzimira
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Bethany Reynolds
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mamie Lush
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Erika L Fuchs
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kristen Ojo
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sam Siebman
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Aron J Hall
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Eduardo Azziz-Baumgartner
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Cria Perrine
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Jason Hsia
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sascha Ellington
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Van T Tong
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Suzanne M Gilboa
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
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Azziz-Baumgartner E, Duca LM, González R, Calvo A, Kaydos-Daniels SC, Olson N, MacNeil A, Veguilla V, Domínguez R, Vicari A, Rauda R, Vuong N, Ropero AM, Armero J, Porter R, Franco D, Pascale JM. Incidence of respiratory virus illness and hospitalizations in a Panama and El Salvador birth cohort, 2014-2018. Lancet Reg Health Am 2022; 13:None. [PMID: 36189114 PMCID: PMC9485193 DOI: 10.1016/j.lana.2022.100304] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Respiratory viruses remain a key cause of early childhood illness, hospitalization, and death globally.The recent pandemic has rekindled interest in the control of respiratory viruses among paediatric populations. We estimate the burden of such viruses among children <2 years. Methods Enrolled neonates were followed until two years of age. Weekly active symptom monitoring for the development of acute respiratory illnesses (ARI) defined as cough, rhinorrhoea, difficulty breathing, asthenia, anorexia, irritability, or vomiting was conducted. When the child had ARI and fever, nasopharyngeal swabbing was performed, and samples were tested through singleplex RT-PCR. Incidence of respiratory viruses was calculated by dividing the number of laboratory-confirmed detections by the person-time accrued during weeks when that virus was detectable through national surveillance then corrected for under-ascertainment among untested children. Findings During December 2014-November 2017, 1567 enrolled neonates contributed 2,186.9 person-years (py). Six in ten (64·4%) children developed ARI (total 2493 episodes). Among children <2 years, incidence of respiratory syncytial virus (RSV)-associated ARI episodes (21·0, 95%CI 19·3-22·8, per 100py) and rhinovirus-associated (20·5, 95%CI 20·4-20·7) were similar and higher than parainfluenza 1-3-associated (14·2, 95%CI 12·2-16·1), human metapneumovirus-associated (9·2, 95%CI 7·7-10·8), influenza-associated (5·9, 95%CI 4·4-7·5), and adenovirus-associated ARI episodes (5·1, 95%CI 5·0-5·2). Children aged <3 months had the highest rates of RSV ARI (49·1, 95%CI 44·0-54·1 per 100py) followed by children aged 3-5 (25·1, 95%CI 20·1-30·0), 6-11 (17·6, 95%CI 13·2-21·9), and 12-23 months (11·9, 95%CI 10·8-12·9). One in ten children with RSV was referred to the hospital (2·5, 95%CI 2·1-2·8, per 100py). Interpretation Children frequently developed viral ARI and a substantive proportion required hospital care. Such findings suggest the importance of exploring the value of new interventions and increasing uptake of existing prevention measures to mitigate burden of epidemic-prone respiratory viruses. Funding The study was supported by the Centers for Disease Control and Prevention.
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Affiliation(s)
| | - Lindsey M Duca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Arlene Calvo
- Gorgas Institute, Panama City, Panama
- University of South Florida, Panama
| | | | - Natalie Olson
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam MacNeil
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Rafael Rauda
- National Institute of Health of El Salvador, El Salvador
| | - Nga Vuong
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Julio Armero
- National Institute of Health of El Salvador, El Salvador
| | - Rachael Porter
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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32
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Iwamoto C, Lesteberg KE, Lamb MM, Calvimontes DM, Guo K, Barrett BS, Mickens KL, Duca LM, Monzon J, Chard AN, Guzman G, Barrios E, Rojop N, Arias K, Gomez M, Paiz C, Bolanos GA, Edwards KM, Zielinski Gutierrez E, Azziz-Baumgartner E, Asturias EJ, Santiago ML, Beckham JD, Olson D. High SARS-CoV-2 Seroprevalence and Rapid Neutralizing Antibody Decline among Agricultural Workers in Rural Guatemala, June 2020-March 2021. Vaccines (Basel) 2022; 10:1160. [PMID: 35891324 PMCID: PMC9323551 DOI: 10.3390/vaccines10071160] [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: 06/24/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Essential agricultural workers work under occupational conditions that may increase the risk of SARS-CoV-2 exposure and transmission. Data from an agricultural worker cohort in Guatemala, and anti-SARS-CoV-2 nucleocapsid IgG (anti-N IgG) testing were used to estimate past infections and analyze risk factors associated with seropositivity at enrollment and association with SARS-CoV-2 infection. The stability of neutralizing antibody (NAb) responses were assessed in a subset of participants. The adjusted relative risk (aRR) for seroprevalence at enrollment was estimated accounting for correlations within worksites. At enrollment, 616 (46.2%) of 1334 (93.2%) participants had anti-N IgG results indicating prior SARS-CoV-2 infection. A cough ≤ 10 days prior to enrollment (aRR = 1.28, 95% CI: 1.13−1.46) and working as a packer (aRR = 2.00, 95% CI: 1.67−2.38) or packing manager within the plants (aRR = 1.82, 95% CI: 1.36−2.43) were associated with increased risk of seropositivity. COVID-19 incidence density among seronegative workers was 2.3/100 Person-Years (P-Y), higher than seropositive workers (0.4/100 P-Y). Most workers with follow-up NAb testing (65/77, 84%) exhibited a 95% average decrease in NAb titers in <6 months. While participants seropositive at baseline were less likely to experience a symptomatic SARS-CoV-2 infection during follow-up, NAb titers rapidly waned, underscoring the need for multipronged COVID-19 prevention strategies in the workplace, including vaccination.
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Affiliation(s)
- Chelsea Iwamoto
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA; (L.M.D.); (A.N.C.); (E.A.-B.)
| | - Kelsey E. Lesteberg
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO 80045, USA; (K.E.L.); (K.G.); (B.S.B.); (K.L.M.); (M.L.S.); (J.D.B.)
| | - Molly M. Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, 13199 E. Montview Blvd, Aurora, CO 80045, USA; (M.M.L.); (E.J.A.); (D.O.)
| | - Diva M. Calvimontes
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
- La Comisión Presidencial de Atención a la Emergencia COVID-19 (Coprecovid), Guatemala City 01010, Guatemala
| | - Kejun Guo
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO 80045, USA; (K.E.L.); (K.G.); (B.S.B.); (K.L.M.); (M.L.S.); (J.D.B.)
| | - Bradley S. Barrett
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO 80045, USA; (K.E.L.); (K.G.); (B.S.B.); (K.L.M.); (M.L.S.); (J.D.B.)
| | - Kaylee L. Mickens
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO 80045, USA; (K.E.L.); (K.G.); (B.S.B.); (K.L.M.); (M.L.S.); (J.D.B.)
| | - Lindsey M. Duca
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA; (L.M.D.); (A.N.C.); (E.A.-B.)
