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Liu H, Shaw-Saliba K, Westerbeck J, Jacobs D, Fenstermacher K, Chao CY, Gong YN, Powell H, Ma Z, Mehoke T, Ernlund AW, Dziedzic A, Vyas S, Evans J, Sauer LM, Wu CC, Chen SH, Rothman RE, Thielen P, Chen KF, Pekosz A. Effect of human H3N2 influenza virus reassortment on influenza incidence and severity during the 2017-18 influenza season in the USA: a retrospective observational genomic analysis. Lancet Microbe 2024:S2666-5247(24)00067-3. [PMID: 38734029 DOI: 10.1016/s2666-5247(24)00067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND During the 2017-18 influenza season in the USA, there was a high incidence of influenza illness and mortality. However, no apparent antigenic change was identified in the dominant H3N2 viruses, and the severity of the season could not be solely attributed to a vaccine mismatch. We aimed to investigate whether the altered virus properties resulting from gene reassortment were underlying causes of the increased case number and disease severity associated with the 2017-18 influenza season. METHODS Samples included were collected from patients with influenza who were prospectively recruited during the 2016-17 and 2017-18 influenza seasons at the Johns Hopkins Hospital Emergency Departments in Baltimore, MD, USA, as well as from archived samples from Johns Hopkins Health System sites. Among 647 recruited patients with influenza A virus infection, 411 patients with whole-genome sequences were available in the Johns Hopkins Center of Excellence for Influenza Research and Surveillance network during the 2016-17 and 2017-18 seasons. Phylogenetic trees were constructed based on viral whole-genome sequences. Representative viral isolates of the two seasons were characterised in immortalised cell lines and human nasal epithelial cell cultures, and patients' demographic data and clinical outcomes were analysed. FINDINGS Unique H3N2 reassortment events were observed, resulting in two predominant strains in the 2017-18 season: HA clade 3C.2a2 and clade 3C.3a, which had novel gene segment constellations containing gene segments from HA clade 3C.2a1 viruses. The reassortant re3C.2a2 viruses replicated with faster kinetics and to a higher peak titre compared with the parental 3C.2a2 and 3C.2a1 viruses (48 h vs 72 h). Furthermore, patients infected with reassortant 3C.2a2 viruses had higher Influenza Severity Scores than patients infected with the parental 3C.2a2 viruses (median 3·00 [IQR 1·00-4·00] vs 1·50 [1·00-2·00]; p=0·018). INTERPRETATION Our findings suggest that the increased severity of the 2017-18 influenza season was due in part to two intrasubtypes, cocirculating H3N2 reassortant viruses with fitness advantages over the parental viruses. This information could help inform future vaccine development and public health policies. FUNDING The Center of Excellence for Influenza Research and Response in the US, National Science and Technology Council, and Chang Gung Memorial Hospital in Taiwan.
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Affiliation(s)
- Hsuan Liu
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Westerbeck
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Jacobs
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine Fenstermacher
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chia-Yu Chao
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Nong Gong
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Harrison Powell
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zexu Ma
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas Mehoke
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Amanda W Ernlund
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Amanda Dziedzic
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Siddhant Vyas
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jared Evans
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chin-Chieh Wu
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Artificial Intelligence, College of Intelligent Computing, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hui Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Thielen
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Kuan-Fu Chen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Artificial Intelligence, College of Intelligent Computing, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Andrew Pekosz
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Mears MC, Ntiforo CA, Sauer LM, Mehta AK, Levine CB. Select Agent Regulatory Challenges in a Patient Care Setting: Review and Recommendations. Health Secur 2024; 22:58-64. [PMID: 38054936 DOI: 10.1089/hs.2023.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
The Federal Select Agent Program ensures the safe and secure possession, use, and transfer of biological select agents and toxins through the select agent regulations (42 CFR §73, 7 CFR §331, and 9 CFR §121). These regulations are primarily written for interpretation by diagnostic and research laboratories, with limited text pertaining to the care of individuals infected with a select agent. The regulations applicable to patient care settings are ambiguous, resulting in challenges with regulatory compliance. The COVID-19 pandemic called attention to these shortcomings and the need to clarify and modify the select agent regulations. In this article, we discuss 3 select agent regulation phrases regarding patient care that need clarification-specifically, the window of time to transfer, patient care setting, and conclusion of patient care-and provide recommendations for improvement. These recommendations include implementing minimum security standards to safeguard patient specimens against theft, loss, or release prior to the appropriate transfer or destruction of the material and increasing the time allowed for the transfer or destruction of specimens before entities are subject to the select agent regulations. We encourage the Federal Select Agent Program to release a policy statement clarifying the select agent regulations regarding patient care discussed herein and to lengthen the designated time to destroy or transfer agents to a registered entity. Addressing these challenges will aid in compliance with the select agent regulations in patient care settings.
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Affiliation(s)
- Megan C Mears
- Megan C. Mears, PhD, MPH, is a Graduate Student, School of Public and Population Health and Department of Pathology; University of Texas Medical Branch, Galveston, TX
| | - Corrie A Ntiforo
- Corrie A. Ntiforo, MSPH, RBP, is a Lead Biosafety Professional, Department of Biosafety, Office of the Provost; University of Texas Medical Branch, Galveston, TX
| | - Lauren M Sauer
- Lauren M. Sauer, MSc, is an Associate Professor, Department of Environmental Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Aneesh K Mehta
- Aneesh K. Mehta, MD, is a Professor, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Corri B Levine
- Corri B. Levine, PhD, MS, MPH, is Program Manager, Division of Infectious Diseases, Department of Internal Medicine; University of Texas Medical Branch, Galveston, TX
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3
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Sauer LM, Resnick B, Links JL, Garibaldi BT, Rutkow L. Information Challenges Associated With Accessing and Sharing of Patient Information in Disasters: A Qualitative Analysis. Health Secur 2023; 21:479-488. [PMID: 37889613 DOI: 10.1089/hs.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Abstract
As disasters increase in frequency and severity, so too does the health impact on affected populations. Disasters exacerbate the already challenging health information-sharing landscape. A reduced capacity to access and share patient information may have negative impacts on providers' ability to care for patients individually and to address disaster health outcomes at the population level. Between October 2018 and July 2019, we conducted 21 semistructured interviews with physicians experienced in providing healthcare during disasters to understand the challenges related to patient information sharing in disaster responses. Key informants noted challenges with patient information management-including accessing, sharing, and transferring information-and that it was a barrier to providing effective clinical care in disasters. Three major areas were identified as challenges: (1) lack of systematic mechanisms for patient information sharing during disaster handoffs, (2) lack of access to a patient's past medical history, and (3) population-level impacts of patient information-sharing breakdowns in disasters. Reducing barriers to effective patient information sharing is a critical need during disasters. Requirements generally fall to overburdened clinicians, and novel solutions that ease this responsibility and leverage existing infrastructure should be explored. Work conducted during the COVID-19 pandemic may inform new solutions. Integrated approaches that support information sharing in real time will improve patient care at the individual level and can support operational improvements to current and future disaster responses.
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Affiliation(s)
- Lauren M Sauer
- Lauren M. Sauer, MSc, is an Associate Professor and Associate Director of Research, Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE. She is also an Associate Professor, Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Beth Resnick
- Beth Resnick, DrPH, is Assistant Dean for Practice and Training and a Senior Scientist, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jonathan L Links
- Jonathan L. Links, PhD, is a Professor, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and Vice Provost and Chief Risk Officer, Office of the Provost, Johns Hopkins University, Baltimore, MD
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEPH, is an Associate Professor, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and Director, Johns Hopkins Biocontainment Unit, Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD
| | - Lainie Rutkow
- Lainie Rutkow, JD, PhD, MPH, is a Professor of Medicine and Physiology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, and Vice Provost for Interdisciplinary Initiatives, Office of the Provost, both at Johns Hopkins University, Baltimore, MD
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Lukowski J, Vasa A, Arguinchona C, ElRayes W, Frank MG, Galdys AL, Garcia MC, Garland JA, Kline S, Persson C, Ruby D, Sauer LM, Vasistha S, Carrasco S, Herstein JJ. A narrative review of high-level isolation unit operational and infrastructure features. BMJ Glob Health 2023; 8:e012037. [PMID: 37423621 DOI: 10.1136/bmjgh-2023-012037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 07/11/2023] Open
Abstract
High-level isolation units (HLIUs) are specially designed facilities for care and management of patients with suspected or confirmed high-consequence infectious diseases (HCIDs), equipped with unique infrastructure and operational features. While individual HLIUs have published on their experiences caring for patients with HCIDs and two previous HLIU consensus efforts have outlined key components of HLIUs, we aimed to summarise the existing literature that describes best practices, challenges and core features of these specialised facilities. A narrative review of the literature was conducted using keywords associated with HLIUs and HCIDs. A total of 100 articles were used throughout the manuscript from the literature search or from alternate methods like reference checks or snowballing. Articles were sorted into categories (eg, physical infrastructure, laboratory, internal transport); for each category, a synthesis of the relevant literature was conducted to describe best practices, experiences and operational features. The review and summary of HLIU experiences, best practices, challenges and components can serve as a resource for units continuing to improve readiness, or for hospitals in early stages of developing their HLIU teams and planning or constructing their units. The COVID-19 pandemic, a global outbreak of mpox, sporadic cases of viral haemorrhagic fevers in Europe and the USA, and recent outbreaks of Lassa fever, Sudan Ebolavirus, and Marburg emphasise the need for an extensive summary of HLIU practices to inform readiness and response.
