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Lewis NM, Zhu Y, Peltan ID, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Bender WS, Taghizadeh L, Brown SM, Hager DN, Gong MN, Mohamed A, Exline MC, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Mohr NM, Mallow C, Lauring AS, Johnson NJ, Gibbs KW, Kwon JH, Columbus C, Gottlieb RL, Raver C, Vaughn IA, Ramesh M, Johnson C, Lamerato L, Safdar B, Casey JD, Rice TW, Halasa N, Chappell JD, Grijalva CG, Talbot HK, Baughman A, Womack KN, Swan SA, Harker E, Price A, DeCuir J, Surie D, Ellington S, Self WH. Vaccine Effectiveness Against Influenza A-Associated Hospitalization, Organ Failure, and Death: United States, 2022-2023. Clin Infect Dis 2024; 78:1056-1064. [PMID: 38051664 DOI: 10.1093/cid/ciad677] [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: 08/09/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Influenza circulation during the 2022-2023 season in the United States largely returned to pre-coronavirus disease 2019 (COVID-19)-pandemic patterns and levels. Influenza A(H3N2) viruses were detected most frequently this season, predominately clade 3C.2a1b.2a, a close antigenic match to the vaccine strain. METHODS To understand effectiveness of the 2022-2023 influenza vaccine against influenza-associated hospitalization, organ failure, and death, a multicenter sentinel surveillance network in the United States prospectively enrolled adults hospitalized with acute respiratory illness between 1 October 2022, and 28 February 2023. Using the test-negative design, vaccine effectiveness (VE) estimates against influenza-associated hospitalization, organ failures, and death were measured by comparing the odds of current-season influenza vaccination in influenza-positive case-patients and influenza-negative, SARS-CoV-2-negative control-patients. RESULTS A total of 3707 patients, including 714 influenza cases (33% vaccinated) and 2993 influenza- and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative controls (49% vaccinated) were analyzed. VE against influenza-associated hospitalization was 37% (95% confidence interval [CI]: 27%-46%) and varied by age (18-64 years: 47% [30%-60%]; ≥65 years: 28% [10%-43%]), and virus (A[H3N2]: 29% [6%-46%], A[H1N1]: 47% [23%-64%]). VE against more severe influenza-associated outcomes included: 41% (29%-50%) against influenza with hypoxemia treated with supplemental oxygen; 65% (56%-72%) against influenza with respiratory, cardiovascular, or renal failure treated with organ support; and 66% (40%-81%) against influenza with respiratory failure treated with invasive mechanical ventilation. CONCLUSIONS During an early 2022-2023 influenza season with a well-matched influenza vaccine, vaccination was associated with reduced risk of influenza-associated hospitalization and organ failure.
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Affiliation(s)
- Nathaniel M Lewis
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah, and University of Utah, Salt Lake City, Utah, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple and Dallas, Texas, and Texas A&M University College of Medicine, Temple, Texas, USA
| | - Tresa McNeal
- Baylor Scott and White Health, and Baylor College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Leyla Taghizadeh
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah, and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St.Louis, Missouri, USA
| | | | - Robert L Gottlieb
- Baylor University Medical Center Dallas, Baylor, Scott & White Heart and Vascular Hospital, Baylor, Scott and White Research Institute, Dallas, Texas, USA
| | | | - Ivana A Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan, USA
| | - Cassandra Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Basmah Safdar
- Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Harker
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ashley Price
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Jennifer DeCuir
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Diya Surie
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sascha Ellington
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt Institute for Clinical and Translational Research, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Lauring AS, Gaglani M, Ghamande S, Peltan ID, Brown SM, Ginde AA, Martinez A, Mohr NM, Gibbs KW, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Bendall EE, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Mosier JM, Safdar B, Casey JD, Talbot HK, Rice TW, Halasa N, Chappell JD, Grijalva CG, Baughman A, Womack KN, Swan SA, Johnson CA, Lwin CT, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults. JAMA Netw Open 2024; 7:e244954. [PMID: 38573635 DOI: 10.1001/jamanetworkopen.2024.4954] [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] [Indexed: 04/05/2024] Open
Abstract
Importance On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making. Objective To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status. Design, Setting, and Participants In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023. Exposures RSV, SARS-CoV-2, or influenza infection. Main Outcomes and Measures Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death. Results Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001). Conclusions and Relevance Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.
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Affiliation(s)
- Diya Surie
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine A Yuengling
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer DeCuir
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Amanda Martinez
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | | | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicholas J Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | | | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Aleda M Leis
- School of Public Health, University of Michigan, Ann Arbor
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Emily E Bendall
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California, Los Angeles
| | - Steven Y Chang
- Department of Medicine, University of California, Los Angeles
| | | | - Jennie H Kwon
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Cristie Columbus
- Baylor Scott &White Health, Dallas, Texas
- Texas A&M University College of Medicine, Dallas
| | - Ivana A Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan
| | - Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona, Tucson
| | - Basmah Safdar
- Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cassandra A Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cara T Lwin
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathaniel M Lewis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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3
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Raglow Z, Surie D, Chappell JD, Zhu Y, Martin ET, Kwon JH, Frosch AE, Mohamed A, Gilbert J, Bendall EE, Bahr A, Halasa N, Talbot HK, Grijalva CG, Baughman A, Womack KN, Johnson C, Swan SA, Koumans E, McMorrow ML, Harcourt JL, Atherton LJ, Burroughs A, Thornburg NJ, Self WH, Lauring AS. SARS-CoV-2 shedding and evolution in patients who were immunocompromised during the omicron period: a multicentre, prospective analysis. Lancet Microbe 2024; 5:e235-e246. [PMID: 38286131 DOI: 10.1016/s2666-5247(23)00336-1] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Prolonged SARS-CoV-2 infections in people who are immunocompromised might predict or source the emergence of highly mutated variants. The types of immunosuppression placing patients at highest risk for prolonged infection have not been systematically investigated. We aimed to assess risk factors for prolonged SARS-CoV-2 infection and associated intrahost evolution. METHODS In this multicentre, prospective analysis, participants were enrolled at five US medical centres. Eligible patients were aged 18 years or older, were SARS-CoV-2-positive in the previous 14 days, and had a moderately or severely immunocompromising condition or treatment. Nasal specimens were tested by real-time RT-PCR every 2-4 weeks until negative in consecutive specimens. Positive specimens underwent viral culture and whole genome sequencing. A Cox proportional hazards model was used to assess factors associated with duration of infection. FINDINGS From April 11, 2022, to Oct 1, 2022, 156 patients began the enrolment process, of whom 150 were enrolled and included in the analyses. Participants had B-cell malignancy or anti-B-cell therapy (n=18), solid organ transplantation or haematopoietic stem-cell transplantation (HSCT; n=59), AIDS (n=5), non-B-cell malignancy (n=23), and autoimmune or autoinflammatory conditions (n=45). 38 (25%) participants were real-time RT-PCR-positive and 12 (8%) were culture-positive 21 days or longer after initial SARS-CoV-2 detection or illness onset. Compared with the group with autoimmune or autoinflammatory conditions, patients with B-cell dysfunction (adjusted hazard ratio 0·32 [95% CI 0·15-0·64]), solid organ transplantation or HSCT (0·60 [0·38-0·94]), and AIDS (0·28 [0·08-1·00]) had longer duration of infection, defined as time to last positive real-time RT-PCR test. There was no significant difference in the non-B-cell malignancy group (0·58 [0·31-1·09]). Consensus de novo spike mutations were identified in five individuals who were real-time RT-PCR-positive longer than 56 days; 14 (61%) of 23 were in the receptor-binding domain. Mutations shared by multiple individuals were rare (<5%) in global circulation. INTERPRETATION In this cohort, prolonged replication-competent omicron SARS-CoV-2 infections were uncommon. Within-host evolutionary rates were similar across patients, but individuals with infections lasting longer than 56 days accumulated spike mutations, which were distinct from those seen globally. Populations at high risk should be targeted for repeated testing and treatment and monitored for the emergence of antiviral resistance. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Zoe Raglow
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Diya Surie
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, MO, USA
| | - Anne E Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Julie Gilbert
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily E Bendall
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Auden Bahr
- Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cassandra Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emilia Koumans
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meredith L McMorrow
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L Harcourt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lydia J Atherton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Burroughs
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natalie J Thornburg
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA.