| | - Jose Monzon
- Centers for Disease Control and Prevention, Division of Global Health Protection (CDC-DGHP), 1600 Clifton Rd., Atlanta, GA 30329, USA; (J.M.); (E.Z.G.)
| | - Anna N. Chard
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA; (L.M.D.); (A.N.C.); (E.A.-B.)
| | - Gerber Guzman
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
| | - Edgar Barrios
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
| | - Neudy Rojop
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
| | - Kareen Arias
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
| | - Melissa Gomez
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
| | - Claudia Paiz
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
| | - Guillermo Antonio Bolanos
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
| | - Kathryn M. Edwards
- Division of Infectious Disease, Department of Pediatrics, Vanderbilt University School of Medicine, 2200 Children’s Way, 6th Floor, Nashville, TN 37232, USA;
| | - Emily Zielinski Gutierrez
- Centers for Disease Control and Prevention, Division of Global Health Protection (CDC-DGHP), 1600 Clifton Rd., Atlanta, GA 30329, USA; (J.M.); (E.Z.G.)
| | - Eduardo Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA; (L.M.D.); (A.N.C.); (E.A.-B.)
| | - Edwin J. Asturias
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, 13199 E. Montview Blvd, Aurora, CO 80045, USA; (M.M.L.); (E.J.A.); (D.O.)
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
- La Comisión Presidencial de Atención a la Emergencia COVID-19 (Coprecovid), Guatemala City 01010, Guatemala
- Division of Infectious Disease, Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
| | - Mario L. Santiago
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO 80045, USA; (K.E.L.); (K.G.); (B.S.B.); (K.L.M.); (M.L.S.); (J.D.B.)
| | - J. David Beckham
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO 80045, USA; (K.E.L.); (K.G.); (B.S.B.); (K.L.M.); (M.L.S.); (J.D.B.)
| | - Daniel Olson
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, 13199 E. Montview Blvd, Aurora, CO 80045, USA; (M.M.L.); (E.J.A.); (D.O.)
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, FSIG, Km 30 carretera de Coatepeque a Chiquirines Caballo Blanco, Retalhuleu 11010, Guatemala; (D.M.C.); (G.G.); (E.B.); (N.R.); (K.A.); (M.G.); (C.P.); (G.A.B.)
- Division of Infectious Disease, Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
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Richardson VL, Franco MAC, Márquez AB, Valdez LM, Ceronio LEC, Cruz VC, Gharpure R, Lafond KE, Yau TS, Azziz-Baumgartner E, Ávila MH. Vaccine Effectiveness of CanSino (Adv5-nCoV) Coronavirus Disease 2019 (COVID-19) Vaccine Among Childcare Workers-Mexico, March-December 2021. Clin Infect Dis 2022; 75:S167-S173. [PMID: 35717650 PMCID: PMC9214173 DOI: 10.1093/cid/ciac488] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Beginning in March 2021, Mexico vaccinated childcare workers with a single-dose CanSino Biologics (Adv5-nCoV) coronavirus disease 2019 (COVID-19) vaccine. Although CanSino is currently approved for use in 10 Latin American, Asian, and European countries, little information is available about its vaccine effectiveness (VE). METHODS We evaluated CanSino VE within a childcare worker cohort that included 1408 childcare facilities. Participants were followed during March-December 2021 and tested through severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction or rapid antigen test if they developed any symptom compatible with COVID-19. Vaccination status was obtained through worker registries. VE was calculated as 100% × (1 - hazard ratio for SARS-CoV-2 infection in fully vaccinated vs unvaccinated participants), using an Andersen-Gill model adjusted for age, sex, state, and local viral circulation. RESULTS The cohort included 43 925 persons who were mostly (96%) female with a median age of 32 years; 37 646 (86%) were vaccinated with CanSino. During March-December 2021, 2250 (5%) participants had laboratory-confirmed COVID-19, of whom 25 were hospitalized and 6 died. Adjusted VE was 20% (95% confidence interval [CI], 10%-29%) against illness, 76% (95% CI, 42%-90%) against hospitalization, and 94% (95% CI, 66%-99%) against death. VE against illness declined from 48% (95% CI, 33%-61%) after 14-60 days following full vaccination to 20% (95% CI, 9%-31%) after 61-120 days. CONCLUSIONS CanSino vaccine was effective at preventing COVID-19 illness and highly effective at preventing hospitalization and death. It will be useful to further evaluate duration of protection and assess the value of booster doses to prevent COVID-19 and severe outcomes.
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Affiliation(s)
- Vesta L Richardson
- Post-Acceptance Corresponding author: Vesta L. Richardson. Coordinación del Servicio de Guardería para el Desarrollo Integral Infantil. Paseo de la Reforma No. 476, Pórtico Planta Alta, Col. Juárez, Alcaldía Cuauhtémoc, C. P. 06600, CDMX.
| | | | - Aurora Bautista Márquez
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Libny Martínez Valdez
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Luis Enrique Castro Ceronio
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Vicente Cruz Cruz
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Radhika Gharpure
- Corresponding author: Radhika Gharpure, US Centers for Disease Control and Prevention. 1600 Clifton Rd NE, Atlanta GA, 30329.
| | | | - Tat S Yau
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mauricio Hernández Ávila
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
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McCarron M, Kondor R, Zureick K, Griffin C, Fuster C, Hammond A, Lievre M, Vandemaele K, Bresee J, Xu X, Dugan VG, Weatherspoon V, Williams T, Vance A, Fry AM, Samaan M, Fitzner J, Zhang W, Moen A, Wentworth DE, Azziz-Baumgartner E. United States Centers for Disease Control and Prevention support for influenza surveillance, 2013-2021. Bull World Health Organ 2022; 100:366-374. [PMID: 35694628 PMCID: PMC9178423 DOI: 10.2471/blt.21.287253] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the stability of improvements in global respiratory virus surveillance in countries supported by the United States Centers for Disease Control and Prevention (CDC) after reductions in CDC funding and with the stress of the coronavirus disease 2019 (COVID-19) pandemic. Methods We assessed whether national influenza surveillance systems of CDC-funded countries: (i) continued to analyse as many specimens between 2013 and 2021; (ii) participated in activities of the World Health Organization's (WHO) Global Influenza Surveillance and Response System; (iii) tested enough specimens to detect rare events or signals of unusual activity; and (iv) demonstrated stability before and during the COVID-19 pandemic. We used CDC budget records and data from the WHO Global Influenza Surveillance and Response System. Findings While CDC reduced per-country influenza funding by about 75% over 10 years, the number of specimens tested annually remained stable (mean 2261). Reporting varied substantially by country and transmission zone. Countries funded by CDC accounted for 71% (range 61-75%) of specimens included in WHO consultations on the composition of influenza virus vaccines. In 2019, only eight of the 17 transmission zones sent enough specimens to WHO collaborating centres before the vaccine composition meeting to reliably identify antigenic variants. Conclusion Great progress has been made in the global understanding of influenza trends and seasonality. To optimize surveillance to identify atypical influenza viruses, and to integrate molecular testing, sequencing and reporting of severe acute respiratory syndrome coronavirus 2 into existing systems, funding must continue to support these efforts.