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Affiliation(s)
- Joseph Lukowski
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Christa Arguinchona
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Wael ElRayes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria G Frank
- School of Medicine, University of Colorado, Denver, Colorado, USA
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Alison L Galdys
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Mary C Garcia
- Department of Laboratory Services, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer A Garland
- Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Susan Kline
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Caroline Persson
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Darrell Ruby
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Lauren M Sauer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sami Vasistha
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sharon Carrasco
- Serious Communicable Disease Program, Emory University, Atlanta, Georgia, USA
| | - Jocelyn J Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Herstein JJ, Stern K, Flinn J, Garland JA, Lowe AE, Sauer LM. Challenges and Approaches to High-Level Isolation Unit Staffing and Just-in-Time Training: A Meeting Report. Open Forum Infect Dis 2023; 10:ofad152. [PMID: 37035492 PMCID: PMC10077825 DOI: 10.1093/ofid/ofad152] [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: 01/18/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
In November 2022, the National Emerging Special Pathogens Training and Education Center hosted a virtual session with global high-level isolation unit (HLIU) representatives to discuss HLIU staffing challenges and approaches. Takeaways are relevant to healthcare institutions seeking solutions to recruit and retain their healthcare workforce amid unprecedented global staffing shortages.
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Affiliation(s)
- Jocelyn J Herstein
- Correspondence: Jocelyn J. Herstein, PhD, MPH, University of Nebraska Medical Center, 984388 Nebraska Medical Center, Omaha, NE 68198 ()
| | - Katie Stern
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jade Flinn
- Biocontainment Unit, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A Garland
- Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Abigail E Lowe
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
- College of Allied Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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6
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Sauer LM, Mukherjee V. Special Pathogens Readiness in the United States: from Ebola to COVID-19 to Disease X and Beyond. Health Secur 2022; 20:S1-S3. [PMID: 35588287 DOI: 10.1089/hs.2022.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lauren M Sauer
- Lauren M. Sauer, MSc, is Director, Special Pathogens Research Network, Global Center for Health Security, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Vikramjit Mukherjee
- Vikramjit Mukherjee, MD, FRCP (Edin), is Director, Medical ICU, NYC Health + Hospitals/Bellevue, and an Assistant Professor of Medicine, Pulmonary and Critical Care Medicine, NYU Grossman School of Medicine, New York, NY
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7
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Mukherjee V, Sauer LM, Mehta AK, Shea SY, Biddinger PD, Carr BG, Evans LE, Schwedhelm S, Lowe JJ. The Evolution of the National Special Pathogen System of Care. Health Secur 2022; 20:S39-S48. [PMID: 35587214 DOI: 10.1089/hs.2022.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Infectious disease outbreaks and pandemics have repeatedly threatened public health and have severely strained healthcare delivery systems throughout the past century. Pathogens causing respiratory illness, such as influenza viruses and coronaviruses, as well as the highly communicable viral hemorrhagic fevers, pose a large threat to the healthcare delivery system in the United States and worldwide. Through the Hospital Preparedness Program, within the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, a nationwide Regional Ebola Treatment Network (RETN) was developed, building upon a state- and jurisdiction-based tiered hospital approach. This network, spearheaded by the National Emerging Special Pathogens Training and Education Center, developed a conceptual framework and plan for the evolution of the RETN into the National Special Pathogen System of Care (NSPS). Building the NSPS strategy involved reviewing the literature and the initial framework used in forming the RETN and conducting an extensive stakeholder engagement process to identify gaps and develop solutions. From this, the NSPS strategy and implementation plan were formed. The resulting NSPS strategy is an ambitious but critical effort that will have impacts on the mitigation efforts of special pathogen threats for years to come.
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Affiliation(s)
- Vikramjit Mukherjee
- Vikramjit Mukherjee, MD, FRCP (Edin), is Director, Medical ICU, NYC Health + Hospitals/Bellevue, and an Assistant Professor of Medicine, NYU Grossman School of Medicine, New York, NY
| | - Lauren M Sauer
- Lauren M. Sauer, MSc, is Director, Special Pathogens Research Network, Global Center for Health Security, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center (UNMC); Omaha, NE
| | - Aneesh K Mehta
- Aneesh K. Mehta, MD, is a Professor, Division of Infectious Diseases, and Co-Principal Investigator, NETEC, Emory University School of Medicine, Atlanta, GA
| | - Sophia Y Shea
- Sophia Y. Shea, MPH, is a Project Manager II, Global Center for Health Security, UNMC; Omaha, NE
| | - Paul D Biddinger
- Paul D. Biddinger, MD, FACEP, is Chief Preparedness and Continuity Officer, Mass General Brigham; Director, Center for Disaster Medicine, Department of Emergency Medicine, Massachusetts General Hospital; and Associate Professor of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Brendan G Carr
- Brendan G. Carr, MD, MS, is Chair and a Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura E Evans
- Laura E. Evans, MD, MSc, is a Professor, Pulmonary, Critical and Sleep Medicine, University of Washington Medical Center, Seattle, WA
| | - Shelly Schwedhelm
- Shelly Schwedhelm, MSN, RN, NEA-BC, is Executive Director, Emergency Management and Biopreparedness, Nebraska Medicine, and Executive Director, Emergency Management and Clinical Operations, Global Center for Health Security, UNMC; Omaha, NE
| | - John J Lowe
- John J. Lowe, PhD, is Co-Principal Investigator, National Emerging Special Pathogens Training and Education Center (NETEC), a Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, and Assistant Vice Chancellor for Health Security Training and Education, UNMC; Omaha, NE
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Lowe AE, Kraft C, Kortepeter MG, Hansen KF, Sanger K, Johnson A, Grein JD, Martin J, Rousselle R, Garland JA, Spotts J, Lowe JJ, Sauer LM, Kratochvil CJ, Gordon BG. Developing a Rapid Response Single IRB Model for Conducting Research During a Public Health Emergency. Health Secur 2022; 20:S60-S70. [PMID: 35544310 DOI: 10.1089/hs.2021.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Research is foundational for evidence-based management of patients. Clinical research, however, takes time to plan, conduct, and disseminate-a luxury that is rarely available during a public health emergency. The University of Nebraska Medical Center (UNMC) developed a single institutional review board (IRB), with a vision to establish a rapid review resource for a network focused on clinical research of emerging pathogens in the United States. A core aspect of successful initiation of research during a pandemic or epidemic is the ability to operationalize an approach for rapid ethical review of human subject research and conduct those reviews at multiple sites-without losing any of the substantive aspects of ethics review. This process must be cultivated in anticipation of a public health emergency. US guidance for operationalizing IRB review for multisite research in a public health emergency is not well studied and processes are not well established. UNMC sought to address operational gaps and identify the unique procedural needs of rapid response single IRB (RR-sIRB) review of multisite research by conducting a series of preparedness exercises to develop and test the RR-sIRB model. For decades, emergency responder, healthcare, and public health organizations have conducted emergency preparedness exercises to test requirements for emergency response. In this article, we describe 2 types of simulation exercises conducted by UNMC: workshops and tabletops. This effort represents a unique use of emergency preparedness exercises to develop, refine, and test rapid review functions for an sIRB and to validate readiness of regulatory research processes. Such processes are crucial for conducting rapid, ethical, and sound clinical research in public health emergencies.
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Affiliation(s)
- Abigail E Lowe
- Abigail E. Lowe, MA, is an Assistant Professor, Global Center for Health Security, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE
| | - Colleen Kraft
- Colleen Kraft, MD, MS, is a Professor, Department of Pathology and Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, and Associate Chief Medical Officer, Emory Hospital, Emory University, Atlanta, GA
| | - Mark G Kortepeter
- Mark G. Kortepeter, MD, is Vice President for Research, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Keith F Hansen
- Keith F. Hansen, MBA, is Co-Director, Center for Preparedness Education, College of Public Health; Co-Executive Director, Association of Healthcare Emergency Preparedness Professionals; and an Instructor, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Kristine Sanger
- Kristine Sanger is Director of Training and Exercise Programs, Center for Preparedness Education, College of Public Health, and Co-Executive Director, Association of Healthcare Emergency Preparedness Professionals, University of Nebraska Medical Center, Omaha, NE
| | - Ann Johnson
- Ann Johnson, PhD, MPH, CIP, is Director, Institutional Review Board and Human Research Program, University of Utah, Salt Lake City, UT
| | - Jonathan D Grein
- Jonathan D. Grein, MD, is Director, Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Julie Martin
- Julie Martin, RN, MEd, CIP, is Assistant Director, Institutional Review Board, Emory University, Atlanta, GA
| | - Rebecca Rousselle
- Rebecca Rousselle, BA, CIP, is Assistant Vice President, Human Research Protection Program, Emory University, Atlanta, GA
| | - Jennifer A Garland
- Jennifer A. Garland, RN-BC, PhD, CIC, is an Epidemiologist and Special Pathogens Clinical Program Manager, Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jessica Spotts
- Jessica Spotts, CIP, is a Senior IRB Education and Quality Improvement Analyst, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John J Lowe
- John J. Lowe, PhD, is Co-Principal Investigator, National Emerging Special Pathogens Training and Education Center (NETEC), a Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, and Assistant Vice Chancellor for Health Security Training and Education, University of Nebraska Medical Center, Omaha, NE
| | - Lauren M Sauer
- Lauren M. Sauer, MSc, is Director, Special Pathogens Research Network, Global Center for Health Security, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Christopher J Kratochvil
- Christopher J. Kratochvil, MD, Associate Vice Chancellor for Clinical Research, University of Nebraska Medical Center, Omaha, NE
| | - Bruce G Gordon
- Bruce G. Gordon, MD, is Assistant Vice Chancellor for Regulatory Affairs, Executive Chairman of Institutional Review Boards, and Professor in the Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
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Casciola-Rosen L, Thiemann DR, Andrade F, Trejo-Zambrano MI, Leonard EK, Spangler JB, Skinner NE, Bailey J, Yegnasubramanian S, Wang R, Vaghasia AM, Gupta A, Cox AL, Ray SC, Linville RM, Guo Z, Searson PC, Machamer CE, Desiderio S, Sauer LM, Laeyendecker O, Garibaldi BT, Gao L, Damarla M, Hassoun PM, Hooper JE, Mecoli CA, Christopher-Stine L, Gutierrez-Alamillo L, Yang Q, Hines D, Clarke WA, Rothman RE, Pekosz A, Fenstermacher KZ, Wang Z, Zeger SL, Rosen A. IgM anti-ACE2 autoantibodies in severe COVID-19 activate complement and perturb vascular endothelial function. JCI Insight 2022; 7:e158362. [PMID: 35349483 PMCID: PMC9090251 DOI: 10.1172/jci.insight.158362] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
BackgroundSome clinical features of severe COVID-19 represent blood vessel damage induced by activation of host immune responses initiated by the coronavirus SARS-CoV-2. We hypothesized autoantibodies against angiotensin-converting enzyme 2 (ACE2), the SARS-CoV-2 receptor expressed on vascular endothelium, are generated during COVID-19 and are of mechanistic importance.MethodsIn an opportunity sample of 118 COVID-19 inpatients, autoantibodies recognizing ACE2 were detected by ELISA. Binding properties of anti-ACE2 IgM were analyzed via biolayer interferometry. Effects of anti-ACE2 IgM on complement activation and endothelial function were demonstrated in a tissue-engineered pulmonary microvessel model.ResultsAnti-ACE2 IgM (not IgG) autoantibodies were associated with severe COVID-19 and found in 18/66 (27.2%) patients with severe disease compared with 2/52 (3.8%) of patients with moderate disease (OR 9.38, 95% CI 2.38-42.0; P = 0.0009). Anti-ACE2 IgM autoantibodies were rare (2/50) in non-COVID-19 ventilated patients with acute respiratory distress syndrome. Unexpectedly, ACE2-reactive IgM autoantibodies in COVID-19 did not undergo class-switching to IgG and had apparent KD values of 5.6-21.7 nM, indicating they are T cell independent. Anti-ACE2 IgMs activated complement and initiated complement-binding and functional changes in endothelial cells in microvessels, suggesting they contribute to the angiocentric pathology of COVID-19.ConclusionWe identify anti-ACE2 IgM as a mechanism-based biomarker strongly associated with severe clinical outcomes in SARS-CoV-2 infection, which has therapeutic implications.FUNDINGBill & Melinda Gates Foundation, Gates Philanthropy Partners, Donald B. and Dorothy L. Stabler Foundation, and Jerome L. Greene Foundation; NIH R01 AR073208, R01 AR069569, Institutional Research and Academic Career Development Award (5K12GM123914-03), National Heart, Lung, and Blood Institute R21HL145216, and Division of Intramural Research, National Institute of Allergy and Infectious Diseases; National Science Foundation Graduate Research Fellowship (DGE1746891).
