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Woodruff RC, Melgar M, Pham H, Sperling LS, Loustalot F, Kirley PD, Austin E, Yousey-Hindes K, Openo KP, Ryan P, Brown C, Lynfield R, Davis SS, Barney G, Tesini B, Sutton M, Talbot HK, Zahid H, Kim L, Havers FP. Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection. JAMA Intern Med 2024:2817609. [PMID: 38619857 PMCID: PMC11019447 DOI: 10.1001/jamainternmed.2024.0212] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 04/16/2024]
Abstract
Importance Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection. Objective To describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection. Design, Setting, and Participants This cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events. Exposures Acute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review. Main Outcomes and Measures Severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events. Results The study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31). Conclusions and Relevance In this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.
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Affiliation(s)
- Rebecca C. Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Melgar
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Huong Pham
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurence S. Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | | | | | | | - Kyle P. Openo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
- Research, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Patricia Ryan
- Emerging Infections Program, Maryland Department of Health, Baltimore
| | - Chloe Brown
- Michigan Department of Health and Human Services, Lansing
| | - Ruth Lynfield
- Health Protection Bureau, Minnesota Department of Health, St. Paul
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque
| | - Grant Barney
- Division of Epidemiology, New York State Department of Health, Albany
| | - Brenda Tesini
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland
| | - H. Keipp Talbot
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hafsa Zahid
- Epidemiology Bureau, Salt Lake County Health Department, Salt Lake City, Utah
| | - Lindsay Kim
- US Public Health Service Commissioned Corps, Rockville, Maryland
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fiona P. Havers
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
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2
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Milucky J, Patel K, Patton ME, Kirley PD, Austin E, Meek J, Anderson EJ, Brooks A, Brown C, Mumm E, Salazar-Sanchez Y, Barney G, Popham K, Sutton M, Talbot HK, Crossland MT, Havers FP. Characteristics and Outcomes of Pregnant Women Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus Before and During the COVID-19 Pandemic. Open Forum Infect Dis 2024; 11:ofae042. [PMID: 38524226 PMCID: PMC10960599 DOI: 10.1093/ofid/ofae042] [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: 12/27/2023] [Accepted: 01/25/2024] [Indexed: 03/26/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause severe disease among infants and older adults. Less is known about RSV among pregnant women. Methods To analyze hospitalizations with laboratory-confirmed RSV among women aged 18 to 49 years, we used data from the RSV Hospitalization Surveillance Network (RSV-NET), a multistate population-based surveillance system. Specifically, we compared characteristics and outcomes among (1) pregnant and nonpregnant women during the pre-COVID-19 pandemic period (2014-2018), (2) pregnant women with respiratory symptoms during the prepandemic and pandemic periods (2021-2023), and (3) pregnant women with and without respiratory symptoms in the pandemic period. Using multivariable logistic regression, we examined whether pregnancy was a risk factor for severe outcomes (intensive care unit admission or in-hospital death) among women aged 18 to 49 years who were hospitalized with RSV prepandemic. Results Prepandemic, 387 women aged 18 to 49 years were hospitalized with RSV. Of those, 350 (90.4%) had respiratory symptoms, among whom 33 (9.4%) were pregnant. Five (15.2%) pregnant women and 74 (23.3%) nonpregnant women were admitted to the intensive care unit; no pregnant women and 5 (1.6%) nonpregnant women died. Among 279 hospitalized pregnant women, 41 were identified prepandemic and 238 during the pandemic: 80.5% and 35.3% had respiratory symptoms, respectively (P < .001). Pregnant women were more likely to deliver during their RSV-associated hospitalization during the pandemic vs the prepandemic period (73.1% vs 43.9%, P < .001). Conclusions Few pregnant women had severe RSV disease, and pregnancy was not a risk factor for a severe outcome. More asymptomatic pregnant women were identified during the pandemic, likely due to changes in testing practices for RSV.
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Affiliation(s)
- Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kadam Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica E Patton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California, USA
| | - Elizabeth Austin
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Departments of Medicine and Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Alicia Brooks
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Chloe Brown
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Erica Mumm
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Kevin Popham
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Fiona P Havers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Kojima N, Taylor CA, Tenforde MW, Ujamaa D, O’Halloran A, Patel K, Chai SJ, Daily Kirley P, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Reeg L, Tellez Nunez V, Lynfield R, Como-Sabetti K, Ropp SL, Shaw YP, Spina NL, Barney G, Bushey S, Popham K, Moran NE, Shiltz E, Sutton M, Abdullah N, Talbot HK, Schaffner W, Chatelain R, Price A, Garg S, Havers FP, Bozio CH. Clinical Outcomes of US Adults Hospitalized for COVID-19 and Influenza in the Respiratory Virus Hospitalization Surveillance Network, October 2021-September 2022. Open Forum Infect Dis 2024; 11:ofad702. [PMID: 38269052 PMCID: PMC10807992 DOI: 10.1093/ofid/ofad702] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
Severe outcomes were common among adults hospitalized for COVID-19 or influenza, while the percentage of COVID-19 hospitalizations involving critical care decreased from October 2021 to September 2022. During the Omicron BA.5 period, intensive care unit admission frequency was similar for COVID-19 and influenza, although patients with COVID-19 had a higher frequency of in-hospital death.