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Affiliation(s)
- Margaret McCarron
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Rebecca Kondor
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Kinda Zureick
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Chelsey Griffin
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Christian Fuster
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Aspen Hammond
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Maja Lievre
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | | | - Joseph Bresee
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Xiyan Xu
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Vivien G Dugan
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Vashonia Weatherspoon
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Thelma Williams
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - April Vance
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Magdi Samaan
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Julia Fitzner
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Wenqing Zhang
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Ann Moen
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A32, Atlanta, GA 30329, United States of America
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Müller-Theissen ML, Azziz-Baumgartner E, Ortiz L, Szablewski CM, Alvarez D, Gonzalez-Reiche AS, Jara J, Davis CT, Cordon-Rosales C. Influenza A virus circulation in backyard animals in the Pacific coast of Guatemala, 2013-2014. Zoonoses Public Health 2022; 69:826-834. [PMID: 35611690 DOI: 10.1111/zph.12972] [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: 05/28/2021] [Revised: 03/18/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022]
Abstract
Due to their documented epidemiological relevance as hosts for influenza A viruses (IAV), humans, poultry and pigs in backyard production systems (BPS) within wetlands could be key to the emergence of novel IAV variants able to transmit between humans or animals. To better understand the circulation of IAV at the human-animal interface of BPS within wetlands, we studied IAV in backyard duck flocks and pig herds in the Pacific Coast of Guatemala. From April 2013 to October 2014, we estimated the monthly IAV per cent seropositive and viral positive flocks and herds in two resource-limited communities. We detected antibodies in sera against the IAV nucleoprotein through ELISA. We also detected IAV viral RNA in respiratory (ducks and pigs) and cloacal (ducks) swabs through rRT-PCR directed at the matrix gene. We attempted viral isolation in eggs or MDCK cells followed by sequencing from swabs positive for IAV. During our study period, IAV seropositivity in duck flocks was 38%, and viral positivity was 23% (n = 86 BPS sampled). IAV seropositivity in pig herds was 42%, and viral positivity was 20% (n = 90 BPS sampled). Both flocks and herds had detectable antibodies against IAV mostly year-round, and IAV was detected in several months. We isolated an H3N2 virus from one pig sampled at the end of 2013. Standard nucleotide BLAST searches indicate that the isolated virus was similar to seasonal viruses circulating in humans, suggesting human-to-pig transmission. Our data show concurrent circulation of IAV in multiple species of poultry and pigs that were commingled in rudimentary conditions in proximity to humans, but no significant risk factors could be identified.
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Affiliation(s)
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucia Ortiz
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala
| | - Christine M Szablewski
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danilo Alvarez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala
| | - Ana S Gonzalez-Reiche
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala
| | - Jorge Jara
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala
| | - C Todd Davis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala
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Natarajan K, Prasad N, Dascomb K, Irving SA, Yang DH, Gaglani M, Klein NP, DeSilva MB, Ong TC, Grannis SJ, Stenehjem E, Link-Gelles R, Rowley EA, Naleway AL, Han J, Raiyani C, Benitez GV, Rao S, Lewis N, Fadel WF, Grisel N, Griggs EP, Dunne MM, Stockwell MS, Mamawala M, McEvoy C, Barron MA, Goddard K, Valvi NR, Arndorfer J, Patel P, Mitchell PK, Smith M, Kharbanda AB, Fireman B, Embi PJ, Dickerson M, Davis JM, Zerbo O, Dalton AF, Wondimu MH, Azziz-Baumgartner E, Bozio CH, Reynolds S, Ferdinands J, Williams J, Schrag SJ, Verani JR, Ball S, Thompson MG, Dixon BE. Effectiveness of Homologous and Heterologous COVID-19 Booster Doses Following 1 Ad.26.COV2.S (Janssen [Johnson & Johnson]) Vaccine Dose Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults - VISION Network, 10 States, December 2021-March 2022. MMWR Morb Mortal Wkly Rep 2022; 71:495-502. [PMID: 35358170 PMCID: PMC8979598 DOI: 10.15585/mmwr.mm7113e2] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CDC recommends that all persons aged ≥18 years receive a single COVID-19 vaccine booster dose ≥2 months after receipt of an Ad.26.COV2.S (Janssen [Johnson & Johnson]) adenovirus vector-based primary series vaccine; a heterologous COVID-19 mRNA vaccine is preferred over a homologous (matching) Janssen vaccine for booster vaccination. This recommendation was made in light of the risks for rare but serious adverse events following receipt of a Janssen vaccine, including thrombosis with thrombocytopenia syndrome and Guillain-Barré syndrome† (1), and clinical trial data indicating similar or higher neutralizing antibody response following heterologous boosting compared with homologous boosting (2). Data on real-world vaccine effectiveness (VE) of different booster strategies following a primary Janssen vaccine dose are limited, particularly during the period of Omicron variant predominance. The VISION Network§ determined real-world VE of 1 Janssen vaccine dose and 2 alternative booster dose strategies: 1) a homologous booster (i.e., 2 Janssen doses) and 2) a heterologous mRNA booster (i.e., 1 Janssen dose/1 mRNA dose). In addition, VE of these booster strategies was compared with VE of a homologous booster following mRNA primary series vaccination (i.e., 3 mRNA doses). The study examined 80,287 emergency department/urgent care (ED/UC) visits¶ and 25,244 hospitalizations across 10 states during December 16, 2021-March 7, 2022, when Omicron was the predominant circulating variant.** VE against laboratory-confirmed COVID-19-associated ED/UC encounters was 24% after 1 Janssen dose, 54% after 2 Janssen doses, 79% after 1 Janssen/1 mRNA dose, and 83% after 3 mRNA doses. VE for the same vaccination strategies against laboratory-confirmed COVID-19-associated hospitalizations were 31%, 67%, 78%, and 90%, respectively. All booster strategies provided higher protection than a single Janssen dose against ED/UC visits and hospitalizations during Omicron variant predominance. Vaccination with 1 Janssen/1 mRNA dose provided higher protection than did 2 Janssen doses against COVID-19-associated ED/UC visits and was comparable to protection provided by 3 mRNA doses during the first 120 days after a booster dose. However, 3 mRNA doses provided higher protection against COVID-19-associated hospitalizations than did other booster strategies during the same time interval since booster dose. All adults who have received mRNA vaccines for their COVID-19 primary series vaccination should receive an mRNA booster dose when eligible. Adults who received a primary Janssen vaccine dose should preferentially receive a heterologous mRNA vaccine booster dose ≥2 months later, or a homologous Janssen vaccine booster dose if mRNA vaccine is contraindicated or unavailable. Further investigation of the durability of protection afforded by different booster strategies is warranted.