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Affiliation(s)
| | | | | | | | - Elissa K. Leonard
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jamie B. Spangler
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
- Translational Tissue Engineering Center
| | | | - Justin Bailey
- Department of Medicine, Division of Infectious Diseases; and
| | | | - Rulin Wang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ajay M. Vaghasia
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anuj Gupta
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea L. Cox
- Department of Medicine, Division of Infectious Diseases; and
| | - Stuart C. Ray
- Department of Medicine, Division of Infectious Diseases; and
| | - Raleigh M. Linville
- Institute for NanoBioTechnology and
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Peter C. Searson
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Institute for NanoBioTechnology and
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Stephen Desiderio
- Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren M. Sauer
- Adult Emergency Department, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Johns Hopkins Biocontainment Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Department of Medicine, Division of Infectious Diseases; and
- Division of Intramural Medicine, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland, USA
| | - Brian T. Garibaldi
- Johns Hopkins Biocontainment Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Li Gao
- Department of Medicine, Division of Allergy and Clinical Immunology; and
| | - Mahendra Damarla
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Paul M. Hassoun
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Jody E. Hooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - David Hines
- Department of Medicine, Division of Rheumatology
| | - William A. Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard E. Rothman
- Adult Emergency Department, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Environmental Health and Engineering
- Department of Molecular Microbiology and Immunology, and
| | | | - Zitong Wang
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott L. Zeger
- Department of Medicine, Division of Rheumatology
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Antony Rosen
- Department of Medicine, Division of Rheumatology
- Department of Cell Biology and
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Grein JD, Garland JA, Arguinchona C, Frank MG, Garibaldi BT, Grindle A, Hewlett A, Kline S, Levine CB, Mehta A, Mukherjee V, Sauer LM, Searle EF, Vanairsdale S, Vasa A. Contributions of the Regional Emerging Special Pathogen Treatment Centers to the US COVID-19 Pandemic Response. Health Secur 2022; 20:S4-S12. [PMID: 35483049 DOI: 10.1089/hs.2021.0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Emerging Special Pathogens Training and Education Center (NETEC) was established in 2015 to improve the capabilities of healthcare facilities to provide safe and effective care to patients with Ebola and other special pathogens in the United States. Through NETEC, a collaborative network of 10 Regional Emerging Special Pathogen Treatment Centers (RESPTCs) undertook readiness activities that included potential respiratory pathogens. These preparations, which took place before the COVID-19 pandemic, established a foundation of readiness that enabled RESPTCs to play a pivotal role in the US COVID-19 pandemic response. As initial COVID-19 cases were detected in the United States, RESPTCs provided essential isolation capacity, supplies, and subject matter expertise that allowed for additional time for healthcare systems to prepare. Through the Special Pathogen Research Network, RESPTCs rapidly enrolled patients into early clinical trials. During periods of high community transmission, RESPTCs provided educational, clinical, and logistical support to a wide range of healthcare and nonhealthcare settings. In this article, we describe how NETEC and the RESPTC network leveraged this foundation of special pathogen readiness to strengthen the national healthcare system's response to the COVID-19 pandemic. NETEC and the RESPTC network have proven to be an effective model that can support the national response to future emerging special pathogens.
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Affiliation(s)
- Jonathan D Grein
- Jonathan D. Grein, MD, is Director, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer A Garland
- Jennifer A. Garland, RN-BC, PhD, CIC, is Special Pathogens Clinical Program Manager, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Christa Arguinchona
- Christa Arguinchona, MSN, RN, CCRN, is Manager, Special Pathogens/Infection Prevention, Providence Sacred Heart Medical Center, Spokane, WA
| | - Maria G Frank
- Maria G. Frank, MD, is a Hospitalist, Division of Hospital Medicine, Denver Health and Hospital Authority, and an Associate Professor of Medicine, School of Medicine, University of Colorado; both in Denver, CO
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Director, Johns Hopkins Biocontainment Unit, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Grindle
- Amanda Grindle, RN, MSN, CNL, CPN, CCRN, is Clinical Program Manager, Special Care Unit, Children's Healthcare of Atlanta, Atlanta, GA
| | - Angela Hewlett
- Angela Hewlett, MD, MS, is an Associate Professor, Division of Infectious Diseases, Department of Internal Medicine; the George W. Orr MD and Linda Orr Chair in Health Security; and Medical Director, Nebraska Biocontainment Unit; all at the University of Nebraska Medical Center, Omaha, NE
| | - Susan Kline
- Susan Kline, MD, MPH, is Executive Medical Director for Infection Prevention, University of Minnesota Medical Center, and a Professor of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School; both in Minneapolis, MN
| | - Corri B Levine
- Corri B. Levine, PhD, MS, MPH, is Program Manager for Emerging and Special Pathogens Program, University of Texas Medical Branch, Galveston, TX
| | - Aneesh Mehta
- Aneesh Mehta, MD, is an Associate Professor of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Vikramjit Mukherjee
- Vikramjit Mukherjee, MD, FRCP(Edin), is an Assistant Professor, NYU School of Medicine; and is Director, Medical Intensive Care Unit, and Director, Special Pathogens Program, Bellevue Hospital Center; all in New York, NY
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, and is an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, Global Center for Health Security; both at the University of Nebraska Medical Center, Omaha, NE
| | - Eileen F Searle
- Eileen F. Searle, PhD, RN, CCRN, is Biothreats Program Director, Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA
| | - Sharon Vanairsdale
- Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, is an Associate Professor, Clinical Track, Nell Hodgson Woodruff School of Nursing, Emory University; Program Director for Serious Communicable Diseases, Emory University Hospital; and Director of Education and Resources, National Emerging Special Pathogens Training and Education Center, Emory University; all in Atlanta, GA
| | - Angela Vasa
- Angela Vasa, MSN, RN, is Director of Isolation and Quarantine Services and Director, Readiness Consultations and Metrics Development, National Emerging Special Pathogens Training and Education Center; both at Nebraska Medicine, Omaha, NE
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11
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Levine CB, Vasistha S, Persson CC, Larson LR, Kratochvil CJ, Mehta AK, Hicks LJ, Lowe AE, Kortepeter MG, Sauer LM. Prepared to Act: Lessons Learned by the Special Pathogens Research Network, Based on Collaborations with the NIAID-Led Adaptive COVID-19 Treatment Trial. Health Secur 2022; 20:S20-S30. [PMID: 35483093 DOI: 10.1089/hs.2021.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The need for well-controlled clinical trials is fundamental to advancing medicine. Care should be taken to maintain high standards in trial design and conduct even during emergency medical events such as an infectious disease outbreak. In 2020, SARS-CoV-2 emerged and rapidly impacted populations around the globe. The need for effective therapeutics was immediately evident, prompting the National Institutes of Health to initiate the Adaptive COVID-19 Treatment Trial. The Special Pathogens Research Network, made up of 10 Regional Emerging Special Pathogens Treatment Centers, was approached to participate in this trial and readily joined the trial on short notice. By trial closure, the Special Pathogens Research Network sites, making up 19% of all study sites, enrolled 26% of the total participants. The initial resources available and experience in running clinical trials at each treatment center varied from minimal experience and few staff to extensive experience and a large staff. Based on experiences during the first phase of this trial, the Special Pathogens Research Network members provided feedback regarding operational lessons learned and recommendations for conducting future studies during a pandemic. Communication, collaboration, information technology, regulatory processes, and access to resources were identified as important topics to address. Key stakeholders including institutions, institutional review boards, and study personnel must maintain routine communication to efficiently and effectively activate when future research needs arise. Regular and standardized training for new personnel will aid in transitions and project continuity, especially in a rapidly evolving environment. Trainings should include local just-in-time training for new staff and sponsor-designed modules to refresh current staff knowledge. We offer recommendations that can be used by institutions and sponsors to determine goals and needs when preparing to set up this type of trial for critical, short-notice needs.