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Gaglani M, Ginde AA, Talbot HK, Casey JD, Mohr NM, Ghamande S, Gibbs KW, Files DC, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Safdar B, Halasa N, Chappell JD, Grijalva CG, Baughman A, Rice TW, Womack KN, Han JH, Swan SA, Mukherjee I, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Disease Severity of Respiratory Syncytial Virus Compared with COVID-19 and Influenza Among Hospitalized Adults Aged ≥60 Years - IVY Network, 20 U.S. States, February 2022-May 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1083-1088. [PMID: 37796753 PMCID: PMC10564326 DOI: 10.15585/mmwr.mm7240a2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
On June 21, 2023, CDC's Advisory Committee on Immunization Practices recommended respiratory syncytial virus (RSV) vaccination for adults aged ≥60 years, offered to individual adults using shared clinical decision-making. Informed use of these vaccines requires an understanding of RSV disease severity. To characterize RSV-associated severity, 5,784 adults aged ≥60 years hospitalized with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 U.S. states during February 1, 2022-May 31, 2023. Multivariable logistic regression was used to compare RSV disease severity with COVID-19 and influenza severity on the basis of the following outcomes: 1) standard flow (<30 L/minute) oxygen therapy, 2) high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV), 3) intensive care unit (ICU) admission, and 4) invasive mechanical ventilation (IMV) or death. Overall, 304 (5.3%) enrolled adults were hospitalized with RSV, 4,734 (81.8%) with COVID-19 and 746 (12.9%) with influenza. Patients hospitalized with RSV were more likely to receive standard flow oxygen, HFNC or NIV, and ICU admission than were those hospitalized with COVID-19 or influenza. Patients hospitalized with RSV were more likely to receive IMV or die compared with patients hospitalized with influenza (adjusted odds ratio = 2.08; 95% CI = 1.33-3.26). Among hospitalized older adults, RSV was less common, but was associated with more severe disease than COVID-19 or influenza. High disease severity in older adults hospitalized with RSV is important to consider in shared clinical decision-making regarding RSV vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Vanderbilt University Medical Center, Nashville, Tennessee; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Baylor, Scott & White Health, Dallas, Texas; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, New York, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Stanford, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; The Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Henry Ford Health, Detroit, Michigan; Yale University School of Medicine, New Haven, Connecticut; Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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5
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Raglow Z, Surie D, Chappell JD, Zhu Y, Martin ET, Kwon JH, Frosch AE, Mohamed A, Gilbert J, Bendall EE, Bahr A, Halasa N, Talbot HK, Grijalva CG, Baughman A, Womack KN, Johnson C, Swan SA, Koumans E, McMorrow ML, Harcourt JL, Atherton LJ, Burroughs A, Thornburg NJ, Self WH, Lauring AS. SARS-CoV-2 shedding and evolution in immunocompromised hosts during the Omicron period: a multicenter prospective analysis. medRxiv 2023:2023.08.22.23294416. [PMID: 37662226 PMCID: PMC10473782 DOI: 10.1101/2023.08.22.23294416] [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] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Prolonged SARS-CoV-2 infections in immunocompromised hosts may predict or source the emergence of highly mutated variants. The types of immunosuppression placing patients at highest risk for prolonged infection and associated intrahost viral evolution remain unclear. Methods Adults aged ≥18 years were enrolled at 5 hospitals and followed from 4/11/2022 - 2/1/2023. Eligible patients were SARS-CoV-2-positive in the previous 14 days and had a moderate or severely immunocompromising condition or treatment. Nasal specimens were tested by rRT-PCR every 2-4 weeks until negative in consecutive specimens. Positive specimens underwent viral culture and whole genome sequencing. A Cox proportional hazards model was used to assess factors associated with duration of infection. Results We enrolled 150 patients with: B cell malignancy or anti-B cell therapy (n=18), solid organ or hematopoietic stem cell transplant (SOT/HSCT) (n=59), AIDS (n=5), non-B cell malignancy (n=23), and autoimmune/autoinflammatory conditions (n=45). Thirty-eight (25%) were rRT-PCR-positive and 12 (8%) were culture-positive ≥21 days after initial SARS-CoV-2 detection or illness onset. Patients with B cell dysfunction had longer duration of rRT-PCR-positivity compared to those with autoimmune/autoinflammatory conditions (aHR 0.32, 95% CI 0.15-0.64). Consensus (>50% frequency) spike mutations were identified in 5 individuals who were rRT-PCR-positive >56 days; 61% were in the receptor-binding domain (RBD). Mutations shared by multiple individuals were rare (<5%) in global circulation. Conclusions In this cohort, prolonged replication-competent Omicron SARS-CoV-2 infections were uncommon. Within-host evolutionary rates were similar across patients, but individuals with infections lasting >56 days accumulated spike mutations, which were distinct from those seen globally.
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Affiliation(s)
- Zoe Raglow
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Diya Surie
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Anne E Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Julie Gilbert
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Emily E Bendall
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Auden Bahr
- Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cassandra Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emilia Koumans
- Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Meredith L McMorrow
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jennifer L Harcourt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Lydia J Atherton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Ashley Burroughs
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Natalie J Thornburg
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research and Department of Emergency Medicine and, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan
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6
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Kojima N, Adams K, Self WH, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Busse LW, Prekker ME, Peltan ID, Brown SM, Hager DN, Ali H, Gong MN, Mohamed A, Exline MC, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Withers CA, Mohr NM, Mallow C, Martin ET, Lauring AS, Johnson NJ, Casey JD, Stubblefield WB, Gibbs KW, Kwon JH, Baughman A, Chappell JD, Hart KW, Jones ID, Rhoads JP, Swan SA, Womack KN, Zhu Y, Surie D, McMorrow ML, Patel MM, Tenforde MW. Changing Severity and Epidemiology of Adults Hospitalized With Coronavirus Disease 2019 (COVID-19) in the United States After Introduction of COVID-19 Vaccines, March 2021-August 2022. Clin Infect Dis 2023; 77:547-557. [PMID: 37255285 PMCID: PMC10526883 DOI: 10.1093/cid/ciad276] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 02/05/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. METHODS Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. RESULTS Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. CONCLUSIONS Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.
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Affiliation(s)
- Noah Kojima
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Department of Pediatrics, Baylor Scott & White Health and Texas A&M University College of Medicine, Temple and Dallas, Texas, USA
| | - Tresa McNeal
- Department of Medical Education, Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Department of Medical Education, Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cori A Withers
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diya Surie
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dimcheff DE, Blair CN, Zhu Y, Chappell JD, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Busse LW, Frosch AEP, Peltan ID, Hager DN, Gong MN, Exline MC, Khan A, Wilson JG, Qadir N, Ginde AA, Douin DJ, Mohr NM, Mallow C, Martin ET, Johnson NJ, Casey JD, Stubblefield WB, Gibbs KW, Kwon JH, Talbot HK, Halasa N, Grijalva CG, Baughman A, Womack KN, Hart KW, Swan SA, Surie D, Thornburg NJ, McMorrow ML, Self WH, Lauring AS. Total and Subgenomic RNA Viral Load in Patients Infected With SARS-CoV-2 Alpha, Delta, and Omicron Variants. J Infect Dis 2023; 228:235-244. [PMID: 36883903 PMCID: PMC10420395 DOI: 10.1093/infdis/jiad061] [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: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic and subgenomic RNA levels are frequently used as a correlate of infectiousness. The impact of host factors and SARS-CoV-2 lineage on RNA viral load is unclear. METHODS Total nucleocapsid (N) and subgenomic N (sgN) RNA levels were measured by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in specimens from 3204 individuals hospitalized with coronavirus disease 2019 (COVID-19) at 21 hospitals. RT-qPCR cycle threshold (Ct) values were used to estimate RNA viral load. The impact of time of sampling, SARS-CoV-2 variant, age, comorbidities, vaccination, and immune status on N and sgN Ct values were evaluated using multiple linear regression. RESULTS Mean Ct values at presentation for N were 24.14 (SD 4.53) for non-variants of concern, 25.15 (SD 4.33) for Alpha, 25.31 (SD 4.50) for Delta, and 26.26 (SD 4.42) for Omicron. N and sgN RNA levels varied with time since symptom onset and infecting variant but not with age, comorbidity, immune status, or vaccination. When normalized to total N RNA, sgN levels were similar across all variants. CONCLUSIONS RNA viral loads were similar among hospitalized adults, irrespective of infecting variant and known risk factors for severe COVID-19. Total N and subgenomic RNA N viral loads were highly correlated, suggesting that subgenomic RNA measurements add little information for the purposes of estimating infectivity.
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Affiliation(s)
- Derek E Dimcheff
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher N Blair
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Anne E P Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah, USA
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, Missouri, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith L McMorrow
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
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8
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Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, Vonderhaar DJ, Whitson MR, Barnes CR, Walco JP, Douglas IS, Krishnamoorthy V, Dagan A, Bastman JJ, Lloyd BD, Gandotra S, Goranson JK, Mitchell SH, White HD, Palakshappa JA, Espinera A, Page DB, Joffe A, Hansen SJ, Hughes CG, George T, Herbert JT, Shapiro NI, Schauer SG, Long BJ, Imhoff B, Wang L, Rhoads JP, Womack KN, Janz DR, Self WH, Rice TW, Ginde AA, Casey JD, Semler MW. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med 2023; 389:418-429. [PMID: 37326325 DOI: 10.1056/nejmoa2301601] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [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] [Indexed: 06/17/2023]
Abstract
BACKGROUND Whether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain. METHODS In a multicenter, randomized trial conducted at 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video-laryngoscope group or the direct-laryngoscope group. The primary outcome was successful intubation on the first attempt. The secondary outcome was the occurrence of severe complications during intubation; severe complications were defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death. RESULTS The trial was stopped for efficacy at the time of the single preplanned interim analysis. Among 1417 patients who were included in the final analysis (91.5% of whom underwent intubation that was performed by an emergency medicine resident or a critical care fellow), successful intubation on the first attempt occurred in 600 of the 705 patients (85.1%) in the video-laryngoscope group and in 504 of the 712 patients (70.8%) in the direct-laryngoscope group (absolute risk difference, 14.3 percentage points; 95% confidence interval [CI], 9.9 to 18.7; P<0.001). A total of 151 patients (21.4%) in the video-laryngoscope group and 149 patients (20.9%) in the direct-laryngoscope group had a severe complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, -3.9 to 4.9). Safety outcomes, including esophageal intubation, injury to the teeth, and aspiration, were similar in the two groups. CONCLUSIONS Among critically ill adults undergoing tracheal intubation in an emergency department or ICU, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than the use of a direct laryngoscope. (Funded by the U.S. Department of Defense; DEVICE ClinicalTrials.gov number, NCT05239195.).