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Klein NP, Stockwell MS, Demarco M, Gaglani M, Kharbanda AB, Irving SA, Rao S, Grannis SJ, Dascomb K, Murthy K, Rowley EA, Dalton AF, DeSilva MB, Dixon BE, Natarajan K, Stenehjem E, Naleway AL, Lewis N, Ong TC, Patel P, Konatham D, Embi PJ, Reese SE, Han J, Grisel N, Goddard K, Barron MA, Dickerson M, Liao IC, Fadel WF, Yang DH, Arndorfer J, Fireman B, Griggs EP, Valvi NR, Hallowell C, Zerbo O, Reynolds S, Ferdinands J, Wondimu MH, Williams J, Bozio CH, Link-Gelles R, Azziz-Baumgartner E, Schrag SJ, Thompson MG, Verani JR. Effectiveness of COVID-19 Pfizer-BioNTech BNT162b2 mRNA Vaccination in Preventing COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Nonimmunocompromised Children and Adolescents Aged 5-17 Years - VISION Network, 10 States, April 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:352-358. [PMID: 35239634 PMCID: PMC8893336 DOI: 10.15585/mmwr.mm7109e3] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The efficacy of the BNT162b2 (Pfizer-BioNTech) vaccine against laboratory-confirmed COVID-19 exceeded 90% in clinical trials that included children and adolescents aged 5-11, 12-15, and 16-17 years (1-3). Limited real-world data on 2-dose mRNA vaccine effectiveness (VE) in persons aged 12-17 years (referred to as adolescents in this report) have also indicated high levels of protection against SARS-CoV-2 (the virus that causes COVID-19) infection and COVID-19-associated hospitalization (4-6); however, data on VE against the SARS-CoV-2 B.1.1.529 (Omicron) variant and duration of protection are limited. Pfizer-BioNTech VE data are not available for children aged 5-11 years. In partnership with CDC, the VISION Network* examined 39,217 emergency department (ED) and urgent care (UC) encounters and 1,699 hospitalizations† among persons aged 5-17 years with COVID-19-like illness across 10 states during April 9, 2021-January 29, 2022,§ to estimate VE using a case-control test-negative design. Among children aged 5-11 years, VE against laboratory-confirmed COVID-19-associated ED and UC encounters 14-67 days after dose 2 (the longest interval after dose 2 in this age group) was 46%. Among adolescents aged 12-15 and 16-17 years, VE 14-149 days after dose 2 was 83% and 76%, respectively; VE ≥150 days after dose 2 was 38% and 46%, respectively. Among adolescents aged 16-17 years, VE increased to 86% ≥7 days after dose 3 (booster dose). VE against COVID-19-associated ED and UC encounters was substantially lower during the Omicron predominant period than the B.1.617.2 (Delta) predominant period among adolescents aged 12-17 years, with no significant protection ≥150 days after dose 2 during Omicron predominance. However, in adolescents aged 16-17 years, VE during the Omicron predominant period increased to 81% ≥7 days after a third booster dose. During the full study period, including pre-Delta, Delta, and Omicron predominant periods, VE against laboratory-confirmed COVID-19-associated hospitalization among children aged 5-11 years was 74% 14-67 days after dose 2, with wide CIs that included zero. Among adolescents aged 12-15 and 16-17 years, VE 14-149 days after dose 2 was 92% and 94%, respectively; VE ≥150 days after dose 2 was 73% and 88%, respectively. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations, including a booster dose for those aged 12-17 years.
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Griffin I, Woodworth KR, Galang RR, Burkel VK, Neelam V, Siebman S, Barton J, Manning SE, Aveni K, Longcore ND, Harvey EM, Ngo V, Mbotha D, Chicchelly S, Lush M, Eckert V, Dzimira P, Sokale A, Valencia-Prado M, Azziz-Baumgartner E, MacNeil A, Gilboa SM, Tong VT. Recurrent SARS-CoV-2 RNA Detection after COVID-19 Illness Onset during Pregnancy. Emerg Infect Dis 2022; 28:873-876. [PMID: 35213801 PMCID: PMC8962892 DOI: 10.3201/eid2804.212354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Surveillance for Emerging Threats to Mothers and Babies Network conducts longitudinal surveillance of pregnant persons in the United States with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection during pregnancy. Of 6,551 infected pregnant persons in this analysis, 142 (2.2%) had positive RNA tests >90 days and up to 416 days after infection.
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Konatham D, Kharbanda AB, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Liao IC, Birch R, Valvi NR, Reynolds S, Arndorfer J, Zerbo O, Dickerson M, Murthy K, Williams J, Bozio CH, Blanton L, Verani JR, Schrag SJ, Dalton AF, Wondimu MH, Link-Gelles R, Azziz-Baumgartner E, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022. [PMID: 35176007 DOI: 10.1558/mmwr.mm7107e2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
CDC recommends that all persons aged ≥12 years receive a booster dose of COVID-19 mRNA vaccine ≥5 months after completion of a primary mRNA vaccination series and that immunocompromised persons receive a third primary dose.* Waning of vaccine protection after 2 doses of mRNA vaccine has been observed during the period of the SARS-CoV-2 B.1.617.2 (Delta) variant predominance† (1-5), but little is known about durability of protection after 3 doses during periods of Delta or SARS-CoV-2 B.1.1.529 (Omicron) variant predominance. A test-negative case-control study design using data from eight VISION Network sites§ examined vaccine effectiveness (VE) against COVID-19 emergency department/urgent care (ED/UC) visits and hospitalizations among U.S. adults aged ≥18 years at various time points after receipt of a second or third vaccine dose during two periods: Delta variant predominance and Omicron variant predominance (i.e., periods when each variant accounted for ≥50% of sequenced isolates).¶ Persons categorized as having received 3 doses included those who received a third dose in a primary series or a booster dose after a 2 dose primary series (including the reduced-dosage Moderna booster). The VISION Network analyzed 241,204 ED/UC encounters** and 93,408 hospitalizations across 10 states during August 26, 2021-January 22, 2022. VE after receipt of both 2 and 3 doses was lower during the Omicron-predominant than during the Delta-predominant period at all time points evaluated. During both periods, VE after receipt of a third dose was higher than that after a second dose; however, VE waned with increasing time since vaccination. During the Omicron period, VE against ED/UC visits was 87% during the first 2 months after a third dose and decreased to 66% among those vaccinated 4-5 months earlier; VE against hospitalizations was 91% during the first 2 months following a third dose and decreased to 78% ≥4 months after a third dose. For both Delta- and Omicron-predominant periods, VE was generally higher for protection against hospitalizations than against ED/UC visits. All eligible persons should remain up to date with recommended COVID-19 vaccinations to best protect against COVID-19-associated hospitalizations and ED/UC visits.