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Affiliation(s)
- Corri B Levine
- Corri B. Levine, PhD, MS, MPH, is Program Manager, Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Sami Vasistha
- Sami Vasistha, MS, is Program Manager, Global Center for Health Security and National Emerging and Special Pathogens Training and Education Center (NETEC), all at the University of Nebraska Medical Center, Omaha, NE
| | - Caroline Croyle Persson
- Caroline Croyle Persson, MPH, MPA, CPH, CIC, is Project Director, Biocontainment Unit, Denver Health and Hospital Authority, Denver, CO
| | - LuAnn R Larson
- LuAnn R. Larson, RN, BSN, is Director of Clinical Research, Center for Clinical and Translational Research and NETEC, all at the University of Nebraska Medical Center, Omaha, NE
| | - Christopher J Kratochvil
- Christopher J. Kratochvil, MD, is Associate Vice Chancellor for Clinical Research, Center for Clinical and Translational Research, all at the University of Nebraska Medical Center, Omaha, NE
| | - Aneesh K Mehta
- Aneesh K. Mehta, MD, is a Professor, Division of Infectious Diseases, and Co-Principal Investigator, NETEC; both at Emory University School of Medicine, Atlanta, GA
| | - Lindsay J Hicks
- Lindsay J. Hicks is IRB Administrator II, Office of Regulatory Affairs, all at the University of Nebraska Medical Center, Omaha, NE
| | - Abigail E Lowe
- Abigail E. Lowe, MA, is an Assistant Professor, College of Allied Health Professions, all at the University of Nebraska Medical Center, Omaha, NE
| | - Mark G Kortepeter
- Mark G. Kortepeter, MD, MPH, is Former Director, Special Pathogens Research Network, NETEC, and is a Professor, Department of Epidemiology, College of Allied Health Professions, all at the University of Nebraska Medical Center, Omaha, NE
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, NETEC, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, Global Center for Health Security, all at the University of Nebraska Medical Center, Omaha, NE
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12
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Herstein JJ, Vasa A, Sauer LM, Vanairsdale S, ElRayes W, Vasistha S, Herzog C, Leo YS, Vasoo S, Jacobs M, Lowe JJ. Increasing International Collaboration and Networking Among High-level Isolation Units and Programs. Health Secur 2022; 20:S85-S89. [PMID: 35475686 DOI: 10.1089/hs.2021.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jocelyn J Herstein
- Jocelyn J. Herstein, PhD, MPH, is Director, International Programs and Engagement, National Emerging Special Pathogens Training and Education Center (NETEC), and an Assistant Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health; all at the University of Nebraska Medical Center, Omaha, NE
| | - Angela Vasa
- Angela Vasa, MSN, RN, is Director, Readiness Consultations and Metrics Development, NETEC, and Director, Isolation and Quarantine, Nebraska Medicine; all at the University of Nebraska Medical Center, Omaha, NE
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, NETEC, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health; all at the University of Nebraska Medical Center, Omaha, NE
| | - Sharon Vanairsdale
- Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, is Director of Education and Resources, NETEC; an Associate Professor, Clinical Track, School of Nursing, Emory University; and Program Director for Serious Communicable Diseases, Emory University Hospital, all in Atlanta, GA
| | - Wael ElRayes
- Wael ElRayes, MBBCh, PhD, MS, FACHE, is an Assistant Professor, Department of Health Services Research and Administration, College of Public Health; all at the University of Nebraska Medical Center, Omaha, NE
| | - Sami Vasistha
- Sami Vasistha, MS, is a Program Manager, NETEC, and a Program Manager, Global Center for Health Security; all at the University of Nebraska Medical Center, Omaha, NE
| | - Christian Herzog
- Christian Herzog, PhD, is Head, Strategy and Incidence Response, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Yee Sin Leo
- Yee Sin Leo, MBBS, M Med, MPH, MRCP, FRCP, FAMS, is Executive Director, National Centre for Infectious Diseases; Senior Consultant, Department of Infectious Diseases, Tan Tock Seng Hospital; and Adjunct Professor, Saw Swee Hock School of Public Health; all in Singapore
| | - Shawn Vasoo
- Shawn Vasoo, MBBS, MRCP, is Clinical Director, National Centre for Infectious Diseases, and a Senior Consultant, Department of Infectious Diseases, Tan Tock Seng Hospital; both in Singapore
| | - Michael Jacobs
- Michael Jacobs, MA, PhD, FRCP, FRCP Edin, DTM&H, is a Consultant and Honorary Associate Professor of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - John J Lowe
- John J. Lowe, PhD, is Co-Principal Investigator, NETEC, a Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, and Assistant Vice Chancellor for Health Security Training and Education; all at the University of Nebraska Medical Center, Omaha, NE
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13
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Shea SY, Hick JL, Schwedhelm S, Sauer LM. Opportunity Among Disaster: Reflecting on 2 Disaster Scenarios During the COVID-19 Pandemic. Health Secur 2022; 20:S49-S53. [PMID: 35452260 DOI: 10.1089/hs.2021.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Maintaining a public health emergency response for a sustained period of time requires availability of resources, physical and information technology infrastructure, and human capital. What perhaps is unprecedented is a medical center experiencing multiple disasters simultaneously. In this case study, the authors describe 2 separate disaster events experienced during the ongoing COVID-19 pandemic: (1) a cyberattack at Nebraska Medicine in Omaha, Nebraska, and (2) civil unrest following the murder of George Floyd in Minneapolis, Minnesota. Although these settings were very different, the following common themes can inform future disaster planning: the benefit of an already active incident command system, the prescient need for continuity of operations, and the anticipation of workforce fatigue. These dual-disaster experiences provide an opportunity to identify lessons learned that will drive improvements in emergency management through preparedness and mitigation measures and response innovations for future simultaneous disasters.
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Affiliation(s)
- Sophia Y Shea
- Sophia Y. Shea, MPH, is a Project Manager II, Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE
| | - John L Hick
- John L. Hick, MD, is a Professor of Emergency Medicine, University of Minnesota, and Medical Director of Emergency Preparedness, Hennepin Healthcare; both in Minneapolis, MN
| | - Shelly Schwedhelm
- Shelly Schwedhelm, MSN, RN, NEA-BC, is Executive Director, Emergency Management and Biopreparedness, Nebraska Medicine, and Executive Director, Emergency Management and Clinical Operations, Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, Global Center for Health Security, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
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14
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Zapf AJ, Hardick J, McBryde B, Sauer LM, Fenstermacher KZJ, Ricketts EP, Lin YC, Chen KF, Hsieh YH, Dugas A, Shaw-Saliba K, Pekosz A, Gaydos CA, Rothman RE. Impact of coinfection status and comorbidity on disease severity in adult emergency department patients with influenza B. Influenza Other Respir Viruses 2021; 16:236-246. [PMID: 34533270 PMCID: PMC8818819 DOI: 10.1111/irv.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Influenza B accounts for approximately one fourth of the seasonal influenza burden. However, research on the importance of influenza B has received less attention compared to influenza A. We sought to describe the association of both coinfections and comorbidities with disease severity among adults presenting to emergency departments (ED) with influenza B. Methods Nasopharyngeal samples from patients found to be influenza B positive in four US and three Taiwanese ED over four consecutive influenza seasons (2014–2018) were tested for coinfections with the ePlex RP RUO panel. Multivariable logistic regressions were fitted to model adjusted odds ratios (aOR) for two severity outcomes separately: hospitalization and pneumonia diagnosis. Adjusting for demographic factors, underlying health conditions, and the National Early Warning Score (NEWS), we estimated the association of upper respiratory coinfections and comorbidity with disease severity (including hospitalization or pneumonia). Results Amongst all influenza B positive individuals (n = 446), presence of another upper respiratory pathogen was associated with an increased likelihood of hospitalization (aOR = 2.99 [95% confidence interval (95% CI): 1.14–7.85, p = 0.026]) and pneumonia (aOR = 2.27 [95% CI: 1.25–4.09, p = 0.007]). Chronic lung diseases (CLD) were the strongest predictor for hospitalization (aOR = 3.43 [95% CI: 2.98–3.95, p < 0.001]), but not for pneumonia (aOR = 1.73 [95% CI: 0.80–3.78, p = 0.166]). Conclusion Amongst ED patients infected with influenza B, the presence of other upper respiratory pathogens was independently associated with both hospitalization and pneumonia; presence of CLD was also associated with hospitalization. These findings may be informative for ED clinician's in managing patients infected with influenza B.
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Affiliation(s)
- Alexander J Zapf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Justin Hardick
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Breana McBryde
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Erin P Ricketts
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yi-Chin Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Loevinsohn G, Hardick J, Mehoke T, Sinywimaanzi P, Hamahuwa M, Fenstermacher KZJ, Shaw-Saliba K, Thielen P, Evans J, Bowden K, Zudock K, Sauer LM, Monze M, Gaydos CA, Rothman RE, Pekosz A, Thuma PE, Sutcliffe CG. Nosocomial Respiratory Infections in a Rural Zambian Hospital. Am J Trop Med Hyg 2021; 105:818-821. [PMID: 34280144 DOI: 10.4269/ajtmh.20-1470] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/25/2021] [Indexed: 11/07/2022] Open
Abstract
The burden of nosocomial respiratory infections in rural southern Africa is poorly understood. We established a surveillance program at a rural Zambian hospital to detect influenza-like illness (ILI) and respiratory infections among hospitalized patients and a cohort of healthcare workers (HCWs). Nasopharyngeal specimens from symptomatic patients and HCWs underwent broadly multiplexed molecular testing to detect viruses and atypical bacteria. During 1 year of surveillance, 15 patients (1.7% of admissions) developed ILI more than 48 hours after admission. Among 44 HCWs, 19 (43%) experienced at least one ILI episode, with a total of 31 ILI episodes detected. Respiratory viruses were detected in 45% of patient and 55% of HCW specimens. The cumulative incidence of influenza infection among HCWs over 1 year was 9%. Overall, respiratory viruses were commonly found among patients and HCWs in a rural Zambian hospital with limited infection control infrastructure.