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Affiliation(s)
- Noah Kojima
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher A Taylor
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dawud Ujamaa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alissa O’Halloran
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kadam Patel
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Evan J Anderson
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Kyle P Openo
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Val Tellez Nunez
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Susan L Ropp
- New Mexico Department of Health, Albuquerque, New Mexico, USA
| | - Yomei P Shaw
- New Mexico Department of Health, Albuquerque, New Mexico, USA
| | - Nancy L Spina
- New York State Department of Health, Albany, New York, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Sophrena Bushey
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Kevin Popham
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | | | - Eli Shiltz
- Ohio Department of Health, Columbus, Ohio, USA
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Nasreen Abdullah
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fiona P Havers
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Catherine H Bozio
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Havers FP, Whitaker M, Melgar M, Chatwani B, Chai SJ, Alden NB, Meek J, Openo KP, Ryan PA, Kim S, Lynfield R, Shaw YP, Barney G, Tesini BL, Sutton M, Talbot HK, Olsen KP, Patton ME. Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023. Am J Transplant 2023; 23:2000-2007. [PMID: 37863432 DOI: 10.1016/j.ajt.2023.10.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI = 15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI = 14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI = 3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI = 3.6%-6.1%) died; 17.2% (95% CI = 14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.
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Affiliation(s)
- Fiona P Havers
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC.
| | - Michael Whitaker
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Michael Melgar
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Bhoomija Chatwani
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Eagle Health Analytics, LLC., Atlanta, Georgia
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California; Career Epidemiology Field Officer Program, CDC
| | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Kyle P Openo
- Emory University School of Medicine, Atlanta, Georgia; Georgia Emerging Infections Program, Georgia Department of Public Health; Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Sue Kim
- Michigan Department of Health & Human Services
| | | | | | | | - Brenda L Tesini
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Monica E Patton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
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5
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Havers FP, Whitaker M, Melgar M, Chatwani B, Chai SJ, Alden NB, Meek J, Openo KP, Ryan PA, Kim S, Lynfield R, Shaw YP, Barney G, Tesini BL, Sutton M, Talbot HK, Olsen KP, Patton ME. Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1075-1082. [PMID: 37796742 PMCID: PMC10564327 DOI: 10.15585/mmwr.mm7240a1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI = 15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI = 14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI = 3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI = 3.6%-6.1%) died; 17.2% (95% CI = 14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - RSV-NET Surveillance Team
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Eagle Health Analytics, LLC., Atlanta, Georgia; California Emerging Infections Program, Oakland, California; Career Epidemiology Field Officer Program, CDC; Colorado Department of Public Health & Environment; Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut; Emory University School of Medicine, Atlanta, Georgia; Georgia Emerging Infections Program, Georgia Department of Public Health; Atlanta Veterans Affairs Medical Center, Decatur, Georgia; Maryland Department of Health; Michigan Department of Health & Human Services; Minnesota Department of Health; New Mexico Department of Health; New York State Department of Health; University of Rochester School of Medicine and Dentistry, Rochester, New York; Public Health Division, Oregon Health Authority; Vanderbilt University Medical Center, Nashville, Tennessee; Salt Lake County Health Department, Salt Lake City, Utah
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6
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Ko JY, Pham H, Anglin O, Chai SJ, Alden NB, Meek J, Anderson EJ, Weigel A, Kohrman A, Lynfield R, Rudin D, Barney G, Bennett NM, Billing LM, Sutton M, Talbot HK, Swain A, Havers FP, Taylor CA. Vaccination Status and Trends in Adult Coronavirus Disease 2019-Associated Hospitalizations by Race and Ethnicity: March 2020-August 2022. Clin Infect Dis 2023; 77:827-838. [PMID: 37132204 PMCID: PMC11019819 DOI: 10.1093/cid/ciad266] [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: 12/14/2022] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND We sought to determine whether race/ethnicity disparities in severe coronavirus disease 2019 (COVID-19) outcomes persist in the era of vaccination. METHODS Population-based age-adjusted monthly rate ratios (RRs) of laboratory-confirmed COVID-19-associated hospitalizations were calculated among adult patients from the COVID-19-Associated Hospitalization Surveillance Network, March 2020 - August 2022 by race/ethnicity. Among randomly sampled patients July 2021 - August 2022, RRs for hospitalization, intensive care unit (ICU) admission, and in-hospital mortality were calculated for Hispanic, Black, American Indian/Alaskan Native (AI/AN), and Asian/Pacific Islander (API) persons vs White persons. RESULTS Based on data from 353 807 patients, hospitalization rates were higher among Hispanic, Black, and AI/AN vs White persons March 2020 - August 2022, yet the magnitude declined over time (for Hispanic persons, RR = 6.7; 95% confidence interval [CI], 6.5-7.1 in June 2020 vs RR < 2.0 after July 2021; for AI/AN persons, RR = 8.4; 95% CI, 8.2-8.7 in May 2020 vs RR < 2.0 after March 2022; and for Black persons RR = 5.3; 95% CI, 4.6-4.9 in July 2020 vs RR < 2.0 after February 2022; all P ≤ .001). Among 8706 sampled patients July 2021 - August 2022, hospitalization and ICU admission RRs were higher for Hispanic, Black, and AI/AN patients (range for both, 1.4-2.4) and lower for API (range for both, 0.6-0.9) vs White patients. All other race and ethnicity groups had higher in-hospital mortality rates vs White persons (RR range, 1.4-2.9). CONCLUSIONS Race/ethnicity disparities in COVID-19-associated hospitalizations declined but persist in the era of vaccination. Developing strategies to ensure equitable access to vaccination and treatment remains important.