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Konatham D, Kharbanda AB, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Liao IC, Birch R, Valvi NR, Reynolds S, Arndorfer J, Zerbo O, Dickerson M, Murthy K, Williams J, Bozio CH, Blanton L, Verani JR, Schrag SJ, Dalton AF, Wondimu MH, Link-Gelles R, Azziz-Baumgartner E, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:255-263. [PMID: 35176007 PMCID: PMC8853475 DOI: 10.15585/mmwr.mm7107e2] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Olson D, Calvimontes DM, Lamb MM, Guzman G, Barrios E, Chacon A, Rojop N, Arias K, Gomez M, Bolanos GA, Monzon J, Chard AN, Iwamoto C, Duca LM, Vuong N, Fineman M, Lesteberg K, Beckham D, Santiago ML, Quicke K, Ebel G, Gutierrez EZ, Azziz-Baumgartner E, Hayden FG, Mansour H, Edwards K, Newman LS, Asturias EJ. Clinical and Economic Impact of COVID-19 on Plantation Workers: Preliminary Results from the Guatemala Agricultural Workers and Respiratory Illness Impact (AGRI) Study. medRxiv 2022:2022.02.07.22270274. [PMID: 35169807 PMCID: PMC8845422 DOI: 10.1101/2022.02.07.22270274] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We evaluated the clinical and socioeconomic burdens of respiratory disease in a cohort of Guatemalan banana plantation workers. All eligible workers were offered enrollment from June 15-December 30, 2020, and annually, then followed for influenza-like illnesses (ILI) through: 1) self-reporting to study nurses, 2) sentinel surveillance at health posts, and 3) absenteeism. Workers with ILI submitted nasopharyngeal swabs for influenza, RSV, and SARS-CoV-2 testing, then completed surveys at days 0, 7, and 28. Through October 10, 2021, 1,833 workers developed 169 ILIs (12.0/100 person-years) and 43 (25.4%) of these ILIs were laboratory-confirmed SARS-CoV-2 (3.1/100 person-years). Workers with SARS-CoV-2-positive ILI reported more anosmia (p<0.01), dysgeusia (p<0.01), difficulty concentrating (p=0.01), and irritability (p=0.01), and greater clinical and well-being severity scores (Flu-iiQ) than test-negative ILIs; they also had greater absenteeism (p<0.01) and lost income (median US$127.1, p<0.01). These results support the prioritization of Guatemalan farm workers for COVID-19 vaccination.
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Affiliation(s)
- Daniel Olson
- University of Colorado School of Medicine, Aurora, CO, USA
- Colorado School of Public Health, Aurora
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Diva M. Calvimontes
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
- La Comisión Presidencial de Atención a la Emergencia COVID-19 (Coprecovid), Guatemala
| | | | - Gerber Guzman
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Edgar Barrios
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Andrea Chacon
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Neudy Rojop
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Kareen Arias
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Melissa Gomez
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | - Jose Monzon
- Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Anna N. Chard
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chelsea Iwamoto
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lindsey M. Duca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nga Vuong
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - David Beckham
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | | | | | | | | | - Kathryn Edwards
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Lee S. Newman
- University of Colorado School of Medicine, Aurora, CO, USA
- Colorado School of Public Health, Aurora
| | - Edwin J. Asturias
- University of Colorado School of Medicine, Aurora, CO, USA
- Colorado School of Public Health, Aurora
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
- La Comisión Presidencial de Atención a la Emergencia COVID-19 (Coprecovid), Guatemala
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Hernandez-Romieu AC, Carton TW, Saydah S, Azziz-Baumgartner E, Boehmer TK, Garret NY, Bailey LC, Cowell LG, Draper C, Mayer KH, Nagavedu K, Puro JE, Rasmussen SA, Trick WE, Wanga V, Chevinsky JR, Jackson BR, Goodman AB, Cope JR, Gundlapalli AV, Block JP. Prevalence of Select New Symptoms and Conditions Among Persons Aged Younger Than 20 Years and 20 Years or Older at 31 to 150 Days After Testing Positive or Negative for SARS-CoV-2. JAMA Netw Open 2022; 5:e2147053. [PMID: 35119459 PMCID: PMC8817203 DOI: 10.1001/jamanetworkopen.2021.47053] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE New symptoms and conditions can develop following SARS-CoV-2 infection. Whether they occur more frequently among persons with SARS-CoV-2 infection compared with those without is unclear. OBJECTIVE To compare the prevalence of new diagnoses of select symptoms and conditions between 31 and 150 days after testing among persons who tested positive vs negative for SARS-CoV-2. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed aggregated electronic health record data from 40 health care systems, including 338 024 persons younger than 20 years and 1 790 886 persons aged 20 years or older who were tested for SARS-CoV-2 during March to December 2020 and who had medical encounters between 31 and 150 days after testing. MAIN OUTCOMES AND MEASURES International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes were used to capture new symptoms and conditions that were recorded 31 to 150 days after a SARS-CoV-2 test but absent in the 18 months to 7 days prior to testing. The prevalence of new symptoms and conditions was compared between persons with positive and negative SARS-CoV-2 tests stratified by age (20 years or older and young than 20 years) and care setting (nonhospitalized, hospitalized, or hospitalized and ventilated). RESULTS A total of 168 701 persons aged 20 years or older and 26 665 younger than 20 years tested positive for SARS-CoV-2, and 1 622 185 persons aged 20 years or older and 311 359 younger than 20 years tested negative. Shortness of breath was more common among persons with a positive vs negative test result among hospitalized patients (≥20 years: prevalence ratio [PR], 1.89 [99% CI, 1.79-2.01]; <20 years: PR, 1.72 [99% CI, 1.17-2.51]). Shortness of breath was also more common among nonhospitalized patients aged 20 years or older with a positive vs negative test result (PR, 1.09 [99% CI, 1.05-1.13]). Among hospitalized persons aged 20 years or older, the prevalence of new fatigue (PR, 1.35 [99% CI, 1.27-1.44]) and type 2 diabetes (PR, 2.03 [99% CI, 1.87-2.19]) was higher among those with a positive vs a negative test result. Among hospitalized persons younger than 20 years, the prevalence of type 2 diabetes (PR, 2.14 [99% CI, 1.13-4.06]) was higher among those with a positive vs a negative test result; however, the prevalence difference was less than 1%. CONCLUSIONS AND RELEVANCE In this cohort study, among persons hospitalized after a positive SARS-CoV-2 test result, diagnoses of certain symptoms and conditions were higher than among those with a negative test result. Health care professionals should be aware of symptoms and conditions that may develop after SARS-CoV-2 infection, particularly among those hospitalized after diagnosis.