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Affiliation(s)
- Gideon Loevinsohn
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Justin Hardick
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Mehoke
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | | | | | | | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter Thielen
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Jared Evans
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Kenneth Bowden
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Kristina Zudock
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mwaka Monze
- Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Philip E Thuma
- Macha Research Trust, Choma, Zambia.,Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine G Sutcliffe
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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16
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Antar AAR, Yu T, Pisanic N, Azamfirei R, Tornheim JA, Brown DM, Kruczynski K, Hardick JP, Sewell T, Jang M, Church T, Walch SN, Reuland C, Bachu VS, Littlefield K, Park HS, Ursin RL, Ganesan A, Kusemiju O, Barnaba B, Charles C, Prizzi M, Johnstone JR, Payton C, Dai W, Fuchs J, Massaccesi G, Armstrong DT, Townsend JL, Keller SC, Demko ZO, Hu C, Wang MC, Sauer LM, Mostafa HH, Keruly JC, Mehta SH, Klein SL, Cox AL, Pekosz A, Heaney CD, Thomas DL, Blair PW, Manabe YC. Delayed Rise of Oral Fluid Antibodies, Elevated BMI, and Absence of Early Fever Correlate With Longer Time to SARS-CoV-2 RNA Clearance in a Longitudinally Sampled Cohort of COVID-19 Outpatients. Open Forum Infect Dis 2021; 8:ofab195. [PMID: 34095338 PMCID: PMC8083254 DOI: 10.1093/ofid/ofab195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sustained molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the upper respiratory tract (URT) in mild to moderate coronavirus disease 2019 (COVID-19) is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection. METHODS Ninety-five symptomatic outpatients self-collected midturbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1-3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models. RESULTS Viral RNA clearance, as measured by SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR), in 507 URT samples occurred a median (interquartile range) 33.5 (17-63.5) days post-symptom onset. Sixteen nasal-OP samples collected 2-11 days post-symptom onset were virus culture positive out of 183 RT-PCR-positive samples tested. All participants but 1 with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8-13 days post-symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.92-0.99; P = .020) and body mass index (BMI) ≥25 kg/m2 (aHR, 0.37; 95% CI, 0.18-0.78; P = .009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as 1 of first 3 COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR, 2.06; 95% CI, 1.02-4.18; P = .044). CONCLUSIONS We demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.
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Affiliation(s)
- Annukka A R Antar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tong Yu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Razvan Azamfirei
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey A Tornheim
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Diane M Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kate Kruczynski
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Justin P Hardick
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thelio Sewell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Minyoung Jang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Taylor Church
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samantha N Walch
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolyn Reuland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vismaya S Bachu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kirsten Littlefield
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca L Ursin
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abhinaya Ganesan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Oyinkansola Kusemiju
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brittany Barnaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Curtisha Charles
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Prizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jaylynn R Johnstone
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine Payton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Weiwei Dai
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joelle Fuchs
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guido Massaccesi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Derek T Armstrong
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L Townsend
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara C Keller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zoe O Demko
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Hu
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mei-Cheng Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Heba H Mostafa
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanne C Keruly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David L Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul W Blair
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Antar AAR, Yu T, Pisanic N, Azamfirei R, Tornheim JA, Brown DM, Kruczynski K, Hardick JP, Sewell T, Jang M, Church T, Walch SN, Reuland C, Bachu VS, Littlefield K, Park HS, Ursin RL, Ganesan A, Kusemiju O, Barnaba B, Charles C, Prizzi M, Johnstone JR, Payton C, Dai W, Fuchs J, Massaccesi G, Armstrong DT, Townsend JL, Keller SC, Demko ZO, Hu C, Wang MC, Sauer LM, Mostafa HH, Keruly JC, Mehta SH, Klein SL, Cox AL, Pekosz A, Heaney CD, Thomas DL, Blair PW, Manabe YC. Delayed rise of oral fluid antibodies, elevated BMI, and absence of early fever correlate with longer time to SARS-CoV-2 RNA clearance in an longitudinally sampled cohort of COVID-19 outpatients. medRxiv 2021. [PMID: 33688688 DOI: 10.1101/2021.03.02.21252420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Sustained molecular detection of SARS-CoV-2 RNA in the upper respiratory tract (URT) in mild to moderate COVID-19 is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection. Methods Ninety-five outpatients self-collected mid-turbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1-3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models. Results Viral RNA clearance, as measured by SARS-CoV-2 RT-PCR, in 507 URT samples occurred a median (IQR) 33.5 (17-63.5) days post-symptom onset. Sixteen nasal-OP samples collected 2-11 days post-symptom onset were virus culture positive out of 183 RT-PCR positive samples tested. All participants but one with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8-13 days post-symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (aHR 0.96, 95% CI 0.92-0.99, p=0.020) and BMI ≥ 25kg/m 2 (aHR 0.37, 95% CI 0.18-0.78, p=0.009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as one of first three COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR 2.06, 95% CI 1.02-4.18, p=0.044). Conclusions We demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.
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Blumenkrantz DR, Mehoke T, Shaw-Saliba K, Powell H, Wohlgemuth N, Liu H, Macias E, Evans J, Lewis M, Medina R, Hardick J, Sauer LM, Dugas A, DuVal A, Lane AP, Gaydos C, Rothman R, Thielen P, Pekosz A. Identification of H3N2 NA and PB1-F2 genetic variants and their association with disease symptoms during the 2014-15 influenza season. Virus Evol 2021; 7:veab047. [PMID: 34131512 PMCID: PMC8197029 DOI: 10.1093/ve/veab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The 2014-15 influenza season saw the emergence of an H3N2 antigenic drift variant that formed the 3C.2a HA clade. Whole viral genomes were sequenced from nasopharyngeal swabs of ninety-four patients with confirmed influenza A virus infection and primary human nasal epithelial cell cultures used to efficiently isolate H3N2 viruses. The isolates were classified by HA clade and the presence of a new set of co-selected mutations in NA (a glycosylation site, NAg+) and PB1-F2 (H75P). The NA and PB1-F2 mutations were present in a subset of clade 3C.2a viruses (NAg+F2P), which dominated during the subsequent influenza seasons. In human nasal epithelial cell cultures, a virus with the novel NAg+F2P genotype replicated less well compared with a virus with the parental genotype. Retrospective analyses of clinical data showed that NAg+F2P genotype viruses were associated with increased cough and shortness of breath in infected patients.
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Affiliation(s)
- Deena R Blumenkrantz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Thomas Mehoke
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Kathryn Shaw-Saliba
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harrison Powell
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Nicholas Wohlgemuth
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Hsuan Liu
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Elizabeth Macias
- Epidemiology Laboratory Service, United States Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH, USA
| | - Jared Evans
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Mitra Lewis
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Medina
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin Hardick
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna DuVal
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew P Lane
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charlotte Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Rothman
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Thielen
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
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Borromeo Flinn J, Benza JJ, Sauer LM, Sulmonte C, Hynes NA, Garibaldi BT. The Risk of Not Being Ready: A Novel Approach to Managing Constant Readiness of a High-Level Isolation Unit During Times of Inactivity. Health Secur 2020; 18:212-218. [PMID: 32559152 DOI: 10.1089/hs.2019.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The biocontainment unit at Johns Hopkins Hospital is a specially designed, inactive high-level isolation unit designated to care for patients infected with high-consequence pathogens. The unit team designed a facility-specific readiness scale and checklist that focus on infrastructure, consumable supplies, and staffing to assess activation readiness of the biocontainment unit. Over a period of 50 days and 14 days, these tools were used as part of a routine risk assessment to first identify barriers and then tier the impact of these barriers into activation categories of "Ready," "Ready with Considerations," and "Not Ready." The assessment identified the greatest risks to activation readiness were staffing and waste management capabilities. Assessing threats to activation readiness and the risk of not being ready should be a priority for maintaining facility, regional, and national capacity to safely isolate and care for patients infected with high-consequence pathogens while maintaining healthcare worker safety.
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Affiliation(s)
- Jade Borromeo Flinn
- Jade Borromeo Flinn, MSN, RN, CCRN, CNRN, is Nurse Educator, Department of Medicine and Department of Neurosciences, Johns Hopkins Hospital, Johns Hopkins University School of Medicine
| | - Jesse J Benza
- Jesse J. Benza, MHA, is Business Service Analyst, Department of Medicine, Johns Hopkins University School of Medicine
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director of Operations and Assistant Professor, Department of Emergency Medicine, Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins University School of Medicine
| | - Christopher Sulmonte
- Christopher Sulmonte, Jr., MHA, is Project Administrator, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine
| | - Noreen A Hynes
- Noreen A. Hynes, MD, MPH, is Associate Professor/Geographic Medicine Center Director, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, and Departments of Environmental Health and Engineering and International Health, Johns Hopkins Bloomberg School of Public Health
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Medical Director of Biocontainment Unit, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
The 2014-2016 West African Ebola epidemic was devastating in many respects, not least of which was the impact on healthcare systems and their health workforce. Healthcare workers-including physicians, clinical officers, nurses, midwives, and community health workers-serve on the front lines of efforts to detect, control, and stop the spread of disease. Risk mitigation strategies, including infection prevention and control (IPC) practices, are meant to keep healthcare workers safe from occupational exposure to disease and to protect patients from healthcare-associated infections. Despite ongoing IPC efforts, steady rates of both healthcare-associated and healthcare worker infections signal that these mitigation measures have been inadequate at all levels and present a potential critical point of failure in efforts to limit and control the spread of outbreaks. The fact that healthcare workers continue to be infected or are a source of infection during public health emergencies reveals a weakness in global preparedness efforts. Identification of key points of failure-both within the health system and during emergencies-is the first step to mitigating risk of exposure. A 2-pronged solution is proposed to address long-term gaps in the health system that impact infection control and emergency response: prioritization of IPC for epidemic preparedness at a global level and development and use of rapid risk assessments to prioritize risk mitigation strategies for IPC. Without global support, evidence, and systems in place to support the lives of healthcare workers, the lives of their patients and the health system in general are also at risk.