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Affiliation(s)
- Matthew E Prekker
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Brian E Driver
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Stacy A Trent
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Daniel Resnick-Ault
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Kevin P Seitz
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Derek W Russell
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - John P Gaillard
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Andrew J Latimer
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Shekhar A Ghamande
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Kevin W Gibbs
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Derek J Vonderhaar
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Micah R Whitson
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Christopher R Barnes
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jeremy P Walco
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Ivor S Douglas
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Vijay Krishnamoorthy
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Alon Dagan
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jill J Bastman
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Bradley D Lloyd
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Sheetal Gandotra
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jordan K Goranson
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Steven H Mitchell
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Heath D White
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jessica A Palakshappa
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Alyssa Espinera
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - David B Page
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Aaron Joffe
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Sydney J Hansen
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Christopher G Hughes
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Tobias George
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - J Taylor Herbert
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Nathan I Shapiro
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Steven G Schauer
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Brit J Long
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Brant Imhoff
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Li Wang
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jillian P Rhoads
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Kelsey N Womack
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - David R Janz
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Wesley H Self
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Todd W Rice
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Adit A Ginde
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jonathan D Casey
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Matthew W Semler
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
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Surie D, Bonnell LN, DeCuir J, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Busse LW, Prekker ME, Peltan ID, Brown SM, Hager DN, Ali H, Gong MN, Mohamed A, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Huynh D, Mohr NM, Mallow C, Martin ET, Lauring AS, Johnson NJ, Casey JD, Gibbs KW, Kwon JH, Baughman A, Chappell JD, Hart KW, Grijalva CG, Rhoads JP, Swan SA, Keipp Talbot H, Womack KN, Zhu Y, Tenforde MW, Adams K, Self WH, McMorrow ML. Comparison of mRNA vaccine effectiveness against COVID-19-associated hospitalization by vaccination source: Immunization information systems, electronic medical records, and self-report-IVY Network, February 1-August 31, 2022. Vaccine 2023:S0264-410X(23)00567-4. [PMID: 37301704 DOI: 10.1016/j.vaccine.2023.05.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Accurate determination of COVID-19 vaccination status is necessary to produce reliable COVID-19 vaccine effectiveness (VE) estimates. Data comparing differences in COVID-19 VE by vaccination sources (i.e., immunization information systems [IIS], electronic medical records [EMR], and self-report) are limited. We compared the number of mRNA COVID-19 vaccine doses identified by each of these sources to assess agreement as well as differences in VE estimates using vaccination data from each individual source and vaccination data adjudicated from all sources combined. METHODS Adults aged ≥18 years who were hospitalized with COVID-like illness at 21 hospitals in 18 U.S. states participating in the IVY Network during February 1-August 31, 2022, were enrolled. Numbers of COVID-19 vaccine doses identified by IIS, EMR, and self-report were compared in kappa agreement analyses. Effectiveness of mRNA COVID-19 vaccines against COVID-19-associated hospitalization was estimated using multivariable logistic regression models to compare the odds of COVID-19 vaccination between SARS-CoV-2-positive case-patients and SARS-CoV-2-negative control-patients. VE was estimated using each source of vaccination data separately and all sources combined. RESULTS A total of 4499 patients were included. Patients with ≥1 mRNA COVID-19 vaccine dose were identified most frequently by self-report (n = 3570, 79 %), followed by IIS (n = 3272, 73 %) and EMR (n = 3057, 68 %). Agreement was highest between IIS and self-report for 4 doses with a kappa of 0.77 (95 % CI = 0.73-0.81). VE point estimates of 3 doses against COVID-19 hospitalization were substantially lower when using vaccination data from EMR only (VE = 31 %, 95 % CI = 16 %-43 %) than when using all sources combined (VE = 53 %, 95 % CI = 41 %-62%). CONCLUSION Vaccination data from EMR only may substantially underestimate COVID-19 VE.
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Affiliation(s)
- Diya Surie
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Levi N Bonnell
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States; General Dynamics Information Technology, Falls Church, VA, United States
| | - Jennifer DeCuir
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Manjusha Gaglani
- Baylor Scott & White Health and Texas A&M University College of Medicine, Temple, TX, United States
| | - Tresa McNeal
- Baylor Scott & White Health and Texas A&M University College of Medicine, Temple, TX, United States
| | - Shekhar Ghamande
- Baylor Scott & White Health and Texas A&M University College of Medicine, Temple, TX, United States
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, MA, United States
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Laurence W Busse
- Department of Medicine, Emory University, Atlanta, GA, United States
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, UT and University of Utah, Salt Lake City, UT, United States
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, UT and University of Utah, Salt Lake City, UT, United States
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Amira Mohamed
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, United States
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, United States
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, United States
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - David Huynh
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, MO, United States
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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DeCuir J, Surie D, Zhu Y, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Phan M, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Gottlieb R, Vaughn IA, Ramesh M, Lamerato LE, Safdar B, Halasa N, Chappell JD, Grijalva CG, Baughman A, Womack KN, Rhoads JP, Hart KW, Swan SA, Lewis N, McMorrow ML, Self WH. Effectiveness of Monovalent mRNA COVID-19 Vaccination in Preventing COVID-19-Associated Invasive Mechanical Ventilation and Death Among Immunocompetent Adults During the Omicron Variant Period - IVY Network, 19 U.S. States, February 1, 2022-January 31, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:463-468. [PMID: 37104244 DOI: 10.15585/mmwr.mm7217a3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
As of April 2023, the COVID-19 pandemic has resulted in 1.1 million deaths in the United States, with approximately 75% of deaths occurring among adults aged ≥65 years (1). Data on the durability of protection provided by monovalent mRNA COVID-19 vaccination against critical outcomes of COVID-19 are limited beyond the Omicron BA.1 lineage period (December 26, 2021-March 26, 2022). In this case-control analysis, the effectiveness of 2-4 monovalent mRNA COVID-19 vaccine doses was evaluated against COVID-19-associated invasive mechanical ventilation (IMV) and in-hospital death among immunocompetent adults aged ≥18 years during February 1, 2022-January 31, 2023. Vaccine effectiveness (VE) against IMV and in-hospital death was 62% among adults aged ≥18 years and 69% among those aged ≥65 years. When stratified by time since last dose, VE was 76% at 7-179 days, 54% at 180-364 days, and 56% at ≥365 days. Monovalent mRNA COVID-19 vaccination provided substantial, durable protection against IMV and in-hospital death among adults during the Omicron variant period. All adults should remain up to date with recommended COVID-19 vaccination to prevent critical COVID-19-associated outcomes.
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11
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Tenforde MW, Patel MM, Lewis NM, Adams K, Gaglani M, Steingrub JS, Shapiro NI, Duggal A, Prekker ME, Peltan ID, Hager DN, Gong MN, Exline MC, Ginde AA, Mohr NM, Mallow C, Martin ET, Talbot HK, Gibbs KW, Kwon JH, Chappell JD, Halasa N, Lauring AS, Lindsell CJ, Swan SA, Hart KW, Womack KN, Baughman A, Grijalva CG, Self WH. Vaccine Effectiveness Against Influenza A(H3N2)-Associated Hospitalized Illness: United States, 2022. Clin Infect Dis 2023; 76:1030-1037. [PMID: 36327388 PMCID: PMC10226741 DOI: 10.1093/cid/ciac869] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic was associated with historically low influenza circulation during the 2020-2021 season, followed by an increase in influenza circulation during the 2021-2022 US season. The 2a.2 subgroup of the influenza A(H3N2) 3C.2a1b subclade that predominated was antigenically different from the vaccine strain. METHODS To understand the effectiveness of the 2021-2022 vaccine against hospitalized influenza illness, a multistate sentinel surveillance network enrolled adults aged ≥18 years hospitalized with acute respiratory illness and tested for influenza by a molecular assay. Using the test-negative design, vaccine effectiveness (VE) was measured by comparing the odds of current-season influenza vaccination in influenza-positive case-patients and influenza-negative, SARS-CoV-2-negative controls, adjusting for confounders. A separate analysis was performed to illustrate bias introduced by including SARS-CoV-2-positive controls. RESULTS A total of 2334 patients, including 295 influenza cases (47% vaccinated), 1175 influenza- and SARS-CoV-2-negative controls (53% vaccinated), and 864 influenza-negative and SARS-CoV-2-positive controls (49% vaccinated), were analyzed. Influenza VE was 26% (95% CI: -14% to 52%) among adults aged 18-64 years, -3% (-54% to 31%) among adults aged ≥65 years, and 50% (15-71%) among adults aged 18-64 years without immunocompromising conditions. Estimated VE decreased with inclusion of SARS-CoV-2-positive controls. CONCLUSIONS During a season where influenza A(H3N2) was antigenically different from the vaccine virus, vaccination was associated with a reduced risk of influenza hospitalization in younger immunocompetent adults. However, vaccination did not provide protection in adults ≥65 years of age. Improvements in vaccines, antivirals, and prevention strategies are warranted.
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Affiliation(s)
- Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nathaniel M Lewis
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew E Prekker
- Departments of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, Missouri, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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Tenforde MW, Self WH, Zhu Y, Naioti EA, Gaglani M, Ginde AA, Jensen K, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Lohuis CT, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Botros MM, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Turbyfill C, Olson S, Murray N, Adams K, Patel MM. Protection of Messenger RNA Vaccines Against Hospitalized Coronavirus Disease 2019 in Adults Over the First Year Following Authorization in the United States. Clin Infect Dis 2023; 76:e460-e468. [PMID: 35580849 PMCID: PMC9129194 DOI: 10.1093/cid/ciac381] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 02/09/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines were authorized in the United States in December 2020. Although vaccine effectiveness (VE) against mild infection declines markedly after several months, limited understanding exists on the long-term durability of protection against COVID-19-associated hospitalization. METHODS Case-control analysis of adults (≥18 years) hospitalized at 21 hospitals in 18 states 11 March-15 December 2021, including COVID-19 case patients and reverse transcriptase-polymerase chain reaction-negative controls. We included adults who were unvaccinated or vaccinated with 2 doses of a mRNA vaccine before the date of illness onset. VE over time was assessed using logistic regression comparing odds of vaccination in cases versus controls, adjusting for confounders. Models included dichotomous time (<180 vs ≥180 days since dose 2) and continuous time modeled using restricted cubic splines. RESULTS A total of 10 078 patients were included, 4906 cases (23% vaccinated) and 5172 controls (62% vaccinated). Median age was 60 years (interquartile range, 46-70), 56% were non-Hispanic White, and 81% had ≥1 medical condition. Among immunocompetent adults, VE <180 days was 90% (95% confidence interval [CI], 88-91) versus 82% (95% CI, 79-85) at ≥180 days (P < .001). VE declined for Pfizer-BioNTech (88% to 79%, P < .001) and Moderna (93% to 87%, P < .001) products, for younger adults (18-64 years) (91% to 87%, P = .005), and for adults ≥65 years of age (87% to 78%, P < .001). In models using restricted cubic splines, similar changes were observed. CONCLUSIONS In a period largely predating Omicron variant circulation, effectiveness of 2 mRNA doses against COVID-19-associated hospitalization was largely sustained through 9 months.