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Affiliation(s)
- Jean Y Ko
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Huong Pham
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Onika Anglin
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Department of Public Health, Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Alexander Kohrman
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Dominic Rudin
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Swain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Fiona P Havers
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Christopher A Taylor
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
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7
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Hamid S, Woodworth K, Pham H, Milucky J, Chai SJ, Kawasaki B, Yousey-Hindes K, Anderson EJ, Henderson J, Lynfield R, Pacheco F, Barney G, Bennett NM, Shiltz E, Sutton M, Talbot HK, Price A, Havers FP, Taylor CA. COVID-19-Associated Hospitalizations Among U.S. Infants Aged <6 Months - COVID-NET, 13 States, June 2021-August 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1442-1448. [PMID: 36355608 PMCID: PMC9707352 DOI: 10.15585/mmwr.mm7145a3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
COVID-19-associated hospitalization rates are highest among adults aged ≥65 years (1); however, COVID-19 can and does cause severe and fatal outcomes in children, including infants (2,3). After the emergence of the SARS-CoV-2 B.1.1.529 (Omicron) BA.1 variant in December 2021, hospitalizations among children aged <5 years, who were ineligible for vaccination, increased more rapidly than did those in other age groups (4). On June 18, 2022, CDC recommended COVID-19 vaccination for infants and children aged ≥6 months (5). Data from the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET)* were analyzed to describe changes in the age distribution of COVID-19-associated hospitalizations since the Delta-predominant period (June 20-December 18, 2021)† with a focus on U.S. infants aged <6 months. During the Omicron BA.2/BA.5-predominant periods (December 19, 2021–August 31, 2022), weekly hospitalizations per 100,000 infants aged <6 months increased from a nadir of 2.2 (week ending April 9, 2022) to a peak of 26.0 (week ending July 23, 2022), and the average weekly hospitalization rate among these infants (13.7) was similar to that among adults aged 65-74 years (13.8). However, the prevalence of indicators of severe disease§ among hospitalized infants did not increase since the B.1.617.2 (Delta)-predominant period. To help protect infants too young to be vaccinated, prevention should focus on nonpharmaceutical interventions and vaccination of pregnant women, which might provide protection through transplacental transfer of antibodies (6).
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Havers FP, Pham H, Taylor CA, Whitaker M, Patel K, Anglin O, Kambhampati AK, Milucky J, Zell E, Moline HL, Chai SJ, Kirley PD, Alden NB, Armistead I, Yousey-Hindes K, Meek J, Openo KP, Anderson EJ, Reeg L, Kohrman A, Lynfield R, Como-Sabetti K, Davis EM, Cline C, Muse A, Barney G, Bushey S, Felsen CB, Billing LM, Shiltz E, Sutton M, Abdullah N, Talbot HK, Schaffner W, Hill M, George A, Hall AJ, Bialek SR, Murthy NC, Murthy BP, McMorrow M. COVID-19-Associated Hospitalizations Among Vaccinated and Unvaccinated Adults 18 Years or Older in 13 US States, January 2021 to April 2022. JAMA Intern Med 2022; 182:1071-1081. [PMID: 36074486 PMCID: PMC9459904 DOI: 10.1001/jamainternmed.2022.4299] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
Importance Understanding risk factors for hospitalization in vaccinated persons and the association of COVID-19 vaccines with hospitalization rates is critical for public health efforts to control COVID-19. Objective To determine characteristics of COVID-19-associated hospitalizations among vaccinated persons and comparative hospitalization rates in unvaccinated and vaccinated persons. Design, Setting, and Participants From January 1, 2021, to April 30, 2022, patients 18 years or older with laboratory-confirmed SARS-CoV-2 infection were identified from more than 250 hospitals in the population-based COVID-19-Associated Hospitalization Surveillance Network. State immunization information system data were linked to cases, and the vaccination coverage data of the defined catchment population were used to compare hospitalization rates in unvaccinated and vaccinated individuals. Vaccinated and unvaccinated patient characteristics were compared in a representative sample with detailed medical record review; unweighted case counts and weighted percentages were calculated. Exposures Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test result within 14 days before or during hospitalization. Main Outcomes and Measures COVID-19-associated hospitalization rates among vaccinated vs unvaccinated persons and factors associated with COVID-19-associated hospitalization in vaccinated persons were assessed. Results Using representative data from 192 509 hospitalizations (see Table 1 for demographic information), monthly COVID-19-associated hospitalization rates ranged from 3.5 times to 17.7 times higher in unvaccinated persons than vaccinated persons regardless of booster dose status. From January to April 2022, when the Omicron variant was predominant, hospitalization rates were 10.5 times higher in unvaccinated persons and 2.5 times higher in vaccinated persons with no booster dose, respectively, compared with those who had received a booster dose. Among sampled cases, vaccinated hospitalized patients with COVID-19 were older than those who were unvaccinated (median [IQR] age, 70 [58-80] years vs 58 [46-70] years, respectively; P < .001) and more likely to have 3 or more underlying medical conditions (1926 [77.8%] vs 4124 [51.6%], respectively; P < .001). Conclusions and Relevance In this cross-sectional study of US adults hospitalized with COVID-19, unvaccinated adults were more likely to be hospitalized compared with vaccinated adults; hospitalization rates were lowest in those who had received a booster dose. Hospitalized vaccinated persons were older and more likely to have 3 or more underlying medical conditions and be long-term care facility residents compared with hospitalized unvaccinated persons. The study results suggest that clinicians and public health practitioners should continue to promote vaccination with all recommended doses for eligible persons.