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Affiliation(s)
- Colby Wilkason
- Colby Wilkason, MPH, is Technical Advisor for Prevent Epidemics
| | - Christopher Lee
- Christopher T. Lee, MD, is Senior Technical Advisor for Prevent Epidemics
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director of Operations and an Assistant Professor, Department of Emergency Medicine, Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins University School of Medicine
| | - Jennifer Nuzzo
- Jennifer Nuzzo, DrPH, SM, is a Senior Scholar, Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda McClelland
- Amanda McClelland, MPHTM, is Senior Vice President; all are at Resolve to Save Lives, New York, New York
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Errett NA, Sauer LM, Rutkow L. An integrative review of the limited evidence on international travel bans as an emerging infectious disease disaster control measure. Am J Disaster Med 2020; 14:193-200. [PMID: 32421851 DOI: 10.5055/ajdm.2019.0331] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In our increasingly interconnected world, the potential for emerging infectious diseases (EIDs) to spread globally is of paramount concern. Travel bans-herein defined as the complete restriction of travel from at least one geographic region to at least one other international geographic region-are a potential policy solution to control the global spread of disease. The social, economic, and health-related consequences of travel bans, as well as the available evidence on the effectiveness of travel restrictions in preventing the global spread of influenza, have been previously described. However, the effectiveness of travel bans in reducing the spread of noninfluenza EIDs, characterized by different rates and modes of transmission, is less well understood. This study employs an integrative review approach to summarize the minimal evidence on effectiveness of travel bans to decrease the spread of severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS), Ebola virus disease (EVD), and Zika virus disease (ZVD). We describe and qualify the evidence presented in six modeling studies that assess the effectiveness of travel bans in controlling these noninfluenza EID events. We conclude that there is an urgent need for additional research to inform policy decisions on the use of travel bans and other control measures to control noninfluenza EIDs in advance of the next outbreak.
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Affiliation(s)
- Nicole A Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lainie Rutkow
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
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22
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Errett NA, Sauer LM, Rutkow L. An integrative review of the limited evidence on international travel bans as an emerging infectious disease disaster control measure. J Emerg Manag 2020; 18:7-14. [PMID: 32031668 DOI: 10.5055/jem.2020.0446] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In our increasingly interconnected world, the potential for emerging infectious diseases (EIDs) to spread globally is of paramount concern. Travel bans-herein defined as the complete restriction of travel from at least one geographic region to at least one other international geographic region-are a potential policy solution to control the global spread of disease. The social, economic, and health-related consequences of travel bans, as well as the available evidence on the effectiveness of travel restrictions in preventing the global spread of influenza, have been previously described. However, the effectiveness of travel bans in reducing the spread of noninfluenza EIDs, characterized by different rates and modes of transmission, is less well understood. This study employs an integrative review approach to summarize the minimal evidence on effectiveness of travel bans to decrease the spread of severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS), Ebola virus disease (EVD), and Zika virus disease (ZVD). We describe and qualify the evidence presented in six modeling studies that assess the effectiveness of travel bans in controlling these noninfluenza EID events. We conclude that there is an urgent need for additional research to inform policy decisions on the use of travel bans and other control measures to control noninfluenza EIDs in advance of the next outbreak.
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Affiliation(s)
- Nicole A Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lainie Rutkow
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
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McLellan S, Kortepeter MG, Bhadelia N, Shenoy ES, Sauer LM, Frank MG, Cieslak TJ. Ebola in the DRC one year later - Boiling the frog? Int J Infect Dis 2019; 85:212-213. [PMID: 31330320 DOI: 10.1016/j.ijid.2019.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Susan McLellan
- Biocontainment Unit, University of Texas Medical Branch, Galveston, TX, United States.
| | - Mark G Kortepeter
- University of Nebraska Medical Center and College of Public Health, Omaha, NE, United States.
| | - Nahid Bhadelia
- Special Pathogens Unit, National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA, United States.
| | - Erica S Shenoy
- Infection Control Unit, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States.
| | - Lauren M Sauer
- Johns Hopkins Biocontainment Unit, Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | - Maria G Frank
- Department of Medicine, Biocontainment Unit, Denver Health Hospital Authority, United States; University of Colorado School of Medicine, United States.
| | - Theodore J Cieslak
- Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE, United States.
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Sauer LM, Romig M, Andonian J, Flinn JB, Hynes N, Maloney R, Maragakis LL, Garibaldi B. Application of the Incident Command System to the Hospital Biocontainment Unit Setting. Health Secur 2019; 17:27-34. [PMID: 30779610 DOI: 10.1089/hs.2019.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
High-consequence pathogens create a unique problem. To provide effective treatment for infected patients while providing safety for the community, a series of 10 high-level isolation units have been created across the country; they are known as Regional Ebola and Special Pathogen Treatment Centers (RESPTCs). The activation of a high-level isolation unit is a highly resource-intensive activity, with effects that ripple across the healthcare system. The incident command system (ICS), a standard tool for command, control, and coordination in domestic emergencies, is a command structure that may be useful in a biocontainment event. A version of this system, the hospital emergency incident command system, provides an adaptable all-hazards approach in healthcare delivery systems. Here we describe its utility in an operational response to safely care for a patient(s) infected with a high-consequence pathogen on a high-level isolation unit. The Johns Hopkins Hospital created a high-level isolation unit to manage the comprehensive and complex needs of patients with high-consequence infectious diseases, including Ebola virus disease. The unique challenges of and opportunities for providing care in this high-level isolation unit led the authors to modify the hospital incident command system model for use during activation. This system has been tested and refined during full-scale functional and tabletop exercises. Lessons learned from the after-action reviews of these exercises led to optimization of the structure and implementation of ICS on the biocontainment unit, including improved job action sheets, designation of physical location of roles, and communication approaches. Overall, the adaptation of ICS for use in the high-level isolation unit setting may be an effective approach to emergency management during an activation.
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Affiliation(s)
- Lauren M Sauer
- Lauren M. Sauer, MSc, is Director of Operations, Johns Hopkins Office of Critical Event Preparedness and Response, Department of Emergency Medicine, School of Medicine, Johns Hopkins University.,Ms. Sauer and Dr. Romig are co-first authors
| | - Mark Romig
- Mark Romig, MD, is Assistant Professor, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Medicine Armstrong Institute for Quality and Patient Safety, Johns Hopkins University, Baltimore, Maryland.,Ms. Sauer and Dr. Romig are co-first authors
| | - Jennifer Andonian
- Jennifer Andonian, MPH, is Senior Infection Control Epidemiologist, Johns Hopkins Hospital Department of Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland
| | - Jade Borromeo Flinn
- Jade Borromeo Flinn, RN, is a Nurse Educator, Biocontainment Unit, Johns Hopkins Hospital Department of Medicine & Department of Neurosciences, Johns Hopkins University, Baltimore, Maryland
| | - Noreen Hynes
- Noreen A. Hynes, MD, MPH, is Associate Professor of Medicine, and Director, Geographic Medicine Center, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert Maloney
- Robert Maloney, MS, NREMT-P, is Senior Director, Johns Hopkins Medicine Office of Emergency Management, Johns Hopkins University, Baltimore, Maryland
| | - Lisa L Maragakis
- Lisa L. Maragakis, MD, MPH, is Associate Professor of Medicine, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Brian Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Director, Johns Hopkins Biocontainment Unit, and Associate Professor, Medicine and Physiology, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Garibaldi BT, Ruparelia C, Shaw-Saliba K, Sauer LM, Maragakis LL, Glancey M, Subah M, Nelson AR, Wilkason C, Scavo L, Litwin L, Osei P, Yazdi Y. A novel personal protective equipment coverall was rated higher than standard Ebola virus personal protective equipment in terms of comfort, mobility and perception of safety when tested by health care workers in Liberia and in a United States biocontainment unit. Am J Infect Control 2019; 47:298-304. [PMID: 30301656 DOI: 10.1016/j.ajic.2018.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/11/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND During the 2014-2016 Ebola virus epidemic, more than 500 health care workers (HCWs) died in spite of the use of personal protective equipment (PPE). The Johns Hopkins University Center for Bioengineering Innovation and Design (CBID) and Jhpiego, an international nongovernmental organization affiliate of Johns Hopkins, collaborated to create new PPE to improve the ease of the doffing process. METHODS HCWs in Liberia and a US biocontainment unit compared standard Médecins Sans Frontière PPE (PPE A) with the new PPE (PPE B). Participants wore each PPE ensemble while performing simulated patient care activities. Range of motion, time to doff, comfort, and perceived risk were measured. RESULTS Overall, 100% of participants preferred PPE B over PPE A (P < .0001); 98.1% of respondents would recommend PPE B for their home clinical unit (P < .0001). There was a trend towards greater comfort in PPE B. HCWs at both sites felt more at risk in PPE A than PPE B (71.9% vs 25% in Liberia, P < .0001; 100% vs 40% in the US biocontainment unit, P < .0001). CONCLUSIONS HCWs preferred a new PPE ensemble to Médecins Sans Frontière PPE for high-consequence pathogens. Further studies on the safety of this new PPE need to be conducted.