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Affiliation(s)
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kelly Jensen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Tresa McNeal
- Baylor Scott & White Health, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott & White Health, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Kevin W Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - D Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Arber Shehu
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Michelle N Gong
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | - Ithan D Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Akram Khan
- Oregon Health & Science University Hospital, Portland, Oregon, USA
| | | | | | | | | | | | - Nida Qadir
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Steven Y Chang
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | | | | | | | | | - Matthew C Exline
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mena M Botros
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adam S Lauring
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Nathan I Shapiro
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ian D Jones
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Kelsey N Womack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Kimberly W Hart
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Nancy Murray
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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13
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Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz K, Russell DW, Gandotra S, Gaillard JP, Gibbs KW, Latimer A, Whitson MR, Ghamande S, Vonderhaar DJ, Walco JP, Hansen SJ, Douglas IS, Barnes CR, Krishnamoorthy V, Bastman JJ, Lloyd BD, Robison SW, Palakshappa JA, Mitchell S, Page DB, White HD, Espinera A, Hughes C, Joffe AM, Herbert JT, Schauer SG, Long BJ, Imhoff B, Wang L, Rhoads JP, Womack KN, Janz D, Self WH, Rice TW, Ginde AA, Casey JD, Semler MW. DirEct versus VIdeo LaryngosCopE (DEVICE): protocol and statistical analysis plan for a randomised clinical trial in critically ill adults undergoing emergency tracheal intubation. BMJ Open 2023; 13:e068978. [PMID: 36639210 PMCID: PMC9843219 DOI: 10.1136/bmjopen-2022-068978] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Among critically ill patients undergoing orotracheal intubation in the emergency department (ED) or intensive care unit (ICU), failure to visualise the vocal cords and intubate the trachea on the first attempt is associated with an increased risk of complications. Two types of laryngoscopes are commonly available: direct laryngoscopes and video laryngoscopes. For critically ill adults undergoing emergency tracheal intubation, it remains uncertain whether the use of a video laryngoscope increases the incidence of successful intubation on the first attempt compared with the use of a direct laryngoscope. METHODS AND ANALYSIS The DirEct versus VIdeo LaryngosCopE (DEVICE) trial is a prospective, multicentre, non-blinded, randomised trial being conducted in 7 EDs and 10 ICUs in the USA. The trial plans to enrol up to 2000 critically ill adults undergoing orotracheal intubation with a laryngoscope. Eligible patients are randomised 1:1 to the use of a video laryngoscope or a direct laryngoscope for the first intubation attempt. The primary outcome is successful intubation on the first attempt. The secondary outcome is the incidence of severe complications between induction and 2 min after intubation, defined as the occurrence of one or more of the following: severe hypoxaemia (lowest oxygen saturation <80%); severe hypotension (systolic blood pressure <65 mm Hg or new or increased vasopressor administration); cardiac arrest or death. Enrolment began on 19 March 2022 and is expected to be completed in 2023. ETHICS AND DISSEMINATION The trial protocol was approved with waiver of informed consent by the single institutional review board at Vanderbilt University Medical Center and the Human Research Protection Office of the Department of Defense. The results will be presented at scientific conferences and submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05239195).
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Affiliation(s)
- Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Stacy A Trent
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Daniel Resnick-Ault
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Kevin Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Derek W Russell
- Pulmonary Section, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sheetal Gandotra
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John P Gaillard
- Department of Emergency Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
- Department of Anesthesiology, Section on Critical Care, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Kevin W Gibbs
- Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew Latimer
- Department of Emergency Medicine, University of Washington Harborview Medical Center, Seattle, Washington, USA
| | - Micah R Whitson
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shekhar Ghamande
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Derek J Vonderhaar
- Department of Pulmonary and Critical Care Medicine, Ochsner Health, New Orleans, Louisiana, USA
| | - Jeremy P Walco
- Department of Anesthesiology, Division of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney J Hansen
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ivor S Douglas
- Division of Pulmonary and Critical Care Medicine, Denver Health Medical Center, Denver, Colorado, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher R Barnes
- Department of Anesthesiology and Critical Care Medicine, University of Washington Harborview Medical Center, Seattle, Washington, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jill J Bastman
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Bradley Daniel Lloyd
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah W Robison
- Pulmonary Section, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica A Palakshappa
- Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven Mitchell
- Department of Emergency Medicine, University of Washington Harborview Medical Center, Seattle, Washington, USA
| | - David B Page
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Heath D White
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Alyssa Espinera
- Department of Pulmonary and Critical Care Medicine, Ochsner Health, New Orleans, Louisiana, USA
| | - Christopher Hughes
- Department of Anesthesiology, Division of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Joffe
- Department of Anesthesiology and Critical Care Medicine, University of Washington Harborview Medical Center, Seattle, Washington, USA
| | - J Taylor Herbert
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven G Schauer
- US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Brit J Long
- 59th Medical Wing, Joint Base San Antonio-Lackland, Texas, USA
| | - Brant Imhoff
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Janz
- Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, University Medical Center New Orleans, New Orleans, Louisiana, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd W Rice
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Jonathan D Casey
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew W Semler
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Surie D, DeCuir J, Zhu Y, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Ali H, Taghizadeh L, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Khan A, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Halasa N, Chappell JD, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Hart KW, Swan SA, Lewis NM, McMorrow ML, Self WH. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years - IVY Network, 18 States, September 8-November 30, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1625-1630. [PMID: 36580424 PMCID: PMC9812444 DOI: 10.15585/mmwr.mm715152e2] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Monovalent COVID-19 mRNA vaccines, designed against the ancestral strain of SARS-CoV-2, successfully reduced COVID-19-related morbidity and mortality in the United States and globally (1,2). However, vaccine effectiveness (VE) against COVID-19-associated hospitalization has declined over time, likely related to a combination of factors, including waning immunity and, with the emergence of the Omicron variant and its sublineages, immune evasion (3). To address these factors, on September 1, 2022, the Advisory Committee on Immunization Practices recommended a bivalent COVID-19 mRNA booster (bivalent booster) dose, developed against the spike protein from ancestral SARS-CoV-2 and Omicron BA.4/BA.5 sublineages, for persons who had completed at least a primary COVID-19 vaccination series (with or without monovalent booster doses) ≥2 months earlier (4). Data on the effectiveness of a bivalent booster dose against COVID-19 hospitalization in the United States are lacking, including among older adults, who are at highest risk for severe COVID-19-associated illness. During September 8-November 30, 2022, the Investigating Respiratory Viruses in the Acutely Ill (IVY) Network§ assessed effectiveness of a bivalent booster dose received after ≥2 doses of monovalent mRNA vaccine against COVID-19-associated hospitalization among immunocompetent adults aged ≥65 years. When compared with unvaccinated persons, VE of a bivalent booster dose received ≥7 days before illness onset (median = 29 days) against COVID-19-associated hospitalization was 84%. Compared with persons who received ≥2 monovalent-only mRNA vaccine doses, relative VE of a bivalent booster dose was 73%. These early findings show that a bivalent booster dose provided strong protection against COVID-19-associated hospitalization in older adults and additional protection among persons with previous monovalent-only mRNA vaccination. All eligible persons, especially adults aged ≥65 years, should receive a bivalent booster dose to maximize protection against COVID-19 hospitalization this winter season. Additional strategies to prevent respiratory illness, such as masking in indoor public spaces, should also be considered, especially in areas where COVID-19 community levels are high (4,5).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- National Center for Immunization and Respiratory Diseases, CDC; Vanderbilt University Medical Center, Nashville, Tennessee; Baylor Scott & White Health – Baylor Scott & White Medical Center, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, New York, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Stanford, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; The Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Baylor Scott & White Health – Baylor University Medical Center, Dallas, Texas
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Surie D, Bonnell L, Adams K, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Frosch AP, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Khan A, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Womack KN, Hart KW, Swan SA, Zhu Y, DeCuir J, Tenforde MW, Patel MM, McMorrow ML, Self WH. Effectiveness of Monovalent mRNA Vaccines Against COVID-19-Associated Hospitalization Among Immunocompetent Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States - IVY Network, 18 States, December 26, 2021-August 31, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1327-1334. [PMID: 36264830 PMCID: PMC9590291 DOI: 10.15585/mmwr.mm7142a3] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Kwon JH, Tenforde MW, Gaglani M, Talbot HK, Ginde AA, McNeal T, Ghamande S, Douin DJ, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Caspers SD, Exline MC, Botros M, Gong MN, Li A, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Khan A, Hough CL, Busse LW, Duggal A, Wilson JG, Perez C, Chang SY, Mallow C, Rovinski R, Babcock HM, Lauring AS, Felley L, Halasa N, Chappell JD, Grijalva CG, Rice TW, Womack KN, Lindsell CJ, Hart KW, Baughman A, Olson SM, Schrag S, Kobayashi M, Verani JR, Patel MM, Self WH. mRNA Vaccine Effectiveness Against Coronavirus Disease 2019 Hospitalization Among Solid Organ Transplant Recipients. J Infect Dis 2022; 226:797-807. [PMID: 35385875 PMCID: PMC9047160 DOI: 10.1093/infdis/jiac118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The study objective was to evaluate 2- and 3-dose coronavirus disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) in preventing COVID-19 hospitalization among adult solid organ transplant (SOT) recipients. METHODS We conducted a 21-site case-control analysis of 10 425 adults hospitalized in March to December 2021. Cases were hospitalized with COVID-19; controls were hospitalized for an alternative diagnosis (severe acute respiratory syndrome coronavirus 2-negative). Participants were classified as follows: SOT recipient (n = 440), other immunocompromising condition (n = 1684), or immunocompetent (n = 8301). The VE against COVID-19-associated hospitalization was calculated as 1-adjusted odds ratio of prior vaccination among cases compared with controls. RESULTS Among SOT recipients, VE was 29% (95% confidence interval [CI], -19% to 58%) for 2 doses and 77% (95% CI, 48% to 90%) for 3 doses. Among patients with other immunocompromising conditions, VE was 72% (95% CI, 64% to 79%) for 2 doses and 92% (95% CI, 85% to 95%) for 3 doses. Among immunocompetent patients, VE was 88% (95% CI, 87% to 90%) for 2 doses and 96% (95% CI, 83% to 99%) for 3 doses. CONCLUSIONS Effectiveness of COVID-19 mRNA vaccines was lower for SOT recipients than immunocompetent adults and those with other immunocompromising conditions. Among SOT recipients, vaccination with 3 doses of an mRNA vaccine led to substantially greater protection than 2 doses.