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Affiliation(s)
- Fiona P Havers
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Huong Pham
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Christopher A Taylor
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Michael Whitaker
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Kadam Patel
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Onika Anglin
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Anita K Kambhampati
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Jennifer Milucky
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Elizabeth Zell
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Stat-Epi Associates, Inc, Ponte Vedra Beach, Florida
| | - Heidi L Moline
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Shua J Chai
- Field Services Branch, Division of State and Local Readiness, Center for Preparedness and Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- California Emerging Infections Program, Oakland
| | | | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver
| | - Isaac Armistead
- Colorado Department of Public Health and Environment, Denver
| | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | - Kyle P Openo
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
| | - Evan J Anderson
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
- Departments of Medicine and Pediatrics, Emory School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing
| | | | | | | | | | - Cory Cline
- New Mexico Department of Health, Santa Fe
| | | | | | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland
| | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Andrea George
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Aron J Hall
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Stephanie R Bialek
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Neil C Murthy
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Bhavini Patel Murthy
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Meredith McMorrow
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
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Taylor CA, Whitaker M, Anglin O, Milucky J, Patel K, Pham H, Chai SJ, Alden NB, Yousey-Hindes K, Anderson EJ, Teno K, Reeg L, Como-Sabetti K, Bleecker M, Barney G, Bennett NM, Billing LM, Sutton M, Talbot HK, McCaffrey K, Havers FP. COVID-19-Associated Hospitalizations Among Adults During SARS-CoV-2 Delta and Omicron Variant Predominance, by Race/Ethnicity and Vaccination Status - COVID-NET, 14 States, July 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:466-473. [PMID: 35324880 PMCID: PMC8956338 DOI: 10.15585/mmwr.mm7112e2] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Garg S, Patel K, Pham H, Whitaker M, O'Halloran A, Milucky J, Anglin O, Kirley PD, Reingold A, Kawasaki B, Herlihy R, Yousey-Hindes K, Maslar A, Anderson EJ, Openo KP, Weigel A, Teno K, Ryan PA, Monroe ML, Reeg L, Kim S, Como-Sabetti K, Bye E, Shrum Davis S, Eisenberg N, Muse A, Barney G, Bennett NM, Felsen CB, Billing L, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Hill M, Chatelain R, Wortham J, Taylor C, Hall A, Fry AM, Kim L, Havers FP. Clinical Trends Among U.S. Adults Hospitalized With COVID-19, March to December 2020 : A Cross-Sectional Study. Ann Intern Med 2021; 174:1409-1419. [PMID: 34370517 PMCID: PMC8381761 DOI: 10.7326/m21-1991] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused substantial morbidity and mortality. OBJECTIVE To describe monthly clinical trends among adults hospitalized with COVID-19. DESIGN Pooled cross-sectional study. SETTING 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET). PATIENTS U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. MEASUREMENTS Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. RESULTS Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. LIMITATION COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. CONCLUSION Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Kadam Patel
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Huong Pham
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Michael Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Jennifer Milucky
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Onika Anglin
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Amber Maslar
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Evan J Anderson
- Emory University School of Medicine and Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (E.J.A.)
| | - Kyle P Openo
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (K.P.O.)
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Kenzie Teno
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Patricia A Ryan
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | | | - Erica Bye
- Minnesota Department of Health, St. Paul, Minnesota (K.C., E.B.)
| | - Sarah Shrum Davis
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Nancy Eisenberg
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Alison Muse
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Grant Barney
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, Ohio (L.B., J.S.)
| | | | | | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Jonathan Wortham
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Christopher Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Aron Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Lindsay Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Fiona P Havers
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
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11
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Acosta AM, Garg S, Pham H, Whitaker M, Anglin O, O’Halloran A, Milucky J, Patel K, Taylor C, Wortham J, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Reeg L, Kohrman A, Lynfield R, Bye E, Torres S, Salazar-Sanchez Y, Muse A, Barney G, Bennett NM, Bushey S, Billing L, Shiltz E, Sutton M, Abdullah N, Talbot HK, Schaffner W, Ortega J, Price A, Fry AM, Hall A, Kim L, Havers FP. Racial and Ethnic Disparities in Rates of COVID-19-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death in the United States From March 2020 to February 2021. JAMA Netw Open 2021; 4:e2130479. [PMID: 34673962 PMCID: PMC8531997 DOI: 10.1001/jamanetworkopen.2021.30479] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Racial and ethnic minority groups are disproportionately affected by COVID-19. OBJECTIVES To evaluate whether rates of severe COVID-19, defined as hospitalization, intensive care unit (ICU) admission, or in-hospital death, are higher among racial and ethnic minority groups compared with non-Hispanic White persons. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 99 counties within 14 US states participating in the COVID-19-Associated Hospitalization Surveillance Network. Participants were persons of all ages hospitalized with COVID-19 from March 1, 2020, to February 28, 2021. EXPOSURES Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test within 14 days prior to or during hospitalization. MAIN OUTCOMES AND MEASURES Cumulative age-adjusted rates (per 100 000 population) of hospitalization, ICU admission, and death by race and ethnicity. Rate ratios (RR) were calculated for each racial and ethnic group compared with White persons. RESULTS Among 153 692 patients with COVID-19-associated hospitalizations, 143 342 (93.3%) with information on race and ethnicity were included in the analysis. Of these, 105 421 (73.5%) were 50 years or older, 72 159 (50.3%) were male, 28 762 (20.1%) were Hispanic or Latino, 2056 (1.4%) were non-Hispanic American Indian or Alaska Native, 7737 (5.4%) were non-Hispanic Asian or Pacific Islander, 40 806 (28.5%) were non-Hispanic Black, and 63 981 (44.6%) were White. Compared with White persons, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely to have higher cumulative age-adjusted rates of hospitalization, ICU admission, and death as follows: American Indian or Alaska Native (hospitalization: RR, 3.70; 95% CI, 3.54-3.87; ICU admission: RR, 6.49; 95% CI, 6.01-7.01; death: RR, 7.19; 95% CI, 6.47-7.99); Latino (hospitalization: RR, 3.06; 95% CI, 3.01-3.10; ICU admission: RR, 4.20; 95% CI, 4.08-4.33; death: RR, 3.85; 95% CI, 3.68-4.01); Black (hospitalization: RR, 2.85; 95% CI, 2.81-2.89; ICU admission: RR, 3.17; 95% CI, 3.09-3.26; death: RR, 2.58; 95% CI, 2.48-2.69); and Asian or Pacific Islander (hospitalization: RR, 1.03; 95% CI, 1.01-1.06; ICU admission: RR, 1.91; 95% CI, 1.83-1.98; death: RR, 1.64; 95% CI, 1.55-1.74). CONCLUSIONS AND RELEVANCE In this cross-sectional analysis, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely than White persons to have a COVID-19-associated hospitalization, ICU admission, or in-hospital death during the first year of the US COVID-19 pandemic. Equitable access to COVID-19 preventive measures, including vaccination, is needed to minimize the gap in racial and ethnic disparities of severe COVID-19.
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Affiliation(s)
- Anna M. Acosta
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shikha Garg
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Huong Pham
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Whitaker
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Onika Anglin
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Alissa O’Halloran
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Milucky
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kadam Patel
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Christopher Taylor
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Wortham
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Shua J. Chai
- California Emerging Infections Program, Oakland
- Career Epidemiology Field Officer, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver
| | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | | | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Kyle P. Openo
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | | | | | | | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing
| | | | | | - Erica Bye
- Minnesota Department of Health, St Paul
| | | | | | | | | | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | | | | | - H. Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Jake Ortega
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Alicia M. Fry
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Aron Hall
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsay Kim
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Fiona P. Havers
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
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12
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Wortham JM, Meador SA, Hadler JL, Yousey-Hindes K, See I, Whitaker M, O’Halloran A, Milucky J, Chai SJ, Reingold A, Alden NB, Kawasaki B, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan PA, Kim S, Reeg L, Lynfield R, McMahon M, Sosin DM, Eisenberg N, Rowe A, Barney G, Bennett NM, Bushey S, Billing LM, Shiltz J, Sutton M, West N, Talbot HK, Schaffner W, McCaffrey K, Spencer M, Kambhampati AK, Anglin O, Piasecki AM, Holstein R, Hall AJ, Fry AM, Garg S, Kim L. Census tract socioeconomic indicators and COVID-19-associated hospitalization rates-COVID-NET surveillance areas in 14 states, March 1-April 30, 2020. PLoS One 2021; 16:e0257622. [PMID: 34559838 PMCID: PMC8462704 DOI: 10.1371/journal.pone.0257622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Some studies suggested more COVID-19-associated hospitalizations among racial and ethnic minorities. To inform public health practice, the COVID-19-associated Hospitalization Surveillance Network (COVID-NET) quantified associations between race/ethnicity, census tract socioeconomic indicators, and COVID-19-associated hospitalization rates. METHODS Using data from COVID-NET population-based surveillance reported during March 1-April 30, 2020 along with socioeconomic and denominator data from the US Census Bureau, we calculated COVID-19-associated hospitalization rates by racial/ethnic and census tract-level socioeconomic strata. RESULTS Among 16,000 COVID-19-associated hospitalizations, 34.8% occurred among non-Hispanic White (White) persons, 36.3% among non-Hispanic Black (Black) persons, and 18.2% among Hispanic or Latino (Hispanic) persons. Age-adjusted COVID-19-associated hospitalization rate were 151.6 (95% Confidence Interval (CI): 147.1-156.1) in census tracts with >15.2%-83.2% of persons living below the federal poverty level (high-poverty census tracts) and 75.5 (95% CI: 72.9-78.1) in census tracts with 0%-4.9% of persons living below the federal poverty level (low-poverty census tracts). Among White, Black, and Hispanic persons living in high-poverty census tracts, age-adjusted hospitalization rates were 120.3 (95% CI: 112.3-128.2), 252.2 (95% CI: 241.4-263.0), and 341.1 (95% CI: 317.3-365.0), respectively, compared with 58.2 (95% CI: 55.4-61.1), 304.0 (95%: 282.4-325.6), and 540.3 (95% CI: 477.0-603.6), respectively, in low-poverty census tracts. CONCLUSIONS Overall, COVID-19-associated hospitalization rates were highest in high-poverty census tracts, but rates among Black and Hispanic persons were high regardless of poverty level. Public health practitioners must ensure mitigation measures and vaccination campaigns address needs of racial/ethnic minority groups and people living in high-poverty census tracts.