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Kraft CS, Kortepeter MG, Gordon B, Sauer LM, Shenoy ES, Eiras DP, Larson L, Garland JA, Mehta AK, Barrett K, Price CS, Croyle C, West LR, Noren B, Kline S, Arguinchona C, Arguinchona H, Grein JD, Connally C, McLellan S, Risi GF, Uyeki TM, Davey RT, Schweinle JE, Schwedhelm MM, Harvey M, Hunt RC, Kratochvil CJ. The Special Pathogens Research Network: Enabling Research Readiness. Health Secur 2019; 17:35-45. [PMID: 30779607 DOI: 10.1089/hs.2018.0106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The 2013-2016 epidemic of Ebola virus disease (EVD) that originated in West Africa underscored many of the challenges to conducting clinical research during an ongoing infectious disease epidemic, both in the most affected countries of Guinea, Liberia, and Sierra Leone, as well as in the United States and Europe, where a total of 27 patients with EVD received care in biocontainment units. The Special Pathogens Research Network (SPRN) was established in the United States in November 2016 to provide an organizational structure to leverage the expertise of the 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs); it was intended to develop and support infrastructure to improve readiness to conduct clinical research in the United States. The network enables the rapid activation and coordination of clinical research in the event of an epidemic and facilitates opportunities for multicenter research when the RESPTCs are actively caring for patients requiring a biocontainment unit. Here we provide an overview of opportunities identified in the clinical research infrastructure during the West Africa EVD epidemic and the SPRN activities to meet the ongoing challenges in the context of Ebola virus and other special pathogens.
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Affiliation(s)
- Colleen S Kraft
- Colleen S. Kraft, MD, MSc, is Associate Professor, Department of Pathology and Laboratory Medicine, and Associate Professor, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Mark G Kortepeter
- Mark G. Kortepeter, MD, MPH, is Professor of Epidemiology, Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE
| | - Bruce Gordon
- Bruce Gordon, MD, is Professor, Division of Pediatric Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Assistant Professor, Director of Research, Johns Hopkins Biocontainment Unit, Department of Emergency Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Erica S Shenoy
- Erica S. Shenoy, MD, PhD, is Assistant Professor of Medicine, Harvard Medical School, and Associate Chief, Infection Control Unit, Massachusetts General Hospital, Boston, MA
| | - Daniel P Eiras
- Daniel P. Eiras, MD, MPH, is Associate Hospital Epidemiologist, Infection Prevention and Control Department, NYU Langone Medical Center, New York, NY
| | - LuAnn Larson
- LuAnn Larson, RN, BSN, is Director of Clinical Operations Nurse Manager, Clinical Research Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - Jennifer A Garland
- Jennifer A. Garland, RN, PhD, is Special Pathogens Program Coordinator, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Aneesh K Mehta
- Aneesh K. Mehta, MD, is an Assistant Professor, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Kevin Barrett
- Kevin Barrett, RN, is a Nurse Specialist, NIH Clinical Center, the National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Connie S Price
- Connie S. Price, MD, is Professor of Medicine, University of Colorado School of Medicine, and Chief Medical Officer, Denver Health and Hospital, Denver, CO
| | - Caroline Croyle
- Caroline Croyle, MPH, is an Infection Prevention Specialist, Denver Health and Hospital, Denver, CO
| | | | - Brooke Noren
- Brooke Noren, RN, is Research Nurse Coordinator, University of Minnesota Medical Center, Minneapolis, MN
| | - Susan Kline
- Susan Kline, MD, MPH, is Associate Professor of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN
| | - Christa Arguinchona
- Christa Arguinchona is Assistant Nurse Manager, Providence Health and Services, Spokane, WA
| | - Henry Arguinchona
- Henry Arguinchona, MD, is an infectious disease specialist, Providence Health and Services, Spokane, WA
| | - Jonathan D Grein
- Jonathan D. Grein, MD, is Director, Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Chad Connally
- Chad Connally, RN, MSN, is Biocontainment and Emergency Management Program Manager, University of Texas Medical Branch, Galveston, TX
| | - Susan McLellan
- Susan McLellan, MD, MPH, is Professor and Biocontainment Unit Director, University of Texas Medical Branch, Galveston, TX
| | - George F Risi
- George F. Risi, MD, MSc, is Senior Medical Adviser, Tunnell Government Services, a contractor, BARDA, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Timothy M Uyeki
- Timothy M. Uyeki, MD, MPH, is Chief Medical Officer, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Richard T Davey
- Richard T. Davey, Jr., MD, is Chief, Clinical Research Section, the National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Jo Ellen Schweinle
- Jo Ellen Schweinle, MD, is a Supervisory Health Scientist, BARDA, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Michelle M Schwedhelm
- Michelle M. Schwedhelm, MSN, is Executive Director, Emergency Management & Biopreparedness, University of Nebraska Medical Center, Omaha, NE
| | - Melissa Harvey
- Melissa Cole Harvey, MSPH, is Director, Division of National Healthcare Preparedness Programs, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Richard C Hunt
- Richard C. Hunt, MD, MS, is Senior Medical Advisor, Division of National Healthcare Preparedness Programs, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Christopher J Kratochvil
- Christopher J. Kratochvil, MD, is Associate Vice Chancellor for Clinical Research, the University of Nebraska Medical Center, Omaha, NE
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Drewry DG, Sauer LM, Shaw-Saliba K, Therkorn J, Rainwater-Lovett K, Pilholski T, Garibaldi BT. Identifying Potential Provider and Environmental Contamination on a Clinical Biocontainment Unit Using Aerosolized Pathogen Simulants. Health Secur 2018; 16:83-91. [PMID: 29624490 DOI: 10.1089/hs.2017.0064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The Johns Hopkins Hospital created a biocontainment unit (BCU) to care for patients with highly infectious diseases while assuring healthcare worker safety. Research to date for BCU protocols and practices are based on case reports and lessons learned from patient care and exercises. This study seeks to be the first to explore the influences of healthcare worker movement and personal protective equipment (PPE) doffing on the transport of simulant pathogen particles in a BCU. A cough device released 1 μm fluorescent polystyrene beads (PSLs) in the patient room. PSL transport was then examined under 2 scenarios: (1) PSL release only, no healthcare workers; and (2) PSL release during 5-minute simulated activity by healthcare workers. Airborne PSL concentrations were quantified every second for 30 minutes per scenario by 7 optical particle sensors located throughout the BCU. PSLs were not detected in the donning room at any time nor in the doffing room during the first test scenario where no healthcare worker was present. The main difference detected between the tested scenarios was the presence of PSLs in the doffing room when healthcare workers were removing PPE, potentially due to re-aerosolization of PSLs off the exterior PPE surface or opening of the patient room door. Future work will further explore the potential for re-aerosolization of particles off of PPE during doffing. The present study provides the groundwork for a systematic method for evaluating the BCU and doffing procedures for their respective safety, and it also pilots a systematic method for evaluating potential pathogen exposure pathways for BCU healthcare workers.
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Spiegel ML, Goldman JW, Wolf BR, Nameth DJ, Grogan TR, Lisberg AE, Wong DJL, Ledezma BA, Mendenhall MA, Genshaft SJ, Gutierrez AJ, Abtin F, Wallace WD, Adame CR, McKenzie JR, Abarca PA, Li AJ, Strunck JL, Famenini S, Carroll JM, Tucker DA, Sauer LM, Moghadam NM, Elashoff DA, Abaya CD, Brennan MB, Garon EB. Non-small cell lung cancer clinical trials requiring biopsies with biomarker-specific results for enrollment provide unique challenges. Cancer 2017; 123:4800-4807. [PMID: 29125624 DOI: 10.1002/cncr.31056] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clinical trials in lung cancer increasingly require patients to provide fresh tumor tissue as a prerequisite to enrollment. The effects of this requirement on enrollment rates, enrollment durations, and patient selection have not been fully elucidated. METHODS The authors retrospectively reviewed data generated by patients who consented to 1 or more interventional lung cancer clinical trials at the University of California-Los Angeles Jonsson Comprehensive Cancer Center between January 2013 and December 2014. Trials were considered to require a biopsy when enrollment was conditional on the procurement of tissue without intervening therapy between procurement and enrollment. RESULTS In total, 311 patients underwent 368 screening incidents for 1 or more of 19 trials. Trials that required a new biopsy had a longer median screening duration (34 vs 14 days) than trials that did not require a biopsy (P < .001). Trials that required a biopsy had a greater screen failure rate (49.1% vs 26.5%; P < .001), which was largely driven by patients who did not undergo the required biopsy or lacked the required biomarker. Worsening performance status led to the majority of screen failures (56.5%) among biomarker-eligible patients. CONCLUSIONS Although the scientific benefits of obtaining a new biopsy and requiring specific results for trial enrollment are clear, these requirements lead to a lengthening of the screening period, which, in some patients, is associated with clinical decline before enrollment. Implications for the interpretation of data from studies of this design should be explored. Cancer 2017;123:4800-7. © 2017 American Cancer Society.
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Affiliation(s)
- Marshall L Spiegel
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Jonathan W Goldman
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Brian R Wolf
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Danielle J Nameth
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Tristan R Grogan
- Department of Medicine, Statistics Core, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Aaron E Lisberg
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Deborah J L Wong
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Blanca A Ledezma
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Melody A Mendenhall
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Scott J Genshaft
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Antonio J Gutierrez
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Fereidoun Abtin
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - W Dean Wallace
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Carlos R Adame
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Jordan R McKenzie
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Phillip A Abarca
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Alice J Li
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Jennifer L Strunck
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Sina Famenini
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - James M Carroll
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - D Andrew Tucker
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Lauren M Sauer
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Nima M Moghadam
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - David A Elashoff
- Department of Medicine, Statistics Core, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Christina D Abaya
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Meghan B Brennan
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Edward B Garon
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
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Jalali S, Sauer LM. Improving Care for Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department. Ann Emerg Med 2015; 66:417-23. [DOI: 10.1016/j.annemergmed.2015.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Indexed: 11/29/2022]
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Abstract
Background: Hospital surge capacity (HSC) is dependent on the ability to increase or conserve resources. The hospital surge model put forth by the Agency for Healthcare Research and Quality (AHRQ) estimates the resources needed by hospitals to treat casualties resulting from 13 national planning scenarios. However, emergency planners need to know which hospital resource are most critical in order to develop a more accurate plan for HSC in the event of a disaster.
Objective: To identify critical hospital resources required in four specific catastrophic scenarios; namely, pandemic influenza, radiation, explosive, and nerve gas.