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Affiliation(s)
- Alfonso C Hernandez-Romieu
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sharon Saydah
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Tegan K Boehmer
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nedra Y Garret
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - L Charles Bailey
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lindsay G Cowell
- Department of Population and Data Sciences, Department of Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Christine Draper
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville
| | - William E Trick
- Health Research & Solutions, Cook County Health, Chicago, Illinois
| | - Valentine Wanga
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Chevinsky
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan R Jackson
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyson B Goodman
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Cope
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adi V Gundlapalli
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
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43
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Davis W, Duque J, Huang QS, Olson N, Grant CC, Newbern EC, Thompson M, Waite B, Prasad N, Trenholme A, Azziz-Baumgartner E. Sensitivity and specificity of surveillance case definitions in detection of influenza and respiratory syncytial virus among hospitalized patients, New Zealand, 2012-2016. J Infect 2022; 84:216-226. [PMID: 34953903 DOI: 10.1016/j.jinf.2021.12.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 11/30/2021] [Accepted: 12/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The WHO is exploring the value of adding RSV testing to existing influenza surveillance systems to inform RSV control programs. We evaluate the usefulness of four commonly used influenza surveillance case-definitions for influenza and RSV surveillance. METHODS SHIVERS, a multi-institutional collaboration, conducted surveillance for influenza and RSV in four New Zealand hospitals. Nurses reviewed admission logs, enrolled patients with suspected acute respiratory infections (ARI), and obtained nasopharyngeal swabs for RT-PCR. We compared the performance characteristics for identifying laboratory-confirmed influenza and RSV severe acute respiratory infection (SARI), defined as persons admitted with measured or reported fever and cough within 10 days of illness, to three other case definitions: 1. reported fever and cough or shortness of breath, 2. cough and shortness of breath, or 3. cough. RESULTS During April-September 2012-2016, SHIVERS identified 16,055 admissions with ARI; of 6374 cases consented and tested for influenza or RSV, 5437 (85%) had SARI and 937 (15%) did not. SARI had the highest specificity in detecting influenza (40.6%) and RSV (40.8%) but the lowest sensitivity (influenza 78.8%, RSV 60.3%) among patients of all ages. Cough or shortness of breath had the highest sensitivity (influenza 99.3%, RSV 99.9%) but the lowest specificity (influenza 1.6%, RSV 1.9%). SARI sensitivity among children aged <3 months was 60.8% for influenza and 43.6% for RSV-both lower than in other age groups. CONCLUSIONS While SARI had the highest specificity, its sensitivity was limited, especially among children aged <3 months. Cough or shortness of breath was the most sensitive.
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Affiliation(s)
- William Davis
- US Centers for Disease Control and Prevention, Atlanta, USA
| | - Jazmin Duque
- US Centers for Disease Control and Prevention, Atlanta, USA; Battelle Atlanta, Atlanta, USA; The University of Auckland, Auckland, New Zealand
| | - Q Sue Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Natalie Olson
- US Centers for Disease Control and Prevention, Atlanta, USA
| | - Cameron C Grant
- The University of Auckland, Auckland, New Zealand; Starship Children's Hospital, Auckland, New Zealand
| | - E Claire Newbern
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Mark Thompson
- US Centers for Disease Control and Prevention, Atlanta, USA
| | - Ben Waite
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Namrata Prasad
- The University of Auckland, Auckland, New Zealand; Institute of Environmental Science and Research, Wellington, New Zealand
| | - Adrian Trenholme
- The University of Auckland, Auckland, New Zealand; Middlemore Hospital, Auckland, New Zealand
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44
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Thompson MG, Natarajan K, Irving SA, Rowley EA, Griggs EP, Gaglani M, Klein NP, Grannis SJ, DeSilva MB, Stenehjem E, Reese SE, Dickerson M, Naleway AL, Han J, Konatham D, McEvoy C, Rao S, Dixon BE, Dascomb K, Lewis N, Levy ME, Patel P, Liao IC, Kharbanda AB, Barron MA, Fadel WF, Grisel N, Goddard K, Yang DH, Wondimu MH, Murthy K, Valvi NR, Arndorfer J, Fireman B, Dunne MM, Embi P, Azziz-Baumgartner E, Zerbo O, Bozio CH, Reynolds S, Ferdinands J, Williams J, Link-Gelles R, Schrag SJ, Verani JR, Ball S, Ong TC. Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:139-145. [PMID: 35085224 PMCID: PMC9351525 DOI: 10.15585/mmwr.mm7104e3] [Citation(s) in RCA: 268] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Estimates of COVID-19 mRNA vaccine effectiveness (VE) have declined in recent months (1,2) because of waning vaccine induced immunity over time,* possible increased immune evasion by SARS-CoV-2 variants (3), or a combination of these and other factors. CDC recommends that all persons aged ≥12 years receive a third dose (booster) of an mRNA vaccine ≥5 months after receipt of the second mRNA vaccine dose and that immunocompromised individuals receive a third primary dose.† A third dose of BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine increases neutralizing antibody levels (4), and three recent studies from Israel have shown improved effectiveness of a third dose in preventing COVID-19 associated with infections with the SARS-CoV-2 B.1.617.2 (Delta) variant (5-7). Yet, data are limited on the real-world effectiveness of third doses of COVID-19 mRNA vaccine in the United States, especially since the SARS-CoV-2 B.1.1.529 (Omicron) variant became predominant in mid-December 2021. The VISION Network§ examined VE by analyzing 222,772 encounters from 383 emergency departments (EDs) and urgent care (UC) clinics and 87,904 hospitalizations from 259 hospitals among adults aged ≥18 years across 10 states from August 26, 2021¶ to January 5, 2022. Analyses were stratified by the period before and after the Omicron variant became the predominant strain (>50% of sequenced viruses) at each study site. During the period of Delta predominance across study sites in the United States (August-mid-December 2021), VE against laboratory-confirmed COVID-19-associated ED and UC encounters was 86% 14-179 days after dose 2, 76% ≥180 days after dose 2, and 94% ≥14 days after dose 3. Estimates of VE for the same intervals after vaccination during Omicron variant predominance were 52%, 38%, and 82%, respectively. During the period of Delta variant predominance, VE against laboratory-confirmed COVID-19-associated hospitalizations was 90% 14-179 days after dose 2, 81% ≥180 days after dose 2, and 94% ≥14 days after dose 3. During Omicron variant predominance, VE estimates for the same intervals after vaccination were 81%, 57%, and 90%, respectively. The highest estimates of VE against COVID-19-associated ED and UC encounters or hospitalizations during both Delta- and Omicron-predominant periods were among adults who received a third dose of mRNA vaccine. All unvaccinated persons should get vaccinated as soon as possible. All adults who have received mRNA vaccines during their primary COVID-19 vaccination series should receive a third dose when eligible, and eligible persons should stay up to date with COVID-19 vaccinations.