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Affiliation(s)
- Jonathan M. Wortham
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Seth A. Meador
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | - James L. Hadler
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, United States of America
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, United States of America
| | - Isaac See
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | | | | | | | - Shua J. Chai
- California Emerging Infections Program, Oakland, CA, United States of America
- CDC Career Epidemiology Field Officer, Oakland, CA, United States of America
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, CA, United States of America
| | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver, CO, United States of America
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, CO, United States of America
| | - Evan J. Anderson
- Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, United States of America
- Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Kyle P. Openo
- Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, United States of America
- Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, IA, United States of America
| | - Maya L. Monroe
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Patricia A. Ryan
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, MI, United States of America
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, MI, United States of America
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, MN, United States of America
| | - Melissa McMahon
- Minnesota Department of Health, St. Paul, MN, United States of America
| | - Daniel M. Sosin
- New Mexico Department of Health, Santa Fe, NM, United States of America
| | - Nancy Eisenberg
- University of New Mexico Emerging Infections Program, Albuquerque, NM, United States of America
| | - Adam Rowe
- New York State Department of Health, Albany, NY, United States of America
| | - Grant Barney
- New York State Department of Health, Albany, NY, United States of America
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, OH, United States of America
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - Nicole West
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - William Schaffner
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Keegan McCaffrey
- Utah Department of Health, Salt Lake City, UT, United States of America
| | - Melanie Spencer
- Salt Lake County Health Department, Salt Lake City, UT, United States of America
| | | | - Onika Anglin
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | | | | | - Aron J. Hall
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | - Alicia M. Fry
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Shikha Garg
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Lindsay Kim
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
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13
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Moline HL, Whitaker M, Deng L, Rhodes JC, Milucky J, Pham H, Patel K, Anglin O, Reingold A, Chai SJ, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Farley MM, Ryan PA, Kim S, Nunez VT, Como-Sabetti K, Lynfield R, Sosin DM, McMullen C, Muse A, Barney G, Bennett NM, Bushey S, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Chatelain R, Ortega J, Murthy BP, Zell E, Schrag SJ, Taylor C, Shang N, Verani JR, Havers FP. Effectiveness of COVID-19 Vaccines in Preventing Hospitalization Among Adults Aged ≥65 Years - COVID-NET, 13 States, February-April 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1088-1093. [PMID: 34383730 PMCID: PMC8360274 DOI: 10.15585/mmwr.mm7032e3] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical trials of COVID-19 vaccines currently authorized for emergency use in the United States (Pfizer-BioNTech, Moderna, and Janssen [Johnson & Johnson]) indicate that these vaccines have high efficacy against symptomatic disease, including moderate to severe illness (1-3). In addition to clinical trials, real-world assessments of COVID-19 vaccine effectiveness are critical in guiding vaccine policy and building vaccine confidence, particularly among populations at higher risk for more severe illness from COVID-19, including older adults. To determine the real-world effectiveness of the three currently authorized COVID-19 vaccines among persons aged ≥65 years during February 1-April 30, 2021, data on 7,280 patients from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) were analyzed with vaccination coverage data from state immunization information systems (IISs) for the COVID-NET catchment area (approximately 4.8 million persons). Among adults aged 65-74 years, effectiveness of full vaccination in preventing COVID-19-associated hospitalization was 96% (95% confidence interval [CI] = 94%-98%) for Pfizer-BioNTech, 96% (95% CI = 95%-98%) for Moderna, and 84% (95% CI = 64%-93%) for Janssen vaccine products. Effectiveness of full vaccination in preventing COVID-19-associated hospitalization among adults aged ≥75 years was 91% (95% CI = 87%-94%) for Pfizer-BioNTech, 96% (95% CI = 93%-98%) for Moderna, and 85% (95% CI = 72%-92%) for Janssen vaccine products. COVID-19 vaccines currently authorized in the United States are highly effective in preventing COVID-19-associated hospitalizations in older adults. In light of real-world data demonstrating high effectiveness of COVID-19 vaccines among older adults, efforts to increase vaccination coverage in this age group are critical to reducing the risk for COVID-19-related hospitalization.