Methods: We convened an expert consensus panel comprised of 23 participants representing health providers (i.e., nurses and physicians), administrators, emergency planners, and specialists. Four disaster scenarios were examined by the panel. Participants were divided into 4 groups of five or six members, each of which were assigned two of four scenarios. They were asked to consider 132 hospital patient care resources- extracted from the AHRQ's hospital surge model- in order to identify the ones that would be critical in their opinion to patient care. The definition for a critical hospital resource was the following: absence of the resource is likely to have a major impact on patient outcomes, i.e., high likelihood of untoward event, possibly death. For items with any disagreement in ranking, we conducted a facilitated discussion (modified Delphi technique) until consensus was reached, which was defined as more than 50% agreement. Intraclass Correlation Coefficients (ICC) were calculated for each scenario, and across all scenarios as a measure of participant agreement on critical resources. For the critical resources common to all scenarios, Kruskal-Wallis test was performed to measure the distribution of scores across all scenarios.
Results: Of the 132 hospital resources, 25 were considered critical for all four scenarios by more than 50% of the participants. The number of hospital resources considered to be critical by consensus varied from one scenario to another; 58 for the pandemic influenza scenario, 51 for radiation exposure, 41 for explosives, and 35 for nerve gas scenario. Intravenous crystalloid solution was the only resource ranked by all participants as critical across all scenarios. The agreement in ranking was strong in nerve agent and pandemic influenza (ICC= 0.7 in both), and moderate in explosives (ICC= 0.6) and radiation (ICC= 0.5).
Conclusion: In four disaster scenarios, namely, radiation, pandemic influenza, explosives, and nerve gas scenarios; supply of as few as 25 common resources may be considered critical to hospital surge capacity. The absence of any these resources may compromise patient care. More studies are needed to identify critical hospital resources in other disaster scenarios.
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Affiliation(s)
- Jamil D Bayram
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA; Center for Refugee and Disaster Response, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA; Center for Refugee and Disaster Response, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christina Catlett
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA
| | - Scott Levin
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gai Cole
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA
| | - Thomas D Kirsch
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA; Center for Refugee and Disaster Response, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew Toerper
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabor Kelen
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA
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Kirsch T, Siddiqui MA, Perrin PC, Robinson WC, Sauer LM, Doocy S. Satisfaction with the humanitarian response to the 2010 Pakistan floods: a call for increased accountability to beneficiaries. Emerg Med J 2012; 30:565-71. [DOI: 10.1136/emermed-2012-201226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kirsch TD, Mitrani-Reiser J, Bissell R, Sauer LM, Mahoney M, Holmes WT, Santa Cruz N, de la Maza F. Impact on hospital functions following the 2010 Chilean earthquake. Disaster Med Public Health Prep 2010; 4:122-8. [PMID: 20526134 DOI: 10.1001/dmphp.4.2.122] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to assess the impact of the 2010 Chilean earthquake on hospital functions and services. Hospitals functioning in a post-disaster environment must provide emergency medical care related to the event, in addition to providing standard community health services. This study focused on damage to both structural and nonstructural components, as well as to utility services. METHODS Site visits were made to every hospital in a single province (Bio-Bio). Engineers conducted damage assessments while interviews of hospital administrators were conducted. The survey was requested by the Chilean Ministry of Health (MOH) to assess the impact of the earthquake on hospital operations and facility responses to those effects. Other important regional and hospital data were gathered from hospital administrators and the MOH. RESULTS Seven government hospitals were surveyed. All hospitals in the region lost communications, municipal electrical power and water for several days. All reported some physical damage although only one suffered significant structural damage. All lost some functional capacity as a result of the earthquake. The loss of telephones and cellular service was identified as the most difficult problem by administrators. An average of 3 physical areas per hospital lost some degree of functional capacity following the earthquake. CONCLUSION Even in an earthquake-prone and very well-prepared country such as Chile hospital functions were widely disrupted by the event. The loss of hospital functions can occur even with minimal damage to the physical structure. The loss of communications can impede or halt response efforts at all levels. Hospitals should be prepared to self-sustain following a disaster for 2-3 days regardless of the level of structural damage. Understanding the details of these impacts is essential to hospital preparedness and plans for continuing services after a disaster.
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Affiliation(s)
- Thomas D Kirsch
- School of Public Health, Johns Hopkins University, Baltimore, MD 21209, USA
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Jenkins JL, McCarthy M, Kelen G, Sauer LM, Kirsch T. Changes needed in the care for sheltered persons: a multistate analysis from Hurricane Katrina. Am J Disaster Med 2009; 4:101-106. [PMID: 19522127] [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: 05/27/2023]
Abstract
OBJECTIVES Following Hurricane Katrina, nearly 1,400 evacuation shelters were opened in 27 states across the nation to accommodate the more than 450,000 evacuees from the gulf region. The levee breaks in New Orleans and storm surge in Mississippi brought about significant morbidity and mortality, ultimately killing more than 1,300 people. The purpose of this study was to summarize the health needs of approximately 30,000 displaced persons who resided in shelters in eight states, including prescription medication needs, dispersement of durable medical equipment, and referrals for further care. METHODS The first available 31,272 medical encounters forms were utilized as a convenience sample of displaced persons in Louisiana, Mississippi, Texas, Alabama, Georgia, Tennessee, Missouri, and Florida. This medical encounter form was completed by volunteer nurses, was standardized across all shelters, and included demographic information, need for acute or preventive care, pre-existing medical conditions, disposition referrals, need for prescription medication, and frequency of volunteer providers who providing care outside of their first-aid scope. RESULTS Sheltered persons who received only acute care numbered 11,306 (36.2 percent), and those who received only preventive/chronic care numbered 10,403 (33.3 percent). A similar number, 9,563 (30.6 percent) persons, received both acute and preventive/chronic care. There were 3,356 (10.7 percent) sheltered persons who received some form of durable medical equipment. Glasses were given to 2,124 people (6.8 percent of the total visits receiving them) and were the most commonly dispense item. This is followed by dental devices (495, 1.6 percent) and glucose meters (339, 1.1 percent). Prescriptions were given to 8,154 (29.0 percent) sheltered persons. Referrals were made to 13,815 (44.2 percent) of sheltered persons who presented for medical care. The pharmacy was the most common location for referrals for 5,785 (18.5 percent) of all sheltered persons seeking medical care. Referrals were also made to outpatient clinics 3,856 (12.3 percent), opticians 2,480 (7.9 percent), and public health resources 1,136 (4.3 percent). Only 1,173 (3.8 percent) sheltered persons who presented for medical care and were referred to the emergency department or hospital for further care. CONCLUSIONS Hurricane Katrina illustrated the need to strengthen the healthcare planning and response in regard to sheltered persons with a particular focus on primary and preventive care services. This study has reemphasized the need for primary medical care and pharmaceuticals in sheltered persons and shown new data regarding the dispersement of durable medical equipment and the frequent need for healthcare beyond the shelter setting as evidenced by referrals.
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Kirsch TD, Jenkins JL, Sauer LM, Hsieh YH, Calvello E, Hsu E. Sheltering patterns and utilization following the 2007 southern California wildfires. Am J Disaster Med 2009; 4:113-119. [PMID: 19522129] [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: 05/27/2023]
Abstract
The 2007 southern California wildfires resulted in over 500,000 residents being displaced. A team from Johns Hopkins University and the American Red Cross surveyed 163 families at shelters and local assistance centers during the disaster. The responses were used to evaluate the needs and movement patterns of a displaced population. The data were also used to determine the risk factors associated with needing sheltering. There is a lower than expected reliance on public shelters, and displaced persons move frequently.
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Affiliation(s)
- Thomas D Kirsch
- Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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Kelen G, Sauer LM. Trend analysis of disaster health articles in peer-reviewed publications pre- and post-9/11. Am J Disaster Med 2008; 3:369-376. [PMID: 19202890] [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: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to determine which journals publish medical disaster-related work, their individual focus, and publication volume pre- and post-9/11. METHODS PubMed and Google Scholar were searched using key words to identify peer-review journals (print or electronic) publishing medical and public health disaster-related manuscripts. All medical journals with an average volume of at least five disaster-related publications per year over the 11-year study period (1996-2006) were selected. Identified journals were categorized as either general or specialty medical, or disaster health dedicated. All disaster-related articles in each journal were identified and classified according to 11 subtopics. RESULTS Of 16 journals meeting entry criteria, 10 were disaster dedicated. Of these, only six existed pre-9/ 11. Only six general journals (JAMA, American Journal of Public Health, The Lancet, New England Journal of Medicine, Annals of Emergency Medicine, Academic Emergency Medicine) had sufficient publications for analysis. Of the 2899 disaster articles identified, 1769 (61 percent) were from the dedicated journals. Publications increased by 320 percent in the general/subspecialty journals and 145 percent for disaster-specific journals in the 5-year period post-9/11 (2002-2006) versus the previous 5-year period (1996-2000). Among the dedicated journals, Journal of Prehospital and Disaster Medicine published the most (21 percent), followed by Disaster Prevention and Management: An International Journal (18 percent). Among the general/subspecialty journals, The Lancet published the most (33 percent), followed by JAMA (28 percent) and Annals of Emergency Medicine (18 percent). These journals published the most pre- and post-9/11. Bioterrorism (36 percent) and Preparedness (18 percent) were the most frequent topic areas for the general/subspecialty journals, while General Disasters (38 percent) and Preparedness (27 percent) were of the highest interest for the dedicated journals. The greatest increase in the proportion of publications pre- and post-9/11 was by the New England Journal of Medicine (2340 percent) and Academic Emergency Medicine (1275 percent). Individual journals appear to emphasize particular subtopic areas. CONCLUSIONS Interest in publishing medical disaster-related articles has increased tremendously since 9/11 in both general/subspecialty journals as well as disaster-dedicated medical journals. Some journals focus on certain topics. Details of this study should help authors identify appropriate journals for their manuscript submissions.
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Affiliation(s)
- Gabor Kelen
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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