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45
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Embi PJ, Levy ME, Naleway AL, Patel P, Gaglani M, Natarajan K, Dascomb K, Ong TC, Klein NP, Liao IC, Grannis SJ, Han J, Stenehjem E, Dunne MM, Lewis N, Irving SA, Rao S, McEvoy C, Bozio CH, Murthy K, Dixon BE, Grisel N, Yang DH, Goddard K, Kharbanda AB, Reynolds S, Raiyani C, Fadel WF, Arndorfer J, Rowley EA, Fireman B, Ferdinands J, Valvi NR, Ball SW, Zerbo O, Griggs EP, Mitchell PK, Porter RM, Kiduko SA, Blanton L, Zhuang Y, Steffens A, Reese SE, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron MA, Thompson MG, DeSilva MB. Effectiveness of two-dose vaccination with mRNA COVID-19 vaccines against COVID-19-associated hospitalizations among immunocompromised adults-Nine States, January-September 2021. Am J Transplant 2022; 22:306-314. [PMID: 34967121 PMCID: PMC9805402 DOI: 10.1111/ajt.16641] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Peter J. Embi
- Regenstrief Institute, Indianapolis, Indiana, USA,Indiana University School of Medicine, Indianapolis, Indiana, USA,Correspondence Peter J. Embi, Regenstrief Institute, Indianapolis, IN, USA.
| | | | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, New York,New York Presbyterian Hospital, New York New, York
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Toan C. Ong
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Shaun J. Grannis
- Indiana University School of Medicine, Indianapolis, Indiana, USA,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Suchitra Rao
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | - Chandni Raiyani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle A. Barron
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Newton SM, Reeves EL, O’Malley Olsen E, Woodworth KR, Farr SL, Galang RR, Reynolds MR, Harvey E, Shi J, Nestoridi E, Barton J, Ngo VP, Lush M, Longcore ND, Dzimira P, Im LK, Sokale A, Siebman S, Delgado López C, Chen T, Mobley EL, Khuwaja S, Romitti PA, Fredette C, Ellis EM, Silcox K, Hall AJ, Azziz-Baumgartner E, Gilboa SM, Shapiro-Mendoza CK, Tong VT. Preterm birth among pregnant persons with severe acute respiratory syndrome Coronavirus 2 infection. J Perinatol 2022; 42:1328-1337. [PMID: 35927486 PMCID: PMC9362668 DOI: 10.1038/s41372-022-01467-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth. STUDY DESIGN We analyzed data for 6336 pregnant persons with SARS-CoV-2 infection in 2020 in the United States. Risk ratios for preterm birth were calculated for illness severity, trimester of infection, and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. RESULT Pregnant persons with critical COVID-19 or asymptomatic infection, compared to mild COVID-19, in the second or third trimester were at increased risk of preterm birth. Pregnant persons with moderate-to-severe COVID-19 did not show increased risk of preterm birth in any trimester. CONCLUSION Critical COVID-19 in the second or third trimester was associated with increased risk of preterm birth. This finding can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons.
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Affiliation(s)
- Suzanne M. Newton
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Emily L. Reeves
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Emily O’Malley Olsen
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Kate R. Woodworth
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Sherry L. Farr
- grid.453445.70000 0004 0540 3431Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA USA
| | - Romeo R. Galang
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Megan R. Reynolds
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Elizabeth Harvey
- grid.416951.e0000 0004 0437 4464Tennessee Department of Health, Nashville, TN USA ,grid.416781.d0000 0001 2186 5810Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA USA
| | - Jing Shi
- grid.238434.a0000 0000 9369 8268New Jersey Department of Health, Trenton, NJ USA
| | - Eirini Nestoridi
- grid.416511.60000 0004 0378 6934Massachusetts Department of Public Health, Boston, MA USA
| | - Jerusha Barton
- grid.420388.50000 0004 4692 4364Georgia Department of Public Health, Atlanta, GA USA
| | - Van P. Ngo
- grid.416097.d0000 0004 0428 8718Los Angeles County Department of Public Health, Los Angeles, CA USA
| | - Mamie Lush
- grid.280417.80000 0004 0420 6102Nebraska Department of Health and Human Services, Lincoln, NE USA
| | - Nicole D. Longcore
- grid.238491.50000 0004 0367 6866New York State Department of Health, Albany, NY USA
| | - Paula Dzimira
- grid.280365.a0000 0004 0455 0659Pennsylvania Department of Health, Harrisburg, PA USA
| | - Lucille K. Im
- grid.413881.70000 0004 0499 951XArkansas Department of Health, Little Rock, AR USA
| | - Ayomide Sokale
- grid.280512.c0000 0004 0453 7577Philadelphia Department of Public Health, Philadelphia, PA USA
| | - Samantha Siebman
- grid.280248.40000 0004 0509 1853Minnesota Department of Health, Saint Paul, MN USA
| | | | - Tiffany Chen
- grid.1658.a0000 0004 0509 9775Washington State Department of Health, Tumwater, WA USA
| | - Evan L. Mobley
- grid.280361.e0000 0004 0414 5063Missouri Department of Health and Senior Services, Jefferson City, MO USA
| | | | - Paul A. Romitti
- grid.214572.70000 0004 1936 8294University of Iowa College of Public Health, Iowa City, IA USA
| | - Carolyn Fredette
- grid.422654.30000 0004 0382 4064New Hampshire Department of Health and Human Services, Concord, NH USA
| | | | - Kristin Silcox
- grid.416491.f0000 0001 0709 8547Maryland Department of Health, Baltimore, MD USA
| | - Aron J. Hall
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Eduardo Azziz-Baumgartner
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Suzanne M. Gilboa
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Carrie K. Shapiro-Mendoza
- grid.416781.d0000 0001 2186 5810Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA USA
| | - Van T. Tong
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
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Kubale J, Kuan G, Gresh L, Ojeda S, Schiller A, Sanchez N, Lopez R, Azziz-Baumgartner E, Wraith S, Harris E, Balmaseda A, Zelner J, Gordon A. Individual-level Association of Influenza Infection With Subsequent Pneumonia: A Case-control and Prospective Cohort Study. Clin Infect Dis 2021; 73:e4288-e4295. [PMID: 32717069 PMCID: PMC8662761 DOI: 10.1093/cid/ciaa1053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pneumonia is a leading cause of mortality worldwide. Influenza may result in primary pneumonia or be associated with secondary bacterial pneumonia. While the association with secondary pneumonia has been established ecologically, individual-level evidence remains sparse and the risk period for pneumonia following influenza poorly defined. METHODS We conducted a matched case-control study and a prospective cohort study among Nicaraguan children aged 0-14 years from 2011 through 2018. Physicians diagnosed pneumonia cases based on Integrated Management for Childhood Illness guidelines. Cases were matched with up to 4 controls on age (months) and study week. We fit conditional logistic regression models to assess the association between influenza subtype and subsequent pneumonia development, and a Bayesian nonlinear survival model to estimate pneumonia hazard following influenza. RESULTS Participants with influenza had greater risk of developing pneumonia in the 30 days following onset compared to those without influenza (matched odds ratio [mOR], 2.7 [95% confidence interval {CI}, 1.9-3.9]). Odds of developing pneumonia were highest for participants following A(H1N1)pdm09 illness (mOR, 3.7 [95% CI, 2.0-6.9]), followed by influenza B and A(H3N2). Participants' odds of pneumonia following influenza were not constant, showing distinct peaks 0-6 days (mOR, 8.3 [95% CI, 4.8-14.5] days) and 14-20 (mOR, 2.5 [95% CI, 1.1-5.5] days) after influenza infection. CONCLUSIONS Influenza is a significant driver of both primary and secondary pneumonia among children. The presence of distinct periods of elevated pneumonia risk in the 30 days following influenza supports multiple etiological pathways.
