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Virk A, Johnson MG, Roellinger DL, Scott CG, Sampathkumar P, Breeher LE, Swift M. Hybrid Immunity Provides Protective Advantage Over Vaccination or Prior Remote Coronavirus Disease 2019 Alone. Open Forum Infect Dis 2023; 10:ofad161. [PMID: 37180597 PMCID: PMC10167982 DOI: 10.1093/ofid/ofad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background The protective efficacy of prior coronavirus disease 2019 (COVID-19) with or without vaccination remains unknown. This study sought to understand if 2 or more messenger RNA (mRNA) vaccine doses provide additional protection in patients with prior infection, or if infection alone provides comparable protection. Methods We conducted a retrospective cohort study of the risk of COVID-19 from 16 December 2020 through 15 March 2022, among vaccinated and unvaccinated patients of all ages with and without prior infection. A Simon-Makuch hazard plot illustrated the incidence of COVID-19 between groups. Multivariable Cox proportional hazards regression was used to examine the association of demographics, prior infection, and vaccination status with new infection. Results Among 101 941 individuals with at least 1 COVID-19 polymerase chain reaction test prior to 15 March 2022, 72 361 (71.0%) received mRNA vaccination and 5957 (5.8%) were previously infected. The cumulative incidence of COVID-19 was substantially higher throughout the study period for those previously uninfected and unvaccinated, and lowest for those previously infected and vaccinated. After accounting for age, sex, and the interaction between vaccination and prior infection, a reduction in reinfection risk was noted during the Omicron and pre-Omicron phases of 26% (95% confidence interval [CI], 8%-41%; P = .0065) to 36% (95% CI, 10%-54%; P = .0108), respectively, among previously infected and vaccinated individuals, compared to previously infected subjects without vaccination. Conclusions Vaccination was associated with lower risk of COVID-19, including in those with prior infection. Vaccination should be encouraged for all including those with prior infection, especially as new variants emerge and variant-specific booster vaccines become available.
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Affiliation(s)
- Abinash Virk
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Christopher G Scott
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Priya Sampathkumar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E Breeher
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie Swift
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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2
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Farah W, Breeher LE, Hainy CM, Tommaso CP, Swift MD. Who is getting boosted? Disparities in COVID-19 vaccine booster uptake among health care workers. Vaccine X 2023; 13:100269. [PMID: 36819216 PMCID: PMC9918311 DOI: 10.1016/j.jvacx.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
COVID-19 vaccination remains one of the most effective tools to reduce the risk of SARS-CoV-2 infection. Unfortunately, vaccine hesitancy has limited primary vaccination and booster uptake among the general population and HCWs. To gain a better understanding of factors associated with booster vaccine uptake, we analyzed COVID-19 vaccine booster rates among HCWs and identified risk factors associated with nonacceptance. Of the 62,387 HCWs included in our analysis, the overall booster uptake rate was 64.8%. Older age, Non-Hispanic White racial group, early initial vaccine uptake and longer duration of employment were associated with higher booster uptake. Significant differences were observed between different job categories. This persistence of vaccine hesitancy and disparities in COVID-19 booster uptake among HCWs, almost 2 years after the rollout of the COVID-19 vaccination, call for further efforts to increase vaccine confidence among HCWs and the general population in light of the continued need for further COVID-19 protection.
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Affiliation(s)
- Wigdan Farah
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, United States,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Laura E. Breeher
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, United States,Occupational Health Service, Mayo Clinic, Rochester, MN, USA
| | - Caitlin M. Hainy
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, United States,Occupational Health Service, Mayo Clinic, Rochester, MN, USA
| | | | - Melanie D. Swift
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, United States,Occupational Health Service, Mayo Clinic, Rochester, MN, USA,Corresponding author at: 200 First Street SW, Rochester, MN 55905, United States
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3
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Swift MD, McDermott MC, Hainy CM, Arendt CJ, Anderson JA, Mahoo JJ, Breeher LE. Early Experience with an Occupational JYNNEOS (Orthopoxvirus) Vaccination Program. J Occup Environ Med 2023:00043764-990000000-00281. [PMID: 36952316 DOI: 10.1097/jom.0000000000002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To identify lessons learned implementing JYNNEOS vaccination for laboratory workers exposed to orthopoxviruses such as mpox. METHODS Workers at risk of laboratory exposure were offered vaccine in a carefully planned occupational health program. Vaccine was procured from the CDC Drug Service which has special requirements. Reasons for accepting or declining vaccine, and side effects were obtained by survey. RESULTS Most workers accepted JYNNEOS, and occupational risk was the most commonly cited reason for acceptance. Most experienced mild local side effects. The administrative requirements of the CDC Drug Service are documented. CONCLUSIONS Occupational health programs caring for laboratory workers handling unusual biological agents require careful planning and coordination to facilitate access to vaccines that are not commercially available, anticipate and mitigate barriers to vaccination, and comply with special CDC requirements.
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Affiliation(s)
| | | | - Caitlin M Hainy
- Occupational Health Services, Mayo Clinic, Rochester, MN, USA
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4
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Pollock BD, Dykhoff HJ, Breeher LE, Mabry TM, Franco PM, Noe KH, Ramar K, Young T, Dowdy SC. A Multisite Assessment of Inpatient Safety Event Rates During the Coronavirus Disease 2019 Pandemic. Mayo Clin Proc Innov Qual Outcomes 2023; 7:51-57. [PMID: 36590139 PMCID: PMC9790867 DOI: 10.1016/j.mayocpiqo.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/27/2022] Open
Abstract
To date, there has been a notable lack of peer-reviewed or publicly available data documenting rates of hospital quality outcomes and patient safety events during the coronavirus disease 2019 pandemic era. The dearth of evidence is perhaps related to the US health care system triaging resources toward patient care and away from reporting and research and also reflects that data used in publicly reported hospital quality rankings and ratings typically lag 2-5 years. At our institution, a learning health system assessment is underway to evaluate how patient safety was affected by the pandemic. Here we share and discuss early findings, noting the limitations of self-reported safety event reporting, and suggest the need for further widespread investigations at other US hospitals. During the 2-year study period from January 1, 2020, through December 31, 2021 across 3 large US academic medical centers at our institution, we documented an overall rate of 25.8 safety events per 1000 inpatient days. The rate of events meeting "harm" criteria was 12.4 per 1000 inpatient days, the rate of nonharm events was 11.1 per 1000 inpatient days, and the fall rate was 2.3 per 1000 inpatient days. This descriptive exploratory analysis suggests that patient safety event rates at our institution did not increase over the course of the pandemic. However, increasing health care worker absences were nonlinearly and strongly associated with patient safety event rates, which raises questions regarding the mechanisms by which patient safety event rates may be affected by staff absences during pandemic peaks.
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Affiliation(s)
- Benjamin D. Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, FL,Correspondence: Address to Benjamin D. Pollock, PhD, MSPH, Health Services Research, Mayo Clinic—Stabile 750N, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Hayley J. Dykhoff
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
| | - Laura E. Breeher
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Tad M. Mabry
- Quality, Experience, & Affordability, Mayo Clinic, Rochester, MN
| | | | | | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, MN
| | - Timothy Young
- Quality, Experience, & Affordability, Mayo Clinic, Eau Claire, WI
| | - Sean C. Dowdy
- Quality, Experience, & Affordability, Mayo Clinic, Rochester, MN
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5
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Swift MD, Hainy CM, Sampathkumar P, Breeher LE. Multiple SARS-CoV-2 Reinfections: A Case Series of Thrice-Infected Individuals. Mayo Clin Proc 2022; 97:1021-1023. [PMID: 35512873 PMCID: PMC8913293 DOI: 10.1016/j.mayocp.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 12/01/2022]
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6
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Tande AJ, Swift MD, Challener DW, Berbari EF, Tommaso CP, Christopherson DR, Binnicker MJ, Breeher LE. Utility of Follow-up COVID-19 Antigen Tests After Acute SARS-CoV-2 Infection Among Healthcare Personnel. Clin Infect Dis 2022; 75:e347-e349. [PMID: 35352091 PMCID: PMC9129106 DOI: 10.1093/cid/ciac235] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
We report the utility of rapid antigen tests (RAgT) in a cohort of US healthcare personnel with coronavirus disease 2019 (COVID-19) infection who met symptom criteria to return to work at day 5 or later of isolation. In total, 11.9% of initial RAgT were negative. RAgT can be helpful to guide return to work decisions.
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Affiliation(s)
- Aaron J Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | - Melanie D Swift
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN USA.,Occupational Health Services, Mayo Clinic, Rochester, MN USA
| | - Douglas W Challener
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | - Elie F Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | | | - Darrin R Christopherson
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | | | - Laura E Breeher
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN USA.,Occupational Health Services, Mayo Clinic, Rochester, MN USA
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7
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Abstract
OBJECTIVE To identify rates of work absence following receipt of COVID-19 vaccine in a cohort of healthcare personnel (HCP). METHODS Short-term disability (STD) usage by HCP attributed to side effects of the COVID-19 vaccine was calculated for each vaccine manufacturer, job category, age group, and work region. Analysis was performed for the cohort of HCP during the initial vaccination campaign. RESULTS 4.1% of COVID-19 vaccinations generated a STD claim for lost work due to side effects, with increased STD rates after dose 2 than dose 1 (7.4% and 0.9%, respectively). Rates were higher for younger HCP and allied health staff. CONCLUSIONS While side effects from mRNA vaccine dose 2 resulted in more work absence, statistically significant geographic differences in STD suggest cultural and staffing factors may impact HCP to utilize STD following vaccination.
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Affiliation(s)
- Laura E Breeher
- Occupational Health Services, Practice Administration, Mayo Clinic, Rochester, Minnesota (Dr Breeher, Dr Tommaso, Hainy, Dr Swift), Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota (Dr Breeher, Dr Wolf, Dr Swift), Occupational Health Services, Mayo Clinic, Scottsdale, Arizona (Dr Geyer), Department of Hospital Internal Medicine, Mayo Clinic, Scottsdale, Arizona (Dr Geyer), Employee Health Services, Mayo Clinic, Jacksonville, Florida (Dr Brinker), Department of Family Medicine, Mayo Clinic, Jacksonville, Florida (Dr Brinker), Recovery and Claims Services, Mayo Clinic, Rochester, Minnesota (Kohlnhofer)
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8
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Breeher LE. Reducing Community Exposure to Protect Health Care Personnel in a Pandemic Environment. Mayo Clin Proc 2021; 96:2295-2297. [PMID: 34481592 PMCID: PMC8408669 DOI: 10.1016/j.mayocp.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/22/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Laura E Breeher
- Occupational Health Services, Practice Administration, Mayo Clinic, Rochester, MN, Occupational Medicine, Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN.
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9
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Tomshine JR, Dennis KD, Bruhnke RE, Christensen JH, Halvorsen TG, Hogan CJ, O'Horo JC, Breeher LE, Callstrom MR, Wehde MB. Combined Effects of Masking and Distance on Aerosol Exposure Potential. Mayo Clin Proc 2021; 96:1792-1800. [PMID: 34218858 DOI: 10.1016/j.mayocp.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To quantify the efficacy of masking and "social distancing" on the transmission of airborne particles from a phantom aerosol source (simulating an infected individual) to a nearby target (simulating a healthy bystander) in a well-controlled setting. METHODS An aerosol was created using monodisperse polystyrene latex beads in place of infectious respiratory secretions. Detection was by aerodynamic particle spectrometry. Both reusable cloth masks and disposable paper masks were studied. Transmission was simulated indoors during a 3-minute interval to eliminate the effect of variable ventilation rate on aerosol exposure. The study commenced on September 16, 2020, and concluded on December 15, 2020. RESULTS Compared with a baseline of 1-foot separation with no masks employed, particle count was reduced by 84% at 3 feet of separation and 97% at 6 feet. A modest decrease in particle count was observed when only the receiver was masked. The most substantial exposure reduction occurred when the aerosol source was masked (or both parties were masked). When both the source and target were masked, particle count was reduced by more than 99.5% of baseline, regardless of separation distance or which type of mask was employed. CONCLUSION These results support the principle of layered protection to mitigate transmission of SARS-CoV-2, the virus causing COVID-19, and other respiratory viruses and emphasize the importance of controlling the spread of aerosol at its source. The combination of masking and distancing reduced the exposure to exhaled particulates more than any individual measure. Combined measures remain the most effective way to combat the spread of respiratory infection.
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Affiliation(s)
| | | | | | | | | | | | - John C O'Horo
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Laura E Breeher
- Department of Preventive Medicine, Mayo Clinic, Rochester, MN
| | | | - Mark B Wehde
- Division of Engineering, Mayo Clinic, Rochester, MN.
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10
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Carter RE, Theel ES, Breeher LE, Swift MD, Van Brunt NA, Smith WR, Blanchfield LL, Daugherty EA, Chapital AB, Matson KM, Bews KA, Johnson PW, Domnick RA, Joyce DE, Geyer HL, Granger D, Hilgart HR, Turgeon CT, Sanders KA, Matern D, Nassar A, Sampathkumar P, Hainy CM, Orford RR, Vachon CM, Didehban R, Morice WG, Ting HH, Williams AW, Gray RJ, Thielen KR, Farrugia G. Prevalence of SARS-CoV-2 Antibodies in a Multistate Academic Medical Center. Mayo Clin Proc 2021; 96:1165-1174. [PMID: 33958053 PMCID: PMC7997730 DOI: 10.1016/j.mayocp.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 03/09/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in health care personnel. METHODS The Mayo Clinic Serology Screening Program was created to provide a voluntary, two-stage testing program for SARS-CoV-2 antibodies to health care personnel. The first stage used a dried blood spot screening test initiated on June 15, 2020. Those participants identified as reactive were advised to have confirmatory testing via a venipuncture. Venipuncture results through August 8, 2020, were considered. Consent and authorization for testing was required to participate in the screening program. This report, which was conducted under an institutional review board-approved protocol, only includes employees who have further authorized their records for use in research. RESULTS A total of 81,113 health care personnel were eligible for the program, and of these 29,606 participated in the screening program. A total of 4284 (14.5%) of the dried blood spot test results were "reactive" and warranted confirmatory testing. Confirmatory testing was completed on 4094 (95.6%) of the screen reactive with an overall seroprevalence rate of 0.60% (95% CI, 0.52% to 0.69%). Significant variation in seroprevalence was observed by region of the country and age group. CONCLUSION The seroprevalence for SARS-CoV-2 antibodies through August 8, 2020, was found to be lower than previously reported in other health care organizations. There was an observation that seroprevalence may be associated with community disease burden.
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11
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Swift MD, Breeher LE, Tande AJ, Tommaso CP, Hainy CM, Chu H, Murad MH, Berbari EF, Virk A. Effectiveness of mRNA COVID-19 vaccines against SARS-CoV-2 infection in a cohort of healthcare personnel. Clin Infect Dis 2021; 73:e1376-e1379. [PMID: 33900384 PMCID: PMC8135611 DOI: 10.1093/cid/ciab361] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [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: 03/08/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
In a large cohort of United States healthcare personnel without prior coronavirus disease 2019 (COVID-19) infection, 94 382 doses of messenger RNA (mRNA) COVID-19 vaccine were administered to 49 220 individuals. The adjusted vaccine effectiveness following 2 doses of each of the 2 available brands of mRNA vaccine exceeded 96%.
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Affiliation(s)
- Melanie D Swift
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Laura E Breeher
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Aaron J Tande
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | - Caitlin M Hainy
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Haitao Chu
- Division of Biostatistics, University of Minnesota Twin Cities, Minneapolis, MN
| | - M Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Elie F Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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12
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Swift MD, Molella RG, Vaughn AIS, Breeher LE, Newcomb RD, Abdellatif S, Murad MH. Determinants of Latent Tuberculosis Treatment Acceptance and Completion in Healthcare Personnel. Clin Infect Dis 2021; 71:284-290. [PMID: 31552416 DOI: 10.1093/cid/ciz817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/16/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND US public health strategy for eliminating tuberculosis (TB) prioritizes treatment of latent TB infection (LTBI). Healthcare personnel (HCP) are less willing to accept treatment than other populations. Little is known about factors associated with HCP LTBI therapy acceptance and completion. METHODS We conducted a retrospective chart review to identify all employees with LTBI at time of hire at a large academic medical center during a 10-year period. Personal demographics, occupational factors, and clinic visit variables were correlated with LTBI treatment acceptance and completion rates using multivariate logistic regression. RESULTS Of 470 HCP with LTBI for whom treatment was recommended, 193 (41.1%) accepted treatment, while 137 (29.1%) completed treatment. Treatment adherence was better with 4 months of rifampin than 9 months of isoniazid (95% vs 68%, P < .005). Increased age of the healthcare worker was independently associated with lower rates of treatment acceptance (odds ratio [95% confidence interval]: 0.97 [0.94-0.99] per year), as was having an occupation of clinician (0.47 [0.26-0.85]) or researcher (0.34 [0.19-0.64]). Male gender was associated with higher treatment acceptance (1.90 [1.21-2.99]). Treatment completion was associated with being from a low- (9.49 [2.06-43.73]) or medium- (8.51 [3.93-18.44]) TB-burden country. CONCLUSIONS Geographic and occupational factors affect acceptance and completion of LTBI therapy. Short-course regimens may improve adherence. Physicians, researchers, and HCP from high-TB-burden countries have lower treatment rates than other HCP. Improving LTBI treatment in HCP will require attending to cultural and occupational differences.
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Affiliation(s)
| | | | | | | | | | | | - M Hassan Murad
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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13
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Sampathkumar P, Beam E, Breeher LE, O'Horo JC. Precautions, Utilization of Personal Protective Equipment, and Conservation Strategies During the COVID-19 Pandemic. Mayo Clin Proc 2020; 95:S11-S13. [PMID: 32807520 PMCID: PMC7306719 DOI: 10.1016/j.mayocp.2020.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Elena Beam
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Laura E Breeher
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - John C O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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14
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Affiliation(s)
- Laura E Breeher
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN; Occupational Health Services, Mayo Clinic, Rochester, MN.
| | | | - Elena Beam
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Melanie D Swift
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN; Occupational Health Services, Mayo Clinic, Rochester, MN
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15
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Dobler CC, Farah WH, Alsawas M, Mohammed K, Breeher LE, Murad MH, Molella RG. Tuberculin Skin Test Conversions and Occupational Exposure Risk in US Healthcare Workers. Clin Infect Dis 2017; 66:706-711. [DOI: 10.1093/cid/cix861] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claudia C Dobler
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Wigdan H Farah
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Mouaz Alsawas
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Khaled Mohammed
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
- Pediatric Residency Program, University of Minnesota, Minneapolis
| | - Laura E Breeher
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Robin G Molella
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota
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16
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Farah WH, Breeher LE, Newcomb RD, Murad MH, Vaughn AIS, Hagen PT, Molella RG. Late boosting phenomenon in TST conversion among health care workers. Occup Med (Lond) 2017; 67:484-489. [PMID: 28898965 DOI: 10.1093/occmed/kqx102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Available information is insufficient to guide determination of whether tuberculin skin test (TST) conversions of health care workers (HCWs) within 2 years of two-step testing are related to occupational exposures or to other causes, including late boosting. AIMS To describe the epidemiologic factors of TST conversion in HCWs, comparing early TST conversion (≤2 years after two-step testing) with late conversion to possibly distinguish late boosting phenomenon from occupational TST conversion. METHODS Retrospective analysis of a database of TSTs of HCWs from 1 January 1998, through 31 May 2014, in the United States Midwest. RESULTS In total, 40142 HCWs had 197932 tests over the 16 years, with 123 conversions (conversion rate: 0.3%; 95% CI 0.3-0.4%). Among 61 HCWs with a negative two-step TST, 30 (49%) were found to have early TST conversion within 2 years; 31 (51%) had late conversion, with likely occupational exposure but no identifiable community risks. Persons with early conversion were more likely to be born outside the USA (89% versus 57%; P < 0.05), had a higher rate of prior bacille Calmette-Guérin (BCG) vaccination (89% versus 52%; P < 0.05) and had no identifiable risk factors for conversion (63% versus 58%; P < 0.05). CONCLUSIONS Early conversions among HCWs after negative two-step TST are associated with various nonoccupational factors, including international birth and BCG vaccination history. Therefore, conversion is not a reliable indicator of recent tuberculosis contact in this population, and two-step TST is insufficient to discount a delayed boosting response for HCWs.
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Affiliation(s)
- W H Farah
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - L E Breeher
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R D Newcomb
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M H Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - A I S Vaughn
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - P T Hagen
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R G Molella
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Newcomb RD, Steffen MW, Breeher LE, Sturchio GM, Murad MH, Wang Z, Molella RG. Screening for depression in the occupational health setting. Occup Med (Lond) 2016; 66:390-3. [PMID: 27154983 DOI: 10.1093/occmed/kqw043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cost of workplace absenteeism and presenteeism due to depression in the USA is substantial. AIMS To assess the frequency of depression and its impact at the point of care in an occupational health (OH) practice. METHODS Patients presenting to an OH practice completed a standardized depression screening tool and were compared to an unscreened group in the same clinic. Respondents with a nine-item Patient Health Questionnaire (PHQ-9) score >15 and untreated for depression were referred for further evaluation per usual practice. A comparison group of unscreened patients were selected from the same clinic from 1 year prior and records were reviewed for evidence of prior depression, treatment and outcomes. After 1 year, frequency of depression, PHQ-9 scoring for screened patients, days absent from work, days on restricted duties and permanent restrictions were recorded for both groups. RESULTS Two hundred and five patients were screened for depression. Screening was associated with increased frequency of a diagnosis of current depression (30 versus 4%; P < 0.05). Screening was associated with similar rates of absenteeism but lower number of days on restricted duties (97 versus 159 days; P < 0.001). After adjusting for age, sex, history of and treatment for depression, screening was associated with lower odds of being on work restrictions [odds ratio (OR) 0.55; 95% confidence interval (CI) 0.38-0.78] or permanent restrictions (OR 0.35; 95% CI 0.23-0.52). CONCLUSIONS Depression was common in this OH practice. Screening for depression, with appropriate recognition and referral, may reduce time for employed patients on restricted duties and permanent restrictions.
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Affiliation(s)
- R D Newcomb
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA,
| | - M W Steffen
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - L E Breeher
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - G M Sturchio
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M H Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Z Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - R G Molella
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
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