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Affiliation(s)
- Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Sean D Caspers
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mena Botros
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alex Li
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Vasisht Srinivasan
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Cynthia Perez
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Christopher Mallow
- Department of Medicine, University of Miami and Jackson Memorial Health System, Miami, Florida, USA
| | - Randal Rovinski
- Department of Medicine, University of Miami and Jackson Memorial Health System, Miami, Florida, USA
| | - Hilary M Babcock
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Felley
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lewis NM, Self WH, Gaglani M, Ginde AA, Douin DJ, Keipp Talbot H, Casey JD, Mohr NM, Zepeski A, Ghamande SA, McNeal TA, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Lauring AS, Halasa N, Chappell JD, Grijalva CG, Rice TW, Rhoads JP, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Adams K, Patel MM, Tenforde MW. Effectiveness of the Ad26.COV2.S (Johnson & Johnson) Coronavirus Disease 2019 (COVID-19) Vaccine for Preventing COVID-19 Hospitalizations and Progression to High Disease Severity in the United States. Clin Infect Dis 2022; 75:S159-S166. [PMID: 35675695 PMCID: PMC9214149 DOI: 10.1093/cid/ciac439] [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] [Received: 04/03/2022] [Indexed: 01/19/2023] Open
Abstract
Background . Adults in the United States (US) began receiving the adenovirus vector coronavirus disease 2019 (COVID-19) vaccine, Ad26.COV2.S (Johnson & Johnson [Janssen]), in February 2021. We evaluated Ad26.COV2.S vaccine effectiveness (VE) against COVID-19 hospitalization and high disease severity during the first 10 months of its use. Methods . In a multicenter case-control analysis of US adults (≥18 years) hospitalized 11 March to 15 December 2021, we estimated VE against susceptibility to COVID-19 hospitalization (VEs), comparing odds of prior vaccination with a single dose Ad26.COV2.S vaccine between hospitalized cases with COVID-19 and controls without COVID-19. Among hospitalized patients with COVID-19, we estimated VE against disease progression (VEp) to death or invasive mechanical ventilation (IMV), comparing odds of prior vaccination between patients with and without progression. Results . After excluding patients receiving mRNA vaccines, among 3979 COVID-19 case-patients (5% vaccinated with Ad26.COV2.S) and 2229 controls (13% vaccinated with Ad26.COV2.S), VEs of Ad26.COV2.S against COVID-19 hospitalization was 70% (95% confidence interval [CI]: 63-75%) overall, including 55% (29-72%) among immunocompromised patients, and 72% (64-77%) among immunocompetent patients, for whom VEs was similar at 14-90 days (73% [59-82%]), 91-180 days (71% [60-80%]), and 181-274 days (70% [54-81%]) postvaccination. Among hospitalized COVID-19 case-patients, VEp was 46% (18-65%) among immunocompetent patients. Conclusions . The Ad26.COV2.S COVID-19 vaccine reduced the risk of COVID-19 hospitalization by 72% among immunocompetent adults without waning through 6 months postvaccination. After hospitalization for COVID-19, vaccinated immunocompetent patients were less likely to require IMV or die compared to unvaccinated immunocompetent patients.
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Affiliation(s)
- Nathaniel M. Lewis
- Corresponding Author Nathaniel M. Lewis, Influenza Prevention and Control Team, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop 46 24/7, Atlanta, Georgia, 30329 ()
| | - Wesley H. Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Adit A. Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J. Douin
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | | | - Kevin W. Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - D. Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Arber Shehu
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Michelle N. Gong
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | - Ithan D. Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M. Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Emily T. Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Arnold S. Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Akram Khan
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | | | | | | | | | - Nida Qadir
- David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Steven Y. Chang
- David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | | | | | | | | | | | - Adam S. Lauring
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Todd W. Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ian D. Jones
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Lewis NM, Naioti EA, Self WH, Ginde AA, Douin DJ, Keipp Talbot H, Casey JD, Mohr NM, Zepeski A, Gaglani M, Ghamande SA, McNeal T, Shapiro NI, Gibbs KW, Clark Files D, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Hubel K, Hough CL, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Rhoads JP, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Schrag SJ, Kobayashi M, Verani JR, Patel MM, Tenforde MW. Effectiveness of mRNA Vaccines Against COVID-19 Hospitalization by Age and Chronic Medical Conditions Burden Among Immunocompetent US Adults, March-August 2021. J Infect Dis 2022; 225:1694-1700. [PMID: 34932114 PMCID: PMC9113447 DOI: 10.1093/infdis/jiab619] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/16/2021] [Indexed: 11/15/2022] Open
Abstract
Vaccine effectiveness (VE) against COVID-19 hospitalization was evaluated among immunocompetent adults (≥18 years) during March-August 2021 using a case-control design. Among 1669 hospitalized COVID-19 cases (11% fully vaccinated) and 1950 RT-PCR-negative controls (54% fully vaccinated), VE was 96% (95% confidence interval [CI], 93%-98%) among patients with no chronic medical conditions and 83% (95% CI, 76%-88%) among patients with ≥ 3 categories of conditions. VE was similar between those aged 18-64 years versus ≥65 years (P > .05). VE against severe COVID-19 was very high among adults without chronic conditions and lessened with increasing comorbidity burden.
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Affiliation(s)
- Nathaniel M Lewis
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Eric A Naioti
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J Douin
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | | | | | - Nathan I Shapiro
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin W Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - D Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Arber Shehu
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Michelle N Gong
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel J Henning
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Ithan D Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kinsley Hubel
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Catherine L Hough
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | | | | | | | | | | | - Nida Qadir
- David Geffen School of Medicine at University of California Los Angeles, Ronald Reagan-University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Steven Y Chang
- David Geffen School of Medicine at University of California Los Angeles, Ronald Reagan-University of California Los Angeles Medical Center, Los Angeles, California, USA
| | | | | | | | | | - Matthew C Exline
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Adam S Lauring
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Kelsey N Womack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kimberly W Hart
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie J Schrag
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Miwako Kobayashi
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Jennifer R Verani
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Manish M Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
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19
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Tenforde MW, Patel MM, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Gaglani M, McNeal T, Ghamande S, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Henning DJ, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CT, Busse L, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Gershengorn HB, Babcock HM, Kwon JH, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Olson SM, Stephenson M, Schrag SJ, Kobayashi M, Verani JR, Self WH. Effectiveness of Severe Acute Respiratory Syndrome Coronavirus 2 Messenger RNA Vaccines for Preventing Coronavirus Disease 2019 Hospitalizations in the United States. Clin Infect Dis 2022; 74:1515-1524. [PMID: 34358310 PMCID: PMC8436392 DOI: 10.1093/cid/ciab687] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination coverage increases in the United States, there is a need to understand the real-world effectiveness against severe coronavirus disease 2019 (COVID-19) and among people at increased risk for poor outcomes. METHODS In a multicenter case-control analysis of US adults hospitalized March 11-May 5, 2021, we evaluated vaccine effectiveness to prevent COVID-19 hospitalizations by comparing odds of prior vaccination with a messenger RNA (mRNA) vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with COVID-19 and hospital-based controls who tested negative for SARS-CoV-2. RESULTS Among 1212 participants, including 593 cases and 619 controls, median age was 58 years, 22.8% were Black, 13.9% were Hispanic, and 21.0% had immunosuppression. SARS-CoV-2 lineage B0.1.1.7 (Alpha) was the most common variant (67.9% of viruses with lineage determined). Full vaccination (receipt of 2 vaccine doses ≥14 days before illness onset) had been received by 8.2% of cases and 36.4% of controls. Overall vaccine effectiveness was 87.1% (95% confidence interval [CI], 80.7-91.3). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.4%; 95% CI, 79.3-9.7). Among 45 patients with vaccine-breakthrough COVID hospitalizations, 44 (97.8%) were ≥50 years old and 20 (44.4%) had immunosuppression. Vaccine effectiveness was lower among patients with immunosuppression (62.9%; 95% CI,20.8-82.6) than without immunosuppression (91.3%; 95% CI, 85.6-94.8). CONCLUSION During March-May 2021, SARS-CoV-2 mRNA vaccines were highly effective for preventing COVID-19 hospitalizations among US adults. SARS-CoV-2 vaccination was beneficial for patients with immunosuppression, but effectiveness was lower in the immunosuppressed population.
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Affiliation(s)
| | | | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado
| | - H Keipp Talbot
- Department of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Heidi L Erickson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Ithan D Peltan
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - C Terri Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Laurence Busse
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | | | | | - Hilary M Babcock
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S Lauring
- Department of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Han JH, Womack KN, Tenforde MW, Files DC, Gibbs KW, Shapiro NI, Prekker ME, Erickson HL, Steingrub JS, Qadir N, Khan A, Hough CL, Johnson NJ, Ely EW, Rice TW, Casey JD, Lindsell CJ, Gong MN, Srinivasan V, Lewis NM, Patel MM, Self WH. Associations between persistent symptoms after mild COVID‐19 and long‐term health status, quality of life, and psychological distress. Influenza Other Respir Viruses 2022; 16:680-689. [PMID: 35347854 PMCID: PMC9111447 DOI: 10.1111/irv.12980] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/29/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
Background We sought to assess whether persistent COVID‐19 symptoms beyond 6 months (Long‐COVID) among patients with mild COVID‐19 is associated with poorer health status, quality of life, and psychological distress. Methods This was a multicenter prospective cohort study that included adult outpatients with acute COVID‐19 from eight sites during 2‐week sampling periods from April 1 and July 28, 2020. Participants were contacted 6–11 months after their first positive SARS‐CoV‐2 to complete a survey, which collected information on the severity of eight COVID‐19 symptoms using a 4‐point scale ranging from 0 (not present) to 3 (severe) at 1 month before COVID‐19 (pre‐illness) and at follow‐up; the difference for each was calculated as an attributable persistent symptom severity score. A total attributable persistent COVID‐19 symptom burden score was calculated by summing the attributable persistent severity scores for all eight symptoms. Outcomes measured at long‐term follow‐up comprised overall health status (EuroQol visual analogue scale), quality of life (EQ‐5D‐5L), and psychological distress (Patient Health Questionnaire‐4). The association between the total attributable persistent COVID‐19 burden score and each outcome was analyzed using multivariable proportional odds regression. Results Of the 2092 outpatients with COVID‐19, 436 (21%) responded to the survey. The median (IQR) attributable persistent COVID‐19 symptom burden score was 2 (0, 4); higher scores were associated with lower overall health status (aOR 0.63; 95% CI: 0.57–0.69), lower quality of life (aOR: 0.65; 95%CI: 0.59–0.72), and higher psychological distress (aOR: 1.40; 95%CI, 1.28–1.54) after adjusting for age, race, ethnicity, education, and income. Conclusions In participants with mild acute COVID‐19, the burden of persistent symptoms was significantly associated with poorer long‐term health status, poorer quality of life, and psychological distress.