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Affiliation(s)
- John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Guillermina Kuan
- Sócrates Flores Vivas Health Center, Ministry of Health, Managua, Nicaragua
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Amy Schiller
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Roger Lopez
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | | | - Steph Wraith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, USA
| | - Angel Balmaseda
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Jon Zelner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Wesley MG, Tinoco Y, Patel A, Suntarratiwong P, Hunt D, Sinthuwattanawibool C, Soto G, Kittikraisak W, Das PK, Arriola CS, Hombroek D, Mott J, Kurhe K, Bhargav S, Prakash A, Florian R, Gonzales O, Cabrera S, Llajaruna E, Brummer T, Malek P, Saha S, Garg S, Azziz-Baumgartner E, Thompson MG, Dawood FS. Performance of Symptom-Based Case Definitions to Identify Influenza Virus Infection Among Pregnant Women in Middle-Income Countries: Findings From the Pregnancy and Influenza Multinational Epidemiologic (PRIME) Study. Clin Infect Dis 2021; 73:e4321-e4328. [PMID: 33173947 PMCID: PMC10563868 DOI: 10.1093/cid/ciaa1697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends case definitions for influenza surveillance that are also used in public health research, although their performance has not been assessed in many risk groups, including pregnant women in whom influenza may manifest differently. We evaluated the performance of symptom-based definitions to detect influenza in a cohort of pregnant women in India, Peru, and Thailand. METHODS In 2017 and 2018, we contacted 11 277 pregnant women twice weekly during the influenza season to identify illnesses with new or worsened cough, runny nose, sore throat, difficulty breathing, or myalgia and collected data on other symptoms and nasal swabs for influenza real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. We calculated sensitivity, specificity, positive-predictive value, and negative-predictive value of each symptom predictor, WHO respiratory illness case definitions, and a de novo definition derived from results of multivariable modeling. RESULTS Of 5444 eligible illness episodes among 3965 participants, 310 (6%) were positive for influenza. In a multivariable model, measured fever ≥38°C (adjusted odds ratio [95% confidence interval], 4.6 [3.1-6.8]), myalgia (3.0 [2.2-4.0]), cough (2.7 [1.9-3.9]), and chills (1.6 [1.1-2.4]) were independently associated with influenza illness. A definition based on these 4 (measured fever, cough, chills, or myalgia) was 95% sensitive and 27% specific. The WHO influenza-like illness (ILI) definition was 16% sensitive and 98% specific. CONCLUSIONS The current WHO ILI case definition was highly specific but had low sensitivity. The intended use of case definitions should be considered when evaluating the tradeoff between sensitivity and specificity.
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Affiliation(s)
- Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yeny Tinoco
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Sawangi, India
| | - Piyarat Suntarratiwong
- Queen Sirikit National Institute of Child Health, Thailand Ministry of Public Health, Bangkok, Thailand
| | | | | | - Giselle Soto
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Wanitchaya Kittikraisak
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Carmen Sofia Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Joshua Mott
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
| | | | | | | | | | | | | | | | | | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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49
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Westercamp M, Soto G, Smith R, Azziz-Baumgartner E, Bollinger S, Castillo R, Cuentas AL, Grogl M, Olson N, Prouty M, Matos E, Romero C, Silva M, Lessa FC, Lessa FC, Arriola CS. 375. High Laboratory-confirmed SARS-CoV-2 Attack Rate in Lima Health Care Personnel During August 2020-March 2021 Suggests Role for Improved Infection Control. Open Forum Infect Dis 2021. [PMCID: PMC8644794 DOI: 10.1093/ofid/ofab466.576] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Peru has one of the highest per capita SARS-CoV-2 death rates in Latin America. Healthcare workers (HCW) are a critical workforce during the COVID-19 pandemic but are themselves often at increased risk of infection. We evaluated SARS-CoV-2 attack rate and risk factors among frontline HCWs. Methods We performed a prospective cohort study of HCW serving two acute care hospitals in Lima, Peru from Aug 2020 to Mar 2021. Participants had baseline SARS-CoV-2 serology using the CDC ELISA, active symptom monitoring, and weekly respiratory specimen collection with COVID-19 exposure/risk assessment for 16-weeks regardless of symptoms. Respiratory specimens were tested by real-time reverse transcriptase PCR (rRT-PCR). Results Of 783 eligible, 667 (85%) HCW were enrolled (33% nurse assistants, 29% non-clinical staff, 26% nurses, 7% physicians, and 6% other). At baseline and prior to COVID-19 vaccine introduction, 214 (32.1%; 214/667) were reactive for SARS-CoV-2 antibodies. In total, 72 (10.8%; 72/667) HCWs were found to be rRT-PCR positive during weekly follow-up. Of the rRT-PCR positive HCWs, 37.5% (27/72) did not report symptoms within 1-week of specimen collection. During follow up, HCW without detectable SARS-CoV-2 antibodies at baseline were significantly more likely to be rRT-PCR positive (65/453, 14.3%) compared to those with SARS-CoV-2 antibodies at baseline (4/214, 1.9%) (p-value: < 0.001). Three HCW were both serologically reactive and rRT-PCR positive at baseline. Looking only at HCW without SARS-CoV-2 antibodies, nurse assistants (rRT-PCR positive: 18.6%; 27/141) and non-clinical healthcare workers (16.5%; 21/127) were at greater risk of infection compared to nurses (8.5%; 10/118), physicians (7.9%; 3/38), and other staff (10.3%; 4/29) (RR 1.95;95%CI 1.2,3.3; p-value: 0.01). Conclusion Baseline SARS-CoV-2 prevalence and 16-week cumulative incidence were substantial in this pre-vaccination Peruvian HCW cohort. Almost 40% of new infections occurred in HCW without complaint of symptoms illustrating a limitation of symptom-based HCW screening for COVID-19 prevention. Nurse assistants and non-clinical healthcare workers were at greater risk of infection indicating a role for focused infection prevention and risk reduction strategies for some groups of HCW. Disclosures Fernanda C. Lessa, MD, MPH, Nothing to disclose
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Affiliation(s)
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | - Rachel Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan Bollinger
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Max Grogl
- U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | - Natalie Olson
- U.S. Centers for Disease Control and Prevention – Influenza Division, Atlanta, Georgia
| | - Mike Prouty
- U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | | | | | - Marita Silva
- U.S. Naval Medical Research Unit No. 6, Lima, Peru
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50
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Naleway AL, Groom HC, Crawford PM, Salas SB, Henninger ML, Donald JL, Smith N, Thompson MG, Blanton LH, Bozio CH, Azziz-Baumgartner E. Incidence of SARS-CoV-2 Infection, Emergency Department Visits, and Hospitalizations Because of COVID-19 Among Persons Aged ≥12 Years, by COVID-19 Vaccination Status - Oregon and Washington, July 4-September 25, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1608-1612. [PMID: 34793417 PMCID: PMC8601415 DOI: 10.15585/mmwr.mm7046a4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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