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DeSilva MB, Knowlton G, Rai NK, Bodurtha P, Essien I, Riddles J, Mehari L, Muscoplat M, Lynfield R, Rowley EA, Chamberlain AM, Patel P, Hughes A, Dickerson M, Thompson MG, Griggs EP, Tenforde M, Winkelman TN, Benitez GV, Drawz PE. Vaccine Effectiveness Against SARS-CoV-2 Related Hospitalizations in People who had Experienced Homelessness or Incarceration - Findings from the Minnesota EHR Consortium. J Community Health 2024; 49:448-457. [PMID: 38066221 PMCID: PMC10981627 DOI: 10.1007/s10900-023-01308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 04/02/2024]
Abstract
COVID-19 disproportionately affects people experiencing homelessness or incarceration. While homelessness or incarceration alone may not impact vaccine effectiveness, medical comorbidities along with social conditions associated with homelessness or incarceration may impact estimated vaccine effectiveness. COVID-19 vaccines reduce rates of hospitalization and death; vaccine effectiveness (VE) against severe outcomes in people experiencing homelessness or incarceration is unknown. We conducted a retrospective, observational cohort study evaluating COVID-19 vaccine VE against SARS-CoV-2 related hospitalization (positive SARS-CoV-2 molecular test same week or within 3 weeks prior to hospital admission) among patients who had experienced homelessness or incarceration. We utilized data from 8 health systems in the Minnesota Electronic Health Record Consortium linked to data from Minnesota's immunization information system, Homeless Management Information System, and Department of Corrections. We included patients 18 years and older with a history of experiencing homelessness or incarceration. VE and 95% Confidence Intervals (CI) against SARS-CoV-2 hospitalization were estimated for primary series and one booster dose from Cox proportional hazard models as 100*(1-Hazard Ratio) during August 26, 2021, through October 8, 2022 adjusting for patient age, sex, comorbid medical conditions, and race/ethnicity. We included 80,051 individuals who had experienced homelessness or incarceration. Adjusted VE was 52% (95% CI, 41-60%) among those 22 weeks or more since their primary series, 66% (95% CI, 53-75%) among those less than 22 weeks since their primary series, and 69% (95% CI: 60-76%) among those with one booster. VE estimates were consistently lower during the Omicron predominance period compared with the combined Omicron and Delta periods. Despite higher exposure risk, COVID-19 vaccines provided good effectiveness against SARS-CoV-2 related hospitalizations in persons who have experienced homelessness or incarceration.
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Affiliation(s)
- Malini B DeSilva
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA.
| | - Gregory Knowlton
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA
| | - Nayanjot K Rai
- Division of Nephrology & Hypertension, University of Minnesota, Minneapolis, MN, USA
| | - Peter Bodurtha
- Health, Homelessness and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Inih Essien
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA
| | | | | | - Miriam Muscoplat
- Division of Infectious Disease, Epidemiology, Prevention, and Control, Department of Health, St Paul, Minnesota, MN, USA
| | | | | | | | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Mark Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Tyler Na Winkelman
- Health, Homelessness and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Gabriela Vazquez Benitez
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA
| | - Paul E Drawz
- Division of Nephrology & Hypertension, University of Minnesota, Minneapolis, MN, USA
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2
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Liu F, Gross FL, Joshi S, Gaglani M, Naleway AL, Murthy K, Groom HC, Wesley MG, Edwards LJ, Grant L, Kim SS, Sambhara S, Gangappa S, Tumpey T, Thompson MG, Fry AM, Flannery B, Dawood FS, Levine MZ. Redirecting antibody responses from egg-adapted epitopes following repeat vaccination with recombinant or cell culture-based versus egg-based influenza vaccines. Nat Commun 2024; 15:254. [PMID: 38177116 PMCID: PMC10767121 DOI: 10.1038/s41467-023-44551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
Repeat vaccination with egg-based influenza vaccines could preferentially boost antibodies targeting the egg-adapted epitopes and reduce immunogenicity to circulating viruses. In this randomized trial (Clinicaltrials.gov: NCT03722589), sera pre- and post-vaccination with quadrivalent inactivated egg-based (IIV4), cell culture-based (ccIIV4), and recombinant (RIV4) influenza vaccines were collected from healthcare personnel (18-64 years) in 2018-19 (N = 723) and 2019-20 (N = 684) influenza seasons. We performed an exploratory analysis. Vaccine egg-adapted changes had the most impact on A(H3N2) immunogenicity. In year 1, RIV4 induced higher neutralizing and total HA head binding antibodies to cell- A(H3N2) virus than ccIIV4 and IIV4. In year 2, among the 7 repeat vaccination arms (IIV4-IIV4, IIV4-ccIIV4, IIV4-RIV4, RIV4-ccIIV4, RIV4-RIV4, ccIIV4-ccIIV4 and ccIIV4-RIV4), repeat vaccination with either RIV4 or ccIIV4 further improved antibody responses to circulating viruses with decreased neutralizing antibody egg/cell ratio. RIV4 also had higher post-vaccination A(H1N1)pdm09 and A(H3N2) HA stalk antibodies in year 1, but there was no significant difference in HA stalk antibody fold rise among vaccine groups in either year 1 or year 2. Multiple seasons of non-egg-based vaccination may be needed to redirect antibody responses from immune memory to egg-adapted epitopes and re-focus the immune responses towards epitopes on the circulating viruses to improve vaccine effectiveness.