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Affiliation(s)
- Jin H. Han
- Vanderbilt University Medical Center Nashville Tennessee USA
- Geriatric Research, Education, and Clinical Center Tennessee Valley Healthcare System Nashville Tennessee USA
| | | | - Mark W. Tenforde
- CDC COVID‐19 Response Team Centers for Disease Control and Prevention Atlanta Georgia USA
| | - D. Clark Files
- Wake Forest University Baptist Medical Center Winston‐Salem North Carolina USA
| | - Kevin W. Gibbs
- Wake Forest University Baptist Medical Center Winston‐Salem North Carolina USA
| | | | | | | | | | - Nida Qadir
- UCLA Medical Center Los Angeles California USA
| | - Akram Khan
- Oregon Health & Sciences University Portland Oregon USA
| | | | | | - E. Wesley Ely
- Vanderbilt University Medical Center Nashville Tennessee USA
- Geriatric Research, Education, and Clinical Center Tennessee Valley Healthcare System Nashville Tennessee USA
| | - Todd W. Rice
- Vanderbilt University Medical Center Nashville Tennessee USA
| | | | | | | | | | - Nathaniel M. Lewis
- CDC COVID‐19 Response Team Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Manish M. Patel
- CDC COVID‐19 Response Team Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Wesley H. Self
- Vanderbilt University Medical Center Nashville Tennessee USA
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Tenforde MW, Self WH, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Frosch AE, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Botros M, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Adams K, Surie D, McMorrow ML, Patel MM. Effectiveness of mRNA Vaccination in Preventing COVID-19-Associated Invasive Mechanical Ventilation and Death - United States, March 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:459-465. [PMID: 35324878 PMCID: PMC8956334 DOI: 10.15585/mmwr.mm7112e1] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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22
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Lauring AS, Tenforde MW, Chappell JD, Gaglani M, Ginde AA, McNeal T, Ghamande S, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Halasa N, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Adams K, Schrag SJ, Olson SM, Kobayashi M, Verani JR, Patel MM, Self WH. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study. BMJ 2022; 376:e069761. [PMID: 35264324 PMCID: PMC8905308 DOI: 10.1136/bmj-2021-069761] [Citation(s) in RCA: 290] [Impact Index Per Article: 145.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To characterize the clinical severity of covid-19 associated with the alpha, delta, and omicron SARS-CoV-2 variants among adults admitted to hospital and to compare the effectiveness of mRNA vaccines to prevent hospital admissions related to each variant. DESIGN Case-control study. SETTING 21 hospitals across the United States. PARTICIPANTS 11 690 adults (≥18 years) admitted to hospital: 5728 with covid-19 (cases) and 5962 without covid-19 (controls). Patients were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and, if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: alpha (11 March to 3 July 2021), delta (4 July to 25 December 2021), and omicron (26 December 2021 to 14 January 2022). MAIN OUTCOME MEASURES Vaccine effectiveness calculated using a test negative design for mRNA vaccines to prevent covid-19 related hospital admissions by each variant (alpha, delta, omicron). Among patients admitted to hospital with covid-19, disease severity on the World Health Organization's clinical progression scale was compared among variants using proportional odds regression. RESULTS Effectiveness of the mRNA vaccines to prevent covid-19 associated hospital admissions was 85% (95% confidence interval 82% to 88%) for two vaccine doses against the alpha variant, 85% (83% to 87%) for two doses against the delta variant, 94% (92% to 95%) for three doses against the delta variant, 65% (51% to 75%) for two doses against the omicron variant; and 86% (77% to 91%) for three doses against the omicron variant. In-hospital mortality was 7.6% (81/1060) for alpha, 12.2% (461/3788) for delta, and 7.1% (40/565) for omicron. Among unvaccinated patients with covid-19 admitted to hospital, severity on the WHO clinical progression scale was higher for the delta versus alpha variant (adjusted proportional odds ratio 1.28, 95% confidence interval 1.11 to 1.46), and lower for the omicron versus delta variant (0.61, 0.49 to 0.77). Compared with unvaccinated patients, severity was lower for vaccinated patients for each variant, including alpha (adjusted proportional odds ratio 0.33, 0.23 to 0.49), delta (0.44, 0.37 to 0.51), and omicron (0.61, 0.44 to 0.85). CONCLUSIONS mRNA vaccines were found to be highly effective in preventing covid-19 associated hospital admissions related to the alpha, delta, and omicron variants, but three vaccine doses were required to achieve protection against omicron similar to the protection that two doses provided against the delta and alpha variants. Among adults admitted to hospital with covid-19, the omicron variant was associated with less severe disease than the delta variant but still resulted in substantial morbidity and mortality. Vaccinated patients admitted to hospital with covid-19 had significantly lower disease severity than unvaccinated patients for all the variants.
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Affiliation(s)
- Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | | | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - H Keipp Talbot
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Heidi L Erickson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Nicholas J Johnson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Vasisht Srinivasan
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | | | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | | | - Carolina Rivas
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Hilary M Babcock
- Department of Medicine, Washington University, St Louis, MI, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, MI, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
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Tenforde MW, Patel MM, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Botros M, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Naioti EA, Adams K, Lewis NM, Surie D, McMorrow ML, Self WH. Effectiveness of a Third Dose of Pfizer-BioNTech and Moderna Vaccines in Preventing COVID-19 Hospitalization Among Immunocompetent and Immunocompromised Adults - United States, August-December 2021. MMWR Morb Mortal Wkly Rep 2022; 71:118-124. [PMID: 35085218 PMCID: PMC9351530 DOI: 10.15585/mmwr.mm7104a2] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
COVID-19 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]) provide protection against infection with SARS-CoV-2, the virus that causes COVID-19, and are highly effective against COVID-19-associated hospitalization among eligible persons who receive 2 doses (1,2). However, vaccine effectiveness (VE) among persons with immunocompromising conditions* is lower than that among immunocompetent persons (2), and VE declines after several months among all persons (3). On August 12, 2021, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for a third mRNA vaccine dose as part of a primary series ≥28 days after dose 2 for persons aged ≥12 years with immunocompromising conditions, and, on November 19, 2021, as a booster dose for all adults aged ≥18 years at least 6 months after dose 2, changed to ≥5 months after dose 2 on January 3, 2022 (4,5,6). Among 2,952 adults (including 1,385 COVID-19 case-patients and 1,567 COVID-19-negative controls) hospitalized at 21 U.S. hospitals during August 19-December 15, 2021, effectiveness of mRNA vaccines against COVID-19-associated hospitalization was compared between adults eligible for but who had not received a third vaccine dose (1,251) and vaccine-eligible adults who received a third dose ≥7 days before illness onset (312). Among 1,875 adults without immunocompromising conditions (including 1,065 [57%] unvaccinated, 679 [36%] 2-dose recipients, and 131 [7%] 3-dose [booster] recipients), VE against COVID-19 hospitalization was higher among those who received a booster dose (97%; 95% CI = 95%-99%) compared with that among 2-dose recipients (82%; 95% CI = 77%-86%) (p <0.001). Among 1,077 adults with immunocompromising conditions (including 324 [30%] unvaccinated, 572 [53%] 2-dose recipients, and 181 [17%] 3-dose recipients), VE was higher among those who received a third dose to complete a primary series (88%; 95% CI = 81%-93%) compared with 2-dose recipients (69%; 95% CI = 57%-78%) (p <0.001). Administration of a third COVID-19 mRNA vaccine dose as part of a primary series among immunocompromised adults, or as a booster dose among immunocompetent adults, provides improved protection against COVID-19-associated hospitalization.
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24
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Tenforde MW, Self WH, Adams K, Gaglani M, Ginde AA, McNeal T, Ghamande S, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Olson SM, Kobayashi M, Verani JR, Patel MM. Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity. JAMA 2021; 326:2043-2054. [PMID: 34734975 PMCID: PMC8569602 DOI: 10.1001/jama.2021.19499] [Citation(s) in RCA: 386] [Impact Index Per Article: 128.7] [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: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022]
Abstract
Importance A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people. Objective To evaluate the association between vaccination with mRNA COVID-19 vaccines-mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)-and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease. Design, Setting, and Participants A US 21-site case-control analysis of 4513 adults hospitalized between March 11 and August 15, 2021, with 28-day outcome data on death and mechanical ventilation available for patients enrolled through July 14, 2021. Date of final follow-up was August 8, 2021. Exposures COVID-19 vaccination. Main Outcomes and Measures Associations were evaluated between prior vaccination and (1) hospitalization for COVID-19, in which case patients were those hospitalized for COVID-19 and control patients were those hospitalized for an alternative diagnosis; and (2) disease progression among patients hospitalized for COVID-19, in which cases and controls were COVID-19 patients with and without progression to death or mechanical ventilation, respectively. Associations were measured with multivariable logistic regression. Results Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination (cases, 15.8%; controls, 54.8%; adjusted OR, 0.15; 95% CI, 0.13-0.18), including for sequenced SARS-CoV-2 Alpha (8.7% vs 51.7%; aOR, 0.10; 95% CI, 0.06-0.16) and Delta variants (21.9% vs 61.8%; aOR, 0.14; 95% CI, 0.10-0.21). This association was stronger for immunocompetent patients (11.2% vs 53.5%; aOR, 0.10; 95% CI, 0.09-0.13) than immunocompromised patients (40.1% vs 58.8%; aOR, 0.49; 95% CI, 0.35-0.69) (P < .001) and weaker at more than 120 days since vaccination with BNT162b2 (5.8% vs 11.5%; aOR, 0.36; 95% CI, 0.27-0.49) than with mRNA-1273 (1.9% vs 8.3%; aOR, 0.15; 95% CI, 0.09-0.23) (P < .001). Among 1197 patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination (12.0% vs 24.7%; aOR, 0.33; 95% CI, 0.19-0.58). Conclusions and Relevance Vaccination with an mRNA COVID-19 vaccine was significantly less likely among patients with COVID-19 hospitalization and disease progression to death or mechanical ventilation. These findings are consistent with risk reduction among vaccine breakthrough infections compared with absence of vaccination.
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Affiliation(s)
| | - Wesley H. Self
- Vanderbilt Institute for Clinical and Translational Research, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Tresa McNeal
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple
| | - Shekhar Ghamande
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple
| | - David J. Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora
| | - H. Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D. Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kevin W. Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - D. Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N. Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E. Prekker
- Departments of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Heidi L. Erickson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Michelle N. Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Jay S. Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Ithan D. Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah; and University of Utah, Salt Lake City
| | - Samuel M. Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah; and University of Utah, Salt Lake City
| | | | | | - Akram Khan
- Department of Medicine, Oregon Health & Science University, Portland
| | | | | | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer G. Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California–Los Angeles, Los Angeles
| | - Steven Y. Chang
- Department of Medicine, University of California–Los Angeles, Los Angeles
| | | | - Carolina Rivas
- Department of Medicine, University of Miami, Miami, Florida
| | | | - Jennie H. Kwon
- Department of Medicine, Washington University, St Louis, Missouri
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S. Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W. Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian D. Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William B. Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N. Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jillian P. Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kimberly W. Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
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25
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Self WH, Tenforde MW, Rhoads JP, Gaglani M, Ginde AA, Douin DJ, Olson SM, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Mills L, Lester SN, Stumpf MM, Naioti EA, Kobayashi M, Verani JR, Thornburg NJ, Patel MM. Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions - United States, March-August 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1337-1343. [PMID: 34555004 PMCID: PMC8459899 DOI: 10.15585/mmwr.mm7038e1] [Citation(s) in RCA: 276] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Three COVID-19 vaccines are authorized or approved for use among adults in the United States (1,2). Two 2-dose mRNA vaccines, mRNA-1273 from Moderna and BNT162b2 from Pfizer-BioNTech, received Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) in December 2020 for persons aged ≥18 years and aged ≥16 years, respectively. A 1-dose viral vector vaccine (Ad26.COV2 from Janssen [Johnson & Johnson]) received EUA in February 2021 for persons aged ≥18 years (3). The Pfizer-BioNTech vaccine received FDA approval for persons aged ≥16 years on August 23, 2021 (4). Current guidelines from FDA and CDC recommend vaccination of eligible persons with one of these three products, without preference for any specific vaccine (4,5). To assess vaccine effectiveness (VE) of these three products in preventing COVID-19 hospitalization, CDC and collaborators conducted a case-control analysis among 3,689 adults aged ≥18 years who were hospitalized at 21 U.S. hospitals across 18 states during March 11-August 15, 2021. An additional analysis compared serum antibody levels (anti-spike immunoglobulin G [IgG] and anti-receptor binding domain [RBD] IgG) to SARS-CoV-2, the virus that causes COVID-19, among 100 healthy volunteers enrolled at three hospitals 2-6 weeks after full vaccination with the Moderna, Pfizer-BioNTech, or Janssen COVID-19 vaccine. Patients with immunocompromising conditions were excluded. VE against COVID-19 hospitalizations was higher for the Moderna vaccine (93%; 95% confidence interval [CI] = 91%-95%) than for the Pfizer-BioNTech vaccine (88%; 95% CI = 85%-91%) (p = 0.011); VE for both mRNA vaccines was higher than that for the Janssen vaccine (71%; 95% CI = 56%-81%) (all p<0.001). Protection for the Pfizer-BioNTech vaccine declined 4 months after vaccination. Postvaccination anti-spike IgG and anti-RBD IgG levels were significantly lower in persons vaccinated with the Janssen vaccine than the Moderna or Pfizer-BioNTech vaccines. Although these real-world data suggest some variation in levels of protection by vaccine, all FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- Vanderbilt University Medical Center, Nashville, Tennessee; CDC COVID-19 Response Team; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Stanford, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan
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Tenforde MW, Self WH, Naioti EA, Ginde AA, Douin DJ, Olson SM, Talbot HK, Casey JD, Mohr NM, Zepeski A, Gaglani M, McNeal T, Ghamande S, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Stephenson M, Schrag SJ, Kobayashi M, Verani JR, Patel MM. Sustained Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Associated Hospitalizations Among Adults - United States, March-July 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1156-1162. [PMID: 34437524 PMCID: PMC8389395 DOI: 10.15585/mmwr.mm7034e2] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Real-world evaluations have demonstrated high effectiveness of vaccines against COVID-19-associated hospitalizations (1-4) measured shortly after vaccination; longer follow-up is needed to assess durability of protection. In an evaluation at 21 hospitals in 18 states, the duration of mRNA vaccine (Pfizer-BioNTech or Moderna) effectiveness (VE) against COVID-19-associated hospitalizations was assessed among adults aged ≥18 years. Among 3,089 hospitalized adults (including 1,194 COVID-19 case-patients and 1,895 non-COVID-19 control-patients), the median age was 59 years, 48.7% were female, and 21.1% had an immunocompromising condition. Overall, 141 (11.8%) case-patients and 988 (52.1%) controls were fully vaccinated (defined as receipt of the second dose of Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines ≥14 days before illness onset), with a median interval of 65 days (range = 14-166 days) after receipt of second dose. VE against COVID-19-associated hospitalization during the full surveillance period was 86% (95% confidence interval [CI] = 82%-88%) overall and 90% (95% CI = 87%-92%) among adults without immunocompromising conditions. VE against COVID-19- associated hospitalization was 86% (95% CI = 82%-90%) 2-12 weeks and 84% (95% CI = 77%-90%) 13-24 weeks from receipt of the second vaccine dose, with no significant change between these periods (p = 0.854). Whole genome sequencing of 454 case-patient specimens found that 242 (53.3%) belonged to the B.1.1.7 (Alpha) lineage and 74 (16.3%) to the B.1.617.2 (Delta) lineage. Effectiveness of mRNA vaccines against COVID-19-associated hospitalization was sustained over a 24-week period, including among groups at higher risk for severe COVID-19; ongoing monitoring is needed as new SARS-CoV-2 variants emerge. To reduce their risk for hospitalization, all eligible persons should be offered COVID-19 vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network Investigators
- CDC COVID-19 Response Team; Vanderbilt University Medical Center, Nashville, Tennessee; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Palo Alto, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan
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27
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Lytle KL, Collins SP, Feldstein LR, Baughman AH, Brown SM, Casey JD, Erickson HL, Exline MC, Files DC, Gibbs KW, Ginde AA, Gong MN, Grijalva CG, Khan A, Lindsell CJ, Peltan ID, Prekker ME, Rice TW, Shapiro NI, Steingrub JS, Stubblefield WB, Tenforde MW, Womack KN, Patel MM, Self WH. Influenza vaccine acceptance and hesitancy among adults hospitalized with severe acute respiratory illnesses, United States 2019-2020. Vaccine 2021; 39:5271-5276. [PMID: 34376307 DOI: 10.1016/j.vaccine.2021.07.057] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/24/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Understanding patient factors associated with not being vaccinated is essential for successful implementation of influenza vaccination programs. METHODS We enrolled adults hospitalized with severe acute respiratory illness at 10 United States (US) hospitals during the 2019-2020 influenza season. We interviewed patients to collect data about influenza vaccination, sociodemographic characteristics, and vaccine perceptions. RESULTS Among 679 participants, 264 (38.9%) reported not receiving influenza vaccination. Among those not vaccinated, 135 (51.1%) reported choosing not to receive a vaccine because of perceived ineffectiveness (36.7%) or risk (14.4%) of influenza vaccination. Sociodemographic factors associated with not being vaccinated included no medical insurance (aOR = 6.42; 95% CI: 2.52-16.38) and being non-White or Hispanic (aOR = 1.54, 95% CI: 1.02-2.32). CONCLUSIONS Optimizing uptake of influenza vaccination in the US may be improved by educational programs regarding vaccine safety and effectiveness and enhancing vaccine access, particularly among non-White and Hispanic Americans and those without medical insurance.
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Affiliation(s)
- Kelsey L Lytle
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean P Collins
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Samuel M Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | | | - Heidi L Erickson
- Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - D Clark Files
- Wake Forest School of Medicine, Winston Salem North Carolina, USA
| | - Kevin W Gibbs
- Wake Forest School of Medicine, Winston Salem North Carolina, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle N Gong
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Akram Khan
- Oregon Health & Sciences University, Portland, OR, USA
| | | | - Ithan D Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Matthew E Prekker
- Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, MN, USA
| | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Mark W Tenforde
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Manish M Patel
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, TN, USA.
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28
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Sami S, Tenforde MW, Talbot HK, Lindsell CJ, Steingrub JS, Shapiro NI, Ginde AA, Douin DJ, Prekker ME, Erickson HL, Brown SM, Peltan ID, Gong MN, Khan A, Exline MC, Files DC, Gibbs KW, Rice TW, Casey JD, Grijalva CG, Stubblefield WB, Womack KN, Hager DN, Qadir N, Chang SY, Henning DJ, Wilson JG, Self WH, Patel MM. Adults Hospitalized With Coronavirus Disease 2019 (COVID-19)-United States, March-June and October-December 2020: Implications for the Potential Effects of COVID-19 Tier-1 Vaccination on Future Hospitalizations and Outcomes. Clin Infect Dis 2021; 73:S32-S37. [PMID: 33977301 PMCID: PMC8136001 DOI: 10.1093/cid/ciab319] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Because of the increased risk for severe coronavirus disease 2019 (COVID-19), the Advisory Committee on Immunization Practices (ACIP) initially prioritized COVID-19 vaccination for persons in long-term care facilities (LTCF), persons aged ≥65 years, and persons aged 16-64 years with high-risk medical conditions when there is limited vaccine supply. We compared characteristics and severe outcomes of hospitalized patients with COVID-19 in the United States between early and later in the pandemic categorized by groups at higher risk of severe COVID-19. METHODS Observational study of sampled patients aged ≥18 years who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and admitted to one of 14 academic hospitals in the United States during March-June and October-December 2020. Demographic and clinical information were gathered from electronic health record data. RESULTS Among 647 patients, 91% met ≥1 of the following risk factors for severe COVID-19 [91% March-June (n = 434); 90% October-December (n = 213)]; 19% were LTCF residents, 45% were aged ≥65-years, and 84% had ≥1 high-risk condition. The proportion of patients who resided in a LTCF declined significantly (25% vs 6%) from early to later pandemic periods. Compared with patients at lower risk for severe COVID-19, in-hospital mortality was higher among patients at high risk for severe COVID-19 (20% vs 7%); these differences were consistently observed between March-June and October-December. CONCLUSIONS Most adults hospitalized with COVID-19 were those recommended to be prioritized for vaccination based on risk for developing severe COVID-19. These findings highlight the continued urgency to vaccinate patients at high risk for severe COVID-19 and monitor vaccination impact on hospitalizations and outcomes.
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Affiliation(s)
- Samira Sami
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Atlanta, Georgia, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Nathan I Shapiro
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J Douin
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | | | - Michelle N Gong
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Akram Khan
- Oregon Health and Sciences University Hospital, Portland, Oregon, USA
| | - Matthew C Exline
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - D Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Kevin W Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Kelsey N Womack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Nida Qadir
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Steven Y Chang
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | | | | | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manish M Patel
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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29
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Tenforde MW, Patel MM, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Gaglani M, McNeal T, Ghamande S, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CT, Busse L, Lohuis CCT, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Gershengorn HB, Babcock HM, Kwon JH, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Olson SM, Stephenson M, Schrag SJ, Kobayashi M, Verani JR, Self WH. Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States. medRxiv 2021:2021.07.08.21259776. [PMID: 34268515 PMCID: PMC8282104 DOI: 10.1101/2021.07.08.21259776] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background As SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe Covid-19 and among people at increased risk for poor outcomes. Methods In a multicenter case-control analysis of US adults hospitalized March 11 - May 5, 2021, we evaluated vaccine effectiveness to prevent Covid-19 hospitalizations by comparing odds of prior vaccination with an mRNA vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with Covid-19 and hospital-based controls who tested negative for SARS-CoV-2. Results Among 1210 participants, median age was 58 years, 22.8% were Black, 13.8% were Hispanic, and 20.6% had immunosuppression. SARS-CoV-2 lineage B.1.1.7 was most common variant (59.7% of sequenced viruses). Full vaccination (receipt of two vaccine doses ≥14 days before illness onset) had been received by 45/590 (7.6%) cases and 215/620 (34.7%) controls. Overall vaccine effectiveness was 86.9% (95% CI: 80.4 to 91.2%). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.3%; 95% CI: 78.9 to 99.7%). Among 45 patients with vaccine-breakthrough Covid hospitalizations, 44 (97.8%) were ≥50 years old and 20 (44.4%) had immunosuppression. Vaccine effectiveness was lower among patients with immunosuppression (59.2%; 95% CI: 11.9 to 81.1%) than without immunosuppression (91.3%; 95% CI: 85.5 to 94.7%). Conclusion During March-May 2021, SARS-CoV-2 mRNA vaccines were highly effective for preventing Covid-19 hospitalizations among US adults. SARS-CoV-2 vaccination was beneficial for patients with immunosuppression, but effectiveness was lower in the immunosuppressed population.
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Affiliation(s)
| | | | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Heidi L Erickson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - C Terri Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Laurence Busse
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | | | | | - Hilary M Babcock
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Tenforde MW, Olson SM, Self WH, Talbot HK, Lindsell CJ, Steingrub JS, Shapiro NI, Ginde AA, Douin DJ, Prekker ME, Brown SM, Peltan ID, Gong MN, Mohamed A, Khan A, Exline MC, Files DC, Gibbs KW, Stubblefield WB, Casey JD, Rice TW, Grijalva CG, Hager DN, Shehu A, Qadir N, Chang SY, Wilson JG, Gaglani M, Murthy K, Calhoun N, Monto AS, Martin ET, Malani A, Zimmerman RK, Silveira FP, Middleton DB, Zhu Y, Wyatt D, Stephenson M, Baughman A, Womack KN, Hart KW, Kobayashi M, Verani JR, Patel MM. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years - United States, January-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:674-679. [PMID: 33956782 PMCID: PMC9368749 DOI: 10.15585/mmwr.mm7018e1] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Adults aged ≥65 years are at increased risk for severe outcomes from COVID-19 and were identified as a priority group to receive the first COVID-19 vaccines approved for use under an Emergency Use Authorization (EUA) in the United States (1-3). In an evaluation at 24 hospitals in 14 states,* the effectiveness of partial or full vaccination† with Pfizer-BioNTech or Moderna vaccines against COVID-19-associated hospitalization was assessed among adults aged ≥65 years. Among 417 hospitalized adults aged ≥65 years (including 187 case-patients and 230 controls), the median age was 73 years, 48% were female, 73% were non-Hispanic White, 17% were non-Hispanic Black, 6% were Hispanic, and 4% lived in a long-term care facility. Adjusted vaccine effectiveness (VE) against COVID-19-associated hospitalization among adults aged ≥65 years was estimated to be 94% (95% confidence interval [CI] = 49%-99%) for full vaccination and 64% (95% CI = 28%-82%) for partial vaccination. These findings are consistent with efficacy determined from clinical trials in the subgroup of adults aged ≥65 years (4,5). This multisite U.S. evaluation under real-world conditions suggests that vaccination provided protection against COVID-19-associated hospitalization among adults aged ≥65 years. Vaccination is a critical tool for reducing severe COVID-19 in groups at high risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- CDC COVID-19 Response Team; Vanderbilt University Medical Center, Nashville, Tennessee; Baystate Medical Center, Springfield, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts; University of Colorado School of Medicine, Aurora, Colorado; Hennepin County Medical Center, Minneapolis, Minnesota; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York; Oregon Health & Science University Hospital, Portland, Oregon; Ohio State University Wexner Medical Center, Columbus, Ohio; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Ronald Reagan-UCLA Medical Center, Los Angeles, California; Stanford University School of Medicine, Palo Alto, California; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; University of Michigan School of Public Health, Ann Arbor, Michigan; St. Joseph Mercy Health System, Ann Arbor, Michigan; University of Pittsburgh Schools of the Health Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - HAIVEN Investigators
- CDC COVID-19 Response Team; Vanderbilt University Medical Center, Nashville, Tennessee; Baystate Medical Center, Springfield, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts; University of Colorado School of Medicine, Aurora, Colorado; Hennepin County Medical Center, Minneapolis, Minnesota; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York; Oregon Health & Science University Hospital, Portland, Oregon; Ohio State University Wexner Medical Center, Columbus, Ohio; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Ronald Reagan-UCLA Medical Center, Los Angeles, California; Stanford University School of Medicine, Palo Alto, California; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; University of Michigan School of Public Health, Ann Arbor, Michigan; St. Joseph Mercy Health System, Ann Arbor, Michigan; University of Pittsburgh Schools of the Health Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Womack KN, Alvord TW, Trullinger-Dwyer CF, Rice SPM, Olson R. Challenging Aggressive Behaviors Experienced by Personal Support Workers in Comparison to Home Care Workers: Relationships between Caregiver Experiences and Psychological Health. Int J Environ Res Public Health 2020; 17:E5486. [PMID: 32751378 PMCID: PMC7432386 DOI: 10.3390/ijerph17155486] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Personal support workers (PSW) are caregivers for children and adults with intellectual and developmental disabilities (IDDs) or adults experiencing mental illness or other behavioral health conditions. The work can be very meaningful, but many PSWs must prepare for, monitor, and manage challenging behaviors, including aggression. This study was designed to estimate the prevalence of aggression experienced by PSWs in Oregon, and compare it to a previous sample of Oregon home care workers (HCWs). This comparison included an analysis of relationships between exposures to aggression and psychological health factors. PSWs in Oregon (N = 240) were surveyed electronically at a single time point. PSWs generally reported higher rates of exposure to aggression compared to HCWs. Experiences with aggression were positively associated with fatigue and weakly associated with depression, but not stress. PSWs' self-reported lost work time injury rate was elevated compared to the US average, but it was comparable to previous self-reported injury rates from HCWs. Physical demands of work were the most prevalent reported primary safety concern, followed by challenging behaviors (including aggression). Developing tailored training to help PSWs understand, plan for, minimize, and manage challenging behaviors is a social priority.
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Affiliation(s)
- Kelsey N. Womack
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Teala W. Alvord
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
- School of Public Health, OHSU-Portland State University (PSU), Portland, OR 97201, USA
| | - Caitlyn F. Trullinger-Dwyer
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Sean P. M. Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
- School of Public Health, OHSU-Portland State University (PSU), Portland, OR 97201, USA
- Department of Psychology, OHSU-Portland State University (PSU), Portland, OR 97201, USA
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Lund AK, Williams AF, Womack KN. Motorcycle helmet use in Texas. Public Health Rep 1991; 106:576-8. [PMID: 1910193 PMCID: PMC1580316] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Helmets worn by motorcyclists decrease head injuries and the likelihood of being killed in a crash by about 30 percent. From 1968 to 1977, Texas had a comprehensive motorcycle helmet use law, which was estimated to have saved 650 lives. But the law was amended in 1977 to apply only to motorcycle operators and passengers under age 18. In September 1989, a new law was passed that required helmets for all motorcycle operators and passengers. Observations of helmet use were conducted before and after the law took effect in 18 Texas cities using a survey design providing a cross-section of urban and suburban traffic across the State. The surveys indicated that helmet use increased from less than 50 percent just before the law to 90 percent immediately after, and it increased further to more than 95 percent 2 months later. These results confirm the unique effectiveness of comprehensive helmet use laws in applying the proven public health benefits of helmets to the reduction of motorcycle injuries and deaths.
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Affiliation(s)
- A K Lund
- Insurance Institute for Highway Safety, Arlington, VA 22201
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