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14
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Kambhampati AK, O’Halloran AC, Whitaker M, Magill SS, Chea N, Chai SJ, Daily Kirley P, Herlihy RK, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Monroe ML, Ryan PA, Kim S, Reeg L, Como-Sabetti K, Danila R, Davis SS, Torres S, Barney G, Spina NL, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Schaffner W, Talbot HK, Chatelain R, Hill M, Brammer L, Fry AM, Hall AJ, Wortham JM, Garg S, Kim L. COVID-19-Associated Hospitalizations Among Health Care Personnel - COVID-NET, 13 States, March 1-May 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1576-1583. [PMID: 33119554 PMCID: PMC7659917 DOI: 10.15585/mmwr.mm6943e3] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Health care personnel (HCP) can be exposed to SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), both within and outside the workplace, increasing their risk for infection. Among 6,760 adults hospitalized during March 1-May 31, 2020, for whom HCP status was determined by the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), 5.9% were HCP. Nursing-related occupations (36.3%) represented the largest proportion of HCP hospitalized with COVID-19. Median age of hospitalized HCP was 49 years, and 89.8% had at least one underlying medical condition, of which obesity was most commonly reported (72.5%). A substantial proportion of HCP with COVID-19 had indicators of severe disease: 27.5% were admitted to an intensive care unit (ICU), 15.8% required invasive mechanical ventilation, and 4.2% died during hospitalization. HCP can have severe COVID-19-associated illness, highlighting the need for continued infection prevention and control in health care settings as well as community mitigation efforts to reduce transmission.
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15
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Delahoy MJ, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Monroe ML, Ryan PA, Fox K, Kim S, Lynfield R, Siebman S, Davis SS, Sosin DM, Barney G, Muse A, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Schaffner W, Talbot HK, George A, Spencer M, Ellington S, Galang RR, Gilboa SM, Tong VT, Piasecki A, Brammer L, Fry AM, Hall AJ, Wortham JM, Kim L, Garg S. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1347-1354. [PMID: 32970655 PMCID: PMC7727497 DOI: 10.15585/mmwr.mm6938e1] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Kim L, Whitaker M, O’Halloran A, Kambhampati A, Chai SJ, Reingold A, Armistead I, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Ryan P, Monroe ML, Fox K, Kim S, Lynfield R, Bye E, Shrum Davis S, Smelser C, Barney G, Spina NL, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Talbot HK, Schaffner W, Risk I, Price A, Brammer L, Fry AM, Hall AJ, Langley GE, Garg S. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1081-1088. [PMID: 32790664 PMCID: PMC7440125 DOI: 10.15585/mmwr.mm6932e3] [Citation(s) in RCA: 373] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Most reported cases of coronavirus disease 2019 (COVID-19) in children aged <18 years appear to be asymptomatic or mild (1). Less is known about severe COVID-19 illness requiring hospitalization in children. During March 1-July 25, 2020, 576 pediatric COVID-19 cases were reported to the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associated hospitalizations in 14 states (2,3). Based on these data, the cumulative COVID-19-associated hospitalization rate among children aged <18 years during March 1-July 25, 2020, was 8.0 per 100,000 population, with the highest rate among children aged <2 years (24.8). During March 21-July 25, weekly hospitalization rates steadily increased among children (from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000). Overall, Hispanic or Latino (Hispanic) and non-Hispanic black (black) children had higher cumulative rates of COVID-19-associated hospitalizations (16.4 and 10.5 per 100,000, respectively) than did non-Hispanic white (white) children (2.1). Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization. Although the cumulative rate of pediatric COVID-19-associated hospitalization remains low (8.0 per 100,000 population) compared with that among adults (164.5),* weekly rates increased during the surveillance period, and one in three hospitalized children were admitted to the ICU, similar to the proportion among adults. Continued tracking of SARS-CoV-2 infections among children is important to characterize morbidity and mortality. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.
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17
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Thompson ND, Penna A, Eure TR, Bamberg WM, Barney G, Barter D, Clogher P, DeSilva MB, Dumyati G, Epson E, Frank L, Godine D, Irizarry L, Kainer MA, Li L, Lynfield R, Mahoehney JP, Nadle J, Ocampo V, Perry L, Ray SM, Davis SS, Sievers M, Wilson LE, Zhang AY, Stone ND, Magill SS. Epidemiology of Antibiotic Use for Urinary Tract Infection in Nursing Home Residents. J Am Med Dir Assoc 2019; 21:91-96. [PMID: 31822391 DOI: 10.1016/j.jamda.2019.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/09/2019] [Revised: 11/01/2019] [Accepted: 11/12/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. DESIGN Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. SETTING AND PARTICIPANTS Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). METHODS EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. RESULTS Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. CONCLUSIONS AND IMPLICATIONS One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship.
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Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Austin Penna
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Taniece R Eure
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver, CO
| | - Grant Barney
- New York Emerging Infections Program, Rochester, NY
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, CO
| | - Paula Clogher
- Connecticut Emerging Infections Program and the Yale School of Public Health, New Haven, CT
| | | | - Ghinwa Dumyati
- New York Emerging Infections Program, Rochester, NY; University of Rochester, Rochester, NY
| | - Erin Epson
- California Department of Health, Richmond, CA
| | - Linda Frank
- California Emerging Infections Program, Oakland, CA
| | | | | | | | - Linda Li
- Maryland Department of Health, Baltimore, MD
| | | | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA
| | | | - Lewis Perry
- Georgia Emerging Infections Program, Atlanta, GA
| | - Susan M Ray
- Georgia Emerging Infections Program, Atlanta, GA; Emory University, Atlanta, GA
| | | | | | | | | | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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18
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Thompson ND, Brown CJ, Eure T, Penna A, Bamberg W, Barney G, Barter D, Clogher P, Desilva M, Dumyati G, Epson E, Frank L, Godine D, Irizarry L, Kainer MA, Lynfield R, Mahoehney JP, Maloney M, Morabit S, Nadle J, Ocampo VLS, Pierce R, Ray SM, Shrum S, Sievers M, Wilson LE, Stone ND, Magill SS. 1831. Point Prevalence and Epidemiology of Antimicrobial Use in US Nursing Homes, 2017. Open Forum Infect Dis 2018. [PMCID: PMC6252607 DOI: 10.1093/ofid/ofy210.1487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The role of nursing homes (NH) in transmission of antimicrobial-resistant (AR) organisms is of growing concern. AR control requires evidence-based NH stewardship interventions; however, data on antimicrobial use (AU) from US NHs are scant. In the absence of other AU surveillance approaches, NH prevalence surveys can generate essential data, including rationale and indication. In 2017, an AU prevalence survey was conducted through the CDC’s Emerging Infections Program (EIP) to determine the prevalence and epidemiology of AU in NH residents. Methods NHs from California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee were randomly selected to participate in a 1-day AU point prevalence survey; participation was voluntary. For NH residents receiving antimicrobial drugs (AD) at the time of the survey, EIP staff reviewed available medical records to collect the AD route, rationale, and infection site(s). AD were categorized using the World Health Organization Anatomical Therapeutic Chemical classification system. Data were analyzed in SAS 9.4. Results Of 15,295 residents in 161 NHs, 1,261 (prevalence 8.2%, 95% confidence interval 7.8%-8.7%) received ≥1 AD at the time of the survey (AD range 1–4/resident). Of 1,452 total ADs, 77% were administered for treatment of an active infection, 19% for prophylaxis, 3% for noninfectious reasons, and no rationale documented in 1%. Most AD (80%) were administered by the oral/enteral route and most (87%) were antibacterials. The three most common infection sites were urinary tract (29%, of which 1/4 was for prophylaxis); wound, cellulitis or soft tissue (20%); and respiratory tract (14%). Among the 1,268 antibacterials (figure), fluoroquinolones (15%), combination penicillins (8%), third-generation cephalosporins (8%), and glycopepetides (5%) ranked among the top 10 classes in use. Conclusion This large-scale prevalence survey provides insight into AU in US NHs. On a given day, approximately 1 in 12 NH residents was receiving ≥1 AD. Notably, 30% of AD were administered for UTI, and AD in classes recommended for stewardship intervention were common. These findings highlight areas for evaluation to identify unnecessary use in NH. Prevalence survey data are important to inform and track the impact of stewardship interventions. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cedric J Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taniece Eure
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Austin Penna
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Grant Barney
- NY Emerging Infections Program, Center for Community Health, University of Rochester Medical Center, Rochester, New York
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Malini Desilva
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota
| | - Ghinwa Dumyati
- NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Linda Frank
- California Emerging Infections Program, Oakland, California
| | - Deborah Godine
- California Emerging Infections Program, Oakland, California
| | | | - Marion A Kainer
- Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, Tennessee
| | - Ruth Lynfield
- State Epidemiologist and Medical Director for Infectious Diseases, Epidemiology and Community Health, Minnesota Department of Health, St. Paul, Minnesota
| | - J P Mahoehney
- Minnesota EIP/Department of Health, Minneapolis, Minnesota
| | - Meghan Maloney
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Susan Morabit
- Georgia Emerging Infections Program, Decatur, Georgia
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Valerie L S Ocampo
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, Oregon
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | - Susan M Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Shrum
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Marla Sievers
- New Mexico EIP/Department of Health, Santa Fe, New Mexico
| | | | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Thompson ND, Brown C, Eure T, Penna A, Barney G, Barter D, Buhr N, Clogher P, Dumyati G, Epson E, Frank L, Godine D, Irizarry L, Johnston H, Kainer MA, Lynfield R, Mahoehney JP, Maloney M, Morabit S, Nadle J, Pierce R, Ray SM, Shrum S, Sievers M, Wilson LE, Stone ND, Magill SS. 1836. Characteristics of Nursing Homes Associated With Self-reported Implementation of Centers for Disease Control and Prevention (CDC) Core Elements of Antibiotic Stewardship. Open Forum Infect Dis 2018. [PMCID: PMC6252518 DOI: 10.1093/ofid/ofy210.1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cedric Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taniece Eure
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Austin Penna
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grant Barney
- NY Emerging Infections Program, Center for Community Health, University of Rochester Medical Center, Rochester, New York
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Nicolai Buhr
- Office of Infectious Disease Epidemiology and Outbreak Response, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | | | - Ghinwa Dumyati
- NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Linda Frank
- California Emerging Infections Program, Oakland, California
| | - Deborah Godine
- California Emerging Infections Program, Oakland, California
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Marion A Kainer
- Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, Tennessee
| | - Ruth Lynfield
- State Epidemiologist and Medical Director for Infectious Diseases, Epidemiology and Community Health, Minnesota Department of Health, St. Paul, Minnesota
| | - J P Mahoehney
- Minnesota EIP/Department of Health, Minneapolis, Minnesota
| | - Meghan Maloney
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Susan Morabit
- Georgia Emerging Infections Program, Decatur, Georgia
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Rebecca Pierce
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, Oregon
| | - Susan M Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Shrum
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Marla Sievers
- New Mexico EIP/Department of Health, Santa Fe, New Mexico
| | | | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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