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Affiliation(s)
- Feng Liu
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - F Liaini Gross
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sneha Joshi
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA
- Baylor College of Medicine, Temple, TX, USA
- Texas A & M University, College of Medicine, Temple, TX, USA
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | - Holly C Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Abt Associates, Atlanta, GA, USA
| | | | - Lauren Grant
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara S Kim
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Terrence Tumpey
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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3
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Zhong S, Ng TWY, Skowronski DM, Iuliano AD, Leung NHL, Perera RAPM, Ho F, Fang VJ, Tam YH, Ip DKM, Havers FG, Fry AM, Aziz-Baumgartner E, Barr IG, Peiris M, Thompson MG, Cowling BJ. Standard-dose versus MF59-adjuvanted, high-dose or recombinant-hemagglutinin influenza vaccine immunogenicity in older adults: comparison of A(H3N2) antibody response by prior season's vaccine status. J Infect Dis 2023:jiad497. [PMID: 37950884 DOI: 10.1093/infdis/jiad497] [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: 07/01/2023] [Revised: 10/19/2023] [Accepted: 11/08/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Annual influenza vaccination is recommended for older adults but repeated vaccination with standard-dose influenza vaccine has been linked to reduced immunogenicity and effectiveness, especially against A(H3N2) viruses. METHODS Community-dwelling Hong Kong adults aged 65-82 years were randomly allocated to receive 2017/18 standard-dose quadrivalent, MF59-adjuvanted trivalent, high-dose trivalent, and recombinant-HA quadrivalent vaccination. Antibody response to unchanged A(H3N2) vaccine antigen was compared among participants with and without self-reported prior year (2016/17) standard-dose vaccination. RESULTS Mean fold rise (MFR) in antibody titers from Day 0 to Day 30 by hemagglutination inhibition and virus microneutralization assays were lower among 2017/18 standard-dose and enhanced vaccine recipients with (range, 1.7-3.0) vs. without (range, 4.3-14.3) prior 2016/17 vaccination. MFR was significantly reduced by about one half to four fifths for previously vaccinated recipients of standard-dose and all three enhanced vaccines (β range, 0.21-0.48). Among prior-year vaccinated older adults, enhanced vaccines induced higher 1.43 to 2.39-fold geometric mean titers and 1.28 to 1.74-fold MFR vs. standard-dose vaccine by microneutralization assay. CONCLUSIONS In the context of unchanged A(H3N2) vaccine strain, prior-year vaccination was associated with reduced antibody response among both standard-dose and enhanced influenza vaccine recipients. Enhanced vaccines improved antibody response among older adults with prior-year standard-dose vaccination.
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Affiliation(s)
- Shuyi Zhong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tiffany W Y Ng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nancy H L Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Ranawaka A P M Perera
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Faith Ho
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vicky J Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yat Hung Tam
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fiona G Havers
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ian G Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Centre of Immunology and Infection, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
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Azziz‐Baumgartner E, Neyra J, Yau TS, Soto G, Owusu D, Zhang C, Romero C, Yoo YM, Gonzales M, Tinoco Y, Silva M, Bravo E, Serrano NR, Matos E, Chavez‐Perez V, Castro JC, Esther Castillo M, Porter R, Munayco C, Rodriguez A, Levine MZ, Prouty M, Thompson MG, Arriola CS. Healthcare personnel in 2016-2019 prospective cohort infrequently got vaccinated, worked while ill, and frequently used antibiotics rather than antivirals against viral influenza illnesses. Influenza Other Respir Viruses 2023; 17:e13189. [PMID: 37693773 PMCID: PMC10485305 DOI: 10.1111/irv.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background Uncertainty about risk of illness and the value of influenza vaccines negatively affects vaccine uptake among persons targeted for influenza vaccination. Methods During 2016-2019, we followed a cohort of healthcare personnel (HCP) targeted for free-of-charge influenza vaccination in five Lima hospitals to quantify risk of influenza, workplace presenteeism (coming to work despite illness), and absenteeism (taking time off from work because of illness). The HCP who developed acute respiratory illnesses (ARI) (≥1 of acute cough, runny nose, body aches, or feverishness) were tested for influenza using reverse-transcription polymerase chain reaction (rt-PCR). Findings The cohort (2968 HCP) contributed 950,888 person-days. Only 36 (6%) of 605 HCP who participated every year were vaccinated. The HCP had 5750 ARI and 147 rt-PCR-confirmed influenza illnesses. The weighted incidence of laboratory-confirmed influenza was 10.0/100 person-years; 37% used antibiotics, and 0.7% used antivirals to treat these illnesses. The HCP with laboratory-confirmed influenza were present at work while ill for a cumulative 1187 hours. Interpretation HCP were frequently ill and often worked rather than stayed at home while ill. Our findings suggest the need for continuing medical education about the risk of influenza and benefits of vaccination and stay-at-home-while-ill policies.
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Affiliation(s)
| | - Joan Neyra
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - Tat S. Yau
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Giselle Soto
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - Daniel Owusu
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Chao Zhang
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Young M. Yoo
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Yeny Tinoco
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - María Silva
- US Naval Medical Research Unit No. 6BellavistaPeru
| | | | | | | | | | | | - Maria Esther Castillo
- Instituto Nacional de Salud del NiñoLimaPeru
- Medicine School from Universidad Peruana Cayetano HerediaLimaPeru
| | - Rachael Porter
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Angel Rodriguez
- Health Emergencies Department, Pan American Health Organization (PAHO/WHO)WashingtonDistrict of ColumbiaUSA
| | - Min Z. Levine
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Mark G. Thompson
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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5
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Embi PJ, Levy ME, Patel P, DeSilva MB, Gaglani M, Dascomb K, Dunne MM, Klein NP, Ong TC, Grannis SJ, Natarajan K, Yang DH, Stenehjem E, Zerbo O, McEvoy C, Rao S, Thompson MG, Konatham D, Irving SA, Dixon BE, Han J, Schrader KE, Grisel N, Lewis N, Kharbanda AB, Barron MA, Reynolds S, Liao IC, Fadel WF, Rowley EA, Arndorfer J, Goddard K, Murthy K, Valvi NR, Weber ZA, Fireman B, Reese SE, Ball SW, Naleway AL. Effectiveness of COVID-19 vaccines at preventing emergency department or urgent care encounters and hospitalizations among immunocompromised adults: An observational study of real-world data across 10 US states from August-December 2021. Vaccine 2023; 41:5424-5434. [PMID: 37479609 PMCID: PMC10201325 DOI: 10.1016/j.vaccine.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Immunocompromised (IC) persons are at increased risk for severe COVID-19 outcomes and are less protected by 1-2 COVID-19 vaccine doses than are immunocompetent (non-IC) persons. We compared vaccine effectiveness (VE) against medically attended COVID-19 of 2-3 mRNA and 1-2 viral-vector vaccine doses between IC and non-IC adults. METHODS Using a test-negative design among eight VISION Network sites, VE against laboratory-confirmed COVID-19-associated emergency department (ED) or urgent care (UC) events and hospitalizations from 26 August-25 December 2021 was estimated separately among IC and non-IC adults and among specific IC condition subgroups. Vaccination status was defined using number and timing of doses. VE for each status (versus unvaccinated) was adjusted for age, geography, time, prior positive test result, and local SARS-CoV-2 circulation. RESULTS We analyzed 8,848 ED/UC events and 18,843 hospitalizations among IC patients and 200,071 ED/UC events and 70,882 hospitalizations among non-IC patients. Among IC patients, 3-dose mRNA VE against ED/UC (73% [95% CI: 64-80]) and hospitalization (81% [95% CI: 76-86]) was lower than that among non-IC patients (ED/UC: 94% [95% CI: 93-94]; hospitalization: 96% [95% CI: 95-97]). Similar patterns were observed for viral-vector vaccines. Transplant recipients had lower VE than other IC subgroups. CONCLUSIONS During B.1.617.2 (Delta) variant predominance, IC adults received moderate protection against COVID-19-associated medical events from three mRNA doses, or one viral-vector dose plus a second dose of any product. However, protection was lower in IC versus non-IC patients, especially among transplant recipients, underscoring the need for additional protection among IC adults.
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Affiliation(s)
- Peter J Embi
- Vanderbilt University Medical Center, Nashville, TN, USA; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
| | | | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA; Texas A&M University College of Medicine, Temple, Texas, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | - Suchitra Rao
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Deepika Konatham
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | - Michelle A Barron
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sue Reynolds
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | | | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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6
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Tenforde MW, Weber ZA, DeSilva MB, Stenehjem E, Yang DH, Fireman B, Gaglani M, Kojima N, Irving SA, Rao S, Grannis SJ, Naleway AL, Kirshner L, Kharbanda AB, Dascomb K, Lewis N, Dalton AF, Ball SW, Natarajan K, Ong TC, Hartmann E, Embi PJ, McEvoy CE, Grisel N, Zerbo O, Dunne MM, Arndorfer J, Goddard K, Dickerson M, Patel P, Timbol J, Griggs EP, Hansen J, Thompson MG, Flannery B, Klein NP. Vaccine Effectiveness Against Influenza-Associated Urgent Care, Emergency Department, and Hospital Encounters During the 2021-2022 Season, VISION Network. J Infect Dis 2023; 228:185-195. [PMID: 36683410 DOI: 10.1093/infdis/jiad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Following historically low influenza activity during the 2020-2021 season, the United States saw an increase in influenza circulating during the 2021-2022 season. Most viruses belonged to the influenza A(H3N2) 3C.2a1b 2a.2 subclade. METHODS We conducted a test-negative case-control analysis among adults ≥18 years of age at 3 sites within the VISION Network. Encounters included emergency department/urgent care (ED/UC) visits or hospitalizations with ≥1 acute respiratory illness (ARI) discharge diagnosis codes and molecular testing for influenza. Vaccine effectiveness (VE) was calculated by comparing the odds of influenza vaccination ≥14 days before the encounter date between influenza-positive cases (type A) and influenza-negative and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative controls, applying inverse probability-to-be-vaccinated weights, and adjusting for confounders. RESULTS In total, 86 732 ED/UC ARI-associated encounters (7696 [9%] cases) and 16 805 hospitalized ARI-associated encounters (649 [4%] cases) were included. VE against influenza-associated ED/UC encounters was 25% (95% confidence interval (CI), 20%-29%) and 25% (95% CI, 11%-37%) against influenza-associated hospitalizations. VE against ED/UC encounters was lower in adults ≥65 years of age (7%; 95% CI, -5% to 17%) or with immunocompromising conditions (4%; 95% CI, -45% to 36%). CONCLUSIONS During an influenza A(H3N2)-predominant influenza season, modest VE was observed. These findings highlight the need for improved vaccines, particularly for A(H3N2) viruses that are historically associated with lower VE.
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Affiliation(s)
- Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Bruce Fireman
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, California, USA
| | - Manjusha Gaglani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott and White Health, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Noah Kojima
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | | | | | | | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ned Lewis
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, California, USA
| | - Alexandra F Dalton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Toan C Ong
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emily Hartmann
- Paso del Norte Health Information Exchange, El Paso, Texas, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ousseny Zerbo
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, California, USA
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Kristin Goddard
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, California, USA
| | - Monica Dickerson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Palak Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julius Timbol
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, California, USA
| | - Eric P Griggs
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Hansen
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, California, USA
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nicola P Klein
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, California, USA
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7
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Adams K, Riddles JJ, Rowley EAK, Grannis SJ, Gaglani M, Fireman B, Hartmann E, Naleway AL, Stenehjem E, Hughes A, Dalton AF, Natarajan K, Dascomb K, Raiyani C, Irving SA, Sloan-Aagard C, Kharbanda AB, DeSilva MB, Dixon BE, Ong TC, Keller J, Dickerson M, Grisel N, Murthy K, Nanez J, Fadel WF, Ball SW, Patel P, Arndorfer J, Mamawala M, Valvi NR, Dunne MM, Griggs EP, Embi PJ, Thompson MG, Link-Gelles R, Tenforde MW. Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021-February 2022, VISION Network: a retrospective cohort study. Lancet Reg Health Am 2023; 23:100530. [PMID: 37333688 PMCID: PMC10266334 DOI: 10.1016/j.lana.2023.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
Background Understanding the usefulness of additional COVID-19 vaccine doses-particularly given varying disease incidence-is needed to support public health policy. We characterize the benefits of COVID-19 booster doses using number needed to vaccinate (NNV) to prevent one COVID-19-associated hospitalization or emergency department encounter. Methods We conducted a retrospective cohort study of immunocompetent adults at five health systems in four U.S. states during SARS-CoV-2 Omicron BA.1 predominance (December 2021-February 2022). Included patients completed a primary mRNA COVID-19 vaccine series and were either eligible to or received a booster dose. NNV were estimated using hazard ratios for each outcome (hospitalization and emergency department encounters), with results stratified by three 25-day periods and site. Findings 1,285,032 patients contributed 938 hospitalizations and 2076 emergency department encounters. 555,729 (43.2%) patients were aged 18-49 years, 363,299 (28.3%) 50-64 years, and 366,004 (28.5%) ≥65 years. Most patients were female (n = 765,728, 59.6%), White (n = 990,224, 77.1%), and non-Hispanic (n = 1,063,964, 82.8%). 37.2% of patients received a booster and 62.8% received only two doses. Median estimated NNV to prevent one hospitalization was 205 (range 44-615) and NNV was lower across study periods for adults aged ≥65 years (110, 46, and 88, respectively) and those with underlying medical conditions (163, 69, and 131, respectively). Median estimated NNV to prevent one emergency department encounter was 156 (range 75-592). Interpretation The number of patients needed to receive a booster dose was highly dependent on local disease incidence, outcome severity, and patient risk factors for moderate-to-severe disease. Funding Funding was provided by the Centers for Disease Control and Prevention though contract 75D30120C07986 to Westat, Inc. and contract 75D30120C07765 to Kaiser Foundation Hospitals.
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Affiliation(s)
- Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA
- Texas A&M University College of Medicine, Temple, TX, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Emily Hartmann
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Alexandra F Dalton
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
- Brigham Young University Department of Public Health, Provo, UT, USA
| | | | | | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Juan Nanez
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | | | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | | | - Eric P Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark G Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Biggs HM, Simões EAF, Abu Khader I, Thompson MG, Gordon A, Hunt DR, DeGroote NP, Porter RM, Bino S, Marar BI, Gresh L, de Jesus-Cornejo J, Langley G, Thornburg NJ, Peret TCT, Whitaker B, Zhang Y, Wang L, Patel MC, McMorrow M, Campbell W, Hasibra I, Duka E, Al-Gazo M, Kubale J, Sanchez F, Lucero MG, Tallo VL, Azziz-Baumgartner E, Simaku A, Gerber SI. Respiratory Syncytial Virus Infection among Hospitalized Infants in Four Middle-Income Countries. J Pediatric Infect Dis Soc 2023:piad042. [PMID: 37313727 DOI: 10.1093/jpids/piad042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Understanding respiratory syncytial virus (RSV) global epidemiology is important to inform future prevention strategies. METHODS Hospitalized infants <1-year-old with acute illness were enrolled prospectively in Albania, Jordan, Nicaragua, and Philippines during respiratory seasons in 2015-2017. Medical chart review, parental interview, and post-discharge follow up were conducted. Respiratory specimens were tested using real-time RT-PCR for RSV. Infant characteristics associated with very severe illness (intensive care unit [ICU] admission or receipt of supplemental oxygen) were assessed using logistic regression to adjust for potential confounders (age, sex, study site, preterm birth). RESULTS Of 3,634 enrolled hospitalized infants, 1,129 (31%) tested positive for RSV. The median age of RSV-positive infants was 2.7 (IQR: 1.4 to 6.1) months and 665 (59%) were male. Very severe illness in 583 (52%) RSV-positive infants was associated with younger age (aOR 4.1, 95% CI: 2.6-6.5 for 0-2 compared to 9-11-months; p<0.01), , low weight-for-age z-score (aOR 1.9, 95%CI: 1.2-2.8; p<0.01), ICU care after birth (aOR 1.6, 95%CI: 1.0-2.5; p=0.48), and cesarean delivery (aOR 1.4, 95% CI: 1.0-1.8; p=.03). RSV subgroups A and B co-circulated at all sites with alternating predominance by year; subgroup was not associated with severity (aOR 1.0, 95% CI: 0.8-1.4). Nine (0.8%) RSV-positive infants died during admission or within ≤30 days of discharge, of which 7 (78%) were <6-months-old. CONCLUSIONS RSV was associated with nearly a third of infant acute illness hospitalizations in four middle-income countries during the respiratory season, where, in addition to young age, factors including low weight-for-age might be important predictors of severity. RSV prevention strategies targeting young infants could substantially reduce RSV-associated hospitalizations in middle-income countries.
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Affiliation(s)
- Holly M Biggs
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric A F Simões
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ilham Abu Khader
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Mark G Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Nicholas P DeGroote
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Bino
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | | | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Joanne de Jesus-Cornejo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Gayle Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teresa C T Peret
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yange Zhang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lijuan Wang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mira C Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Iris Hasibra
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Enkeleda Duka
- Pediatric Department, Mother Theresa University Hospital Center, Tirana, Albania
| | - Mahmoud Al-Gazo
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Felix Sanchez
- Hospital Infantil Manuel de Jesus Rivera, Ministry of Health, Managua, Nicaragua
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Veronica L Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Artan Simaku
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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9
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Naleway AL, Kim SS, Flannery B, Levine MZ, Murthy K, Sambhara S, Gangappa S, Edwards LJ, Ball S, Grant L, Zunie T, Cao W, Gross FL, Groom H, Fry AM, Hunt D, Jeddy Z, Mishina M, Wesley MG, Spencer S, Thompson MG, Gaglani M, Dawood FS. Immunogenicity of High-Dose Egg-Based, Recombinant, and Cell Culture-Based Influenza Vaccines Compared With Standard-Dose Egg-Based Influenza Vaccine Among Health Care Personnel Aged 18-65 Years in 2019-2020. Open Forum Infect Dis 2023; 10:ofad223. [PMID: 37305842 PMCID: PMC10249269 DOI: 10.1093/ofid/ofad223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
Background Emerging data suggest that second-generation influenza vaccines with higher hemagglutinin (HA) antigen content and/or different production methods may induce stronger antibody responses to HA than standard-dose egg-based influenza vaccines in adults. We compared antibody responses to high-dose egg-based inactivated (HD-IIV3), recombinant (RIV4), and cell culture-based (ccIIV4) vs standard-dose egg-based inactivated influenza vaccine (SD-IIV4) among health care personnel (HCP) aged 18-65 years in 2 influenza seasons (2018-2019, 2019-2020). Methods In the second trial season, newly and re-enrolled HCPs who received SD-IIV4 in season 1 were randomized to receive RIV4, ccIIV4, or SD-IIV4 or were enrolled in an off-label, nonrandomized arm to receive HD-IIV3. Prevaccination and 1-month-postvaccination sera were tested by hemagglutination inhibition (HI) assay against 4 cell culture propagated vaccine reference viruses. Primary outcomes, adjusted for study site and baseline HI titer, were seroconversion rate (SCR), geometric mean titers (GMTs), mean fold rise (MFR), and GMT ratios that compared vaccine groups to SD-IIV4. Results Among 390 HCP in the per-protocol population, 79 received HD-IIV3, 103 RIV4, 106 ccIIV4, and 102 SD-IIV4. HD-IIV3 recipients had similar postvaccination antibody titers compared with SD-IIV4 recipients, whereas RIV4 recipients had significantly higher 1-month-postvaccination antibody titers against vaccine reference viruses for all outcomes. Conclusions HD-IIV3 did not induce higher antibody responses than SD-IIV4, but, consistent with previous studies, RIV4 was associated with higher postvaccination antibody titers. These findings suggest that recombinant vaccines rather than vaccines with higher egg-based antigen doses may provide improved antibody responses in highly vaccinated populations.
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Affiliation(s)
- Allison L Naleway
- Correspondence: Allison Naleway, PhD, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227 (); or Fatimah Dawood, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 ()
| | - Sara S Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Z Levine
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | | | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Weiping Cao
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - F Liaini Gross
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly Groom
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Meredith G Wesley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Abt Associates, Atlanta, Georgia, USA
| | - Sarah Spencer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA
- Texas A&M University, College of Medicine, Temple, Texas, USA
| | - Fatimah S Dawood
- Correspondence: Allison Naleway, PhD, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227 (); or Fatimah Dawood, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 ()
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10
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Klein NP, Demarco M, Fleming-Dutra KE, Stockwell MS, Kharbanda AB, Gaglani M, Rao S, Lewis N, Irving SA, Hartmann E, Natarajan K, Dalton AF, Zerbo O, DeSilva MB, Konatham D, Stenehjem E, Rowley EAK, Ong TC, Grannis SJ, Sloan-Aagard C, Han J, Verani JR, Raiyani C, Dascomb K, Reese SE, Barron MA, Fadel WF, Naleway AL, Nanez J, Dickerson M, Goddard K, Murthy K, Grisel N, Weber ZA, Dixon BE, Patel P, Fireman B, Arndorfer J, Valvi NR, Griggs EP, Hallowell C, Embi PJ, Ball SW, Thompson MG, Tenforde MW, Link-Gelles R. Effectiveness of BNT162b2 COVID-19 Vaccination in Children and Adolescents. Pediatrics 2023; 151:191035. [PMID: 37026401 DOI: 10.1542/peds.2022-060894] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES We assessed BNT162b2 vaccine effectiveness (VE) against mild to moderate and severe coronavirus disease 2019 (COVID-19) in children and adolescents through the Omicron BA.4/BA.5 period. METHODS Using VISION Network records from April 2021 to September 2022, we conducted a test-negative, case-control study assessing VE against COVID-19-associated emergency department/urgent care (ED/UC) encounters and hospitalizations using logistic regression, conditioned on month and site, adjusted for covariates. RESULTS We compared 9800 ED/UC cases with 70 232 controls, and 305 hospitalized cases with 2612 controls. During Delta, 2-dose VE against ED/UC encounters at 12 to 15 years was initially 93% (95% confidence interval 89 to 95), waning to 77% (69% to 84%) after ≥150 days. At ages 16 to 17, VE was initially 93% (86% to 97%), waning to 72% (63% to 79%) after ≥150 days. During Omicron, VE at ages 12 to 15 was initially 64% (44% to 77%), waning to 13% (3% to 23%) after 60 days; at ages 16 to 17 VE was 31% (10% to 47%) during days 60 to 149, waning to 7% (-8 to 20%) after 150 days. A monovalent booster increased VE to 54% (40% to 65%) at ages 12 to 15 and 46% (30% to 58%) at ages 16 to 17. At ages 5 to 11, 2-dose VE was 49% (33% to 61%) initially and 41% (29% to 51%) after 150 days. During Delta, VE against hospitalizations at ages 12 to 17 was high (>97%), and at ages 16 to 17 remained 98% (73% to 100%) beyond 150 days; during Omicron, hospitalizations were too infrequent to precisely estimate VE. CONCLUSIONS BNT162b2 protected children and adolescents against mild to moderate and severe COVID-19. VE was lower during Omicron predominance including BA.4/BA.5, waned after dose 2 but increased after a monovalent booster. Children and adolescents should receive all recommended COVID-19 vaccinations.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | | | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
- NewYork-Presbyterian Hospital, New York, New York
| | | | - Manjusha Gaglani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | - Emily Hartmann
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
| | - Karthik Natarajan
- NewYork-Presbyterian Hospital, New York, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Alexandra F Dalton
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | - Deepika Konatham
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Toan C Ong
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
- Brigham Young University Department of Public Health, Provo, Utah
| | - Jungmi Han
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
| | - Jennifer R Verani
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Chandni Raiyani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Michelle A Barron
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis; and
| | | | - Juan Nanez
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Kempapura Murthy
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis; and
| | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | | | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Mark W Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Ruth Link-Gelles
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
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Ellingson KD, Hollister J, Porter CJ, Khan SM, Feldstein LR, Naleway AL, Gaglani M, Caban-Martinez AJ, Tyner HL, Lowe AA, Olsho LEW, Meece J, Yoon SK, Mak J, Kuntz JL, Solle NS, Respet K, Baccam Z, Wesley MG, Thiese MS, Yoo YM, Odean MJ, Miiro FN, Pickett SL, Phillips AL, Grant L, Romine JK, Herring MK, Hegmann KT, Lamberte JM, Sokol B, Jovel KS, Thompson MG, Rivers P, Pilishvili T, Lutrick K, Burgess JL, Midgley CM, Fowlkes AL. Risk Factors for Reinfection with SARS-CoV-2 Omicron Variant among Previously Infected Frontline Workers. Emerg Infect Dis 2023; 29:599-604. [PMID: 36703252 PMCID: PMC9973698 DOI: 10.3201/eid2903.221314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.
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12
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Bozio CH, Butterfield KA, Briggs Hagen M, Grannis S, Drawz P, Hartmann E, Ong TC, Fireman B, Natarajan K, Dascomb K, Gaglani M, DeSilva MB, Yang DH, Midgley CM, Dixon BE, Naleway AL, Grisel N, Liao IC, Reese SE, Fadel WF, Irving SA, Lewis N, Arndorfer J, Murthy K, Riddles J, Valvi NR, Mamawala M, Embi PJ, Thompson MG, Stenehjem E. Protection from COVID-19 mRNA vaccination and prior SARS-CoV-2 infection against COVID-19-associated encounters in adults during Delta and Omicron predominance. J Infect Dis 2023:7045997. [PMID: 36806690 DOI: 10.1093/infdis/jiad040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Data assessing protection conferred from COVID-19 mRNA vaccination and/or prior SARS-CoV-2 infection during Delta and Omicron predominance periods in the U.S. are limited. METHODS This cohort study included persons ≥18 years who had ≥1 healthcare encounter across four health systems and had been tested for SARS-CoV-2 before August 26, 2021. COVID-19 mRNA vaccination and prior SARS-CoV-2 infection defined the exposure. Cox regression estimated hazard ratios (HRs) for the Delta and Omicron periods; protection was calculated as (1-HR)x100%. RESULTS Compared to unvaccinated and previously uninfected persons, during Delta predominance, protection against COVID-19-associated hospitalizations was high for those 2- or 3-dose vaccinated and previously infected, 3-dose vaccinated alone, and prior infection alone (range:91%-97%, with overlapping 95% confidence intervals (95%CIs)); during Omicron predominance, estimates were lower (range:77%-90%). Protection against COVID-19-associated emergency department/urgent care (ED/UC) encounters during Delta predominance was high for those exposure groups (range:86%-93%); during Omicron predominance, protection remained high for those 3-dose vaccinated with or without a prior infection (76% (95%CI=67%-83%) and 71% (95%CI=67%-73%), respectively). CONCLUSIONS COVID-19 mRNA vaccination and/or prior SARS-CoV-2 infection provided protection against COVID-19-associated hospitalizations and ED/UC encounters regardless of variant. Staying up-to-date with COVID-19 vaccination still provides protection against severe COVID-19 disease, regardless of prior infection.
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Affiliation(s)
- Catherine H Bozio
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | | | - Melissa Briggs Hagen
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | - Shaun Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul Drawz
- Division of Nephrology & Hypertension, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emily Hartmann
- Paso Del Norte Health Information Exchange, El Paso, Texas, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas
| | | | | | - Claire M Midgley
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | | | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Mufaddal Mamawala
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
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13
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Herring MK, Romine JK, Wesley MG, Ellingson KD, Yoon SK, Caban-Martinez AJ, Meece J, Gaglani M, Grant L, Olsho LEW, Tyner HL, Naleway AL, Khan SM, Phillips AL, Schaefer Solle N, Rose S, Mak J, Fuller SB, Hunt A, Kuntz JL, Beitel S, Yoo YM, Zheng PQ, Arani G, Mayo Lamberte J, Edwards T, Thompson MG, Sprissler R, Thornburg NJ, Lowe AA, Pilishvili T, Uhrlaub JL, Lutrick K, Burgess JL, Fowlkes AL. SARS-CoV-2 infection history and antibody response to three COVID-19 mRNA vaccine doses. Clin Infect Dis 2022; 76:1822-1831. [PMID: 36578137 DOI: 10.1093/cid/ciac976] [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: 10/08/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Three doses of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines produce robust antibody responses, but data are limited among individuals previously infected with SARS-CoV-2. From a cohort of health care personnel (75.5%), first responders (4.6%), and other frontline workers (19.8%) in 6 US states, we longitudinally assessed antibody waning after dose-2, and response to dose-3, according to SARS-CoV-2 infection history. METHODS Participants submitted sera every three months, after SARS-CoV-2 infection, and after each COVID-19 vaccine dose. Sera were tested for antibodies and reported quantitatively as area under the serial dilution curve (AUC). Changes in the AUC values over time were compared as fold-changes using a linear mixed model. RESULTS Analysis included 388 participants who received dose-3 by November 2021. Three comparison groups: (1) vaccine only with no known prior SARS-CoV-2 infection (n = 224); (2) infection prior to dose-1 (n = 123); and (3) infection after dose 2 and before dose-3 (n = 41). The interval from dose 2 and dose 3 was approximately 8-months. After dose-3, antibody levels rose 2.5-fold (95%CI = 2.2-3.0) in group 2, and 2.9-fold (95%CI = 2.6-3.3) in group 1. Those infected within 90 days before dose-3 (and median 233 days (IQR = 213-246) after dose-2) did not increase significantly after dose-3. CONCLUSIONS A third dose of mRNA vaccine typically elicited a robust humoral immune response among those with primary vaccination regardless of SARS-CoV-2 infection >3 months prior to boosting. Those with infection < 3 months prior to boosting did not have a significant increase in antibody concentrations in response to a booster.
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Affiliation(s)
| | - James K Romine
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Katherine D Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Sarang K Yoon
- University of Utah Health, Rocky Mountain Center for Occupational and Environmental Health, Salt Lake City, Utah
| | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas.,Texas A&M University College of Medicine, Temple, Texas
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | | | | | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Andrew L Phillips
- University of Utah Health, Rocky Mountain Center for Occupational and Environmental Health, Salt Lake City, Utah
| | | | | | - Josephine Mak
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | | | - Angela Hunt
- St. Luke's Regional Health Care System, Duluth, Minnesota
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Young M Yoo
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | | | - Gayatri Arani
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Taylor Edwards
- University of Arizona Genetics Core, Office for Research, Innovation and Impact, University of Arizona, Tucson, ArizonaUSA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Ryan Sprissler
- University of Arizona Genetics Core, Office for Research, Innovation and Impact, University of Arizona, Tucson, ArizonaUSA
| | - Natalie J Thornburg
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Ashley A Lowe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Jennifer L Uhrlaub
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Karen Lutrick
- College of Medicine - Tucson, University of Arizona, Tucson, Arizona
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
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14
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DeSilva MB, Mitchell PK, Klein NP, Dixon BE, Tenforde MW, Thompson MG, Naleway AL, Grannis SJ, Ong TC, Natarajan K, Reese SE, Zerbo O, Kharbanda AB, Patel P, Stenehjem E, Raiyani C, Irving SA, Fadel WF, Rao S, Han J, Reynolds S, Davis JM, Lewis N, McEvoy C, Dickerson M, Dascomb K, Valvi NR, Barron MA, Goddard K, Vazquez-Benitez G, Grisel N, Mamawala M, Embi PJ, Fireman B, Essien IJ, Griggs EP, Arndorfer J, Gaglani M. Protection of 2 and 3 mRNA Vaccine Doses Against Severe Outcomes Among Adults Hospitalized with COVID-19 – VISION Network, August 2021 – March 2022. J Infect Dis 2022; 227:961-969. [PMID: 36415904 DOI: 10.1093/infdis/jiac458] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
We assessed COVID-19 vaccination impact on illness severity among adults hospitalized with COVID-19 August 2021–March 2022.
Methods
We evaluated differences in intensive care unit (ICU) admission, in-hospital death, and length of stay among vaccinated (2 or 3 mRNA vaccine doses) versus unvaccinated patients aged ≥18 years hospitalized for ≥24 hours with COVID-19-like illness (CLI) and positive SARS-CoV-2 molecular testing. We calculated odds ratios for ICU admission and death and subdistribution hazard ratios (SHR) for time to hospital discharge adjusted for age, geographic region, calendar time, and local virus circulation.
Results
We included 27,149 SARS-CoV-2 positive hospitalizations. During both Delta and Omicron-predominant periods, protection against ICU admission was strongest among 3-dose vaccinees compared with unvaccinated patients (Delta OR [CI]: 0.52 [0.28–0.96]); Omicron OR [CI]: 0.69 [0.54–0.87]). During both periods, risk of in-hospital of death was lower among vaccinated compared with unvaccinated but ORs were overlapping; during Omicron, lowest among 3-dose vaccinees (OR [CI] 0.39 [0.28–0.54]). We observed SHR >1 across all vaccination strata in both periods indicating faster discharge for vaccinated patients.
Conclusions
COVID-19 vaccination was associated with lower rates of ICU admission and in-hospital death in both Delta and Omicron periods compared with being unvaccinated.
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Affiliation(s)
- Malini B DeSilva
- HealthPartners Institute , Minneapolis, Minnesota , United States
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- Fairbanks School of Public Health, Indiana University , Indianapolis, Indiana , United States
| | - Mark W Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest , Portland, Oregon , United States
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- School of Medicine, Indiana University , Indianapolis, Indiana , United States
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado , United States
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York , New York
- New York Presbyterian Hospital, New York , New York , United States
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | | | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | | | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest , Portland, Oregon , United States
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- Fairbanks School of Public Health, Indiana University , Indianapolis, Indiana , United States
| | - Suchitra Rao
- School of Medicine, Indiana University , Indianapolis, Indiana , United States
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York , New York
| | - Sue Reynolds
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | - Charlene McEvoy
- HealthPartners Institute , Minneapolis, Minnesota , United States
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
| | - Michelle A Barron
- School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado , United States
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | | | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | | | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- Vanderbilt University Medical Center , Nashville, Tennessee , United States
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | - Inih J Essien
- HealthPartners Institute , Minneapolis, Minnesota , United States
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | - Manjusha Gaglani
- Texas A&M University College of Medicine , Temple, Texas , United States
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15
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Thompson MG, Yoon SK, Naleway AL, Meece J, Fabrizio TP, Caban-Martinez AJ, Burgess JL, Gaglani M, Olsho LEW, Bateman A, Lundgren J, Grant L, Phillips AL, Groom HC, Stefanski E, Solle NS, Ellingson K, Lutrick K, Dunnigan K, Wesley MG, Guenther K, Hunt A, Mak J, Hegmann KT, Kuntz JL, Bissonnette A, Hollister J, Rose S, Morrill TC, Respet K, Fowlkes AL, Thiese MS, Rivers P, Herring MK, Odean MJ, Yoo YM, Brunner M, Bedrick EJ, Fleary DE, Jones JT, Praggastis J, Romine J, Dickerson M, Khan SM, Lamberte JM, Beitel S, Webby RJ, Tyner HL. Association of mRNA Vaccination With Clinical and Virologic Features of COVID-19 Among US Essential and Frontline Workers. JAMA 2022; 328:1523-1533. [PMID: 36255426 PMCID: PMC9579910 DOI: 10.1001/jama.2022.18550] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022]
Abstract
Importance Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance. Objective To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages. Design, Setting, and Participants A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase-polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported. Exposures SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status. Main Outcomes and Measures Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase-polymerase chain reaction testing along with viral viability. Results Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, -6.1 [95% CI, -11.8 to -0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/μL; difference, -1.0 [95% CI, -1.7 to -0.2] for Delta and 2.8 vs 3.5 log10 copies/μL, difference, -1.0 [95% CI, -1.7 to -0.3] for Omicron). Conclusions and Relevance In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.
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Affiliation(s)
- Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | | | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
| | | | | | | | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Holly C Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | | | - Katherine Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Karen Lutrick
- College of Medicine - Tucson, University of Arizona, Tucson
| | | | | | | | - Angela Hunt
- St Luke's Regional Health Care System, Duluth, Minnesota
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | | | - Karley Respet
- St Luke's Regional Health Care System, Duluth, Minnesota
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Patrick Rivers
- College of Medicine - Tucson, University of Arizona, Tucson
| | | | - Marilyn J Odean
- Whiteside Institute for Clinical Research, St Luke's, Duluth, Minnesota
| | - Young M Yoo
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Matthew Brunner
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Edward J Bedrick
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | - John T Jones
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Jenna Praggastis
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - James Romine
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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16
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Liao IC, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Murthy K, Birch R, Valvi NR, Arndorfer J, Zerbo O, Dickerson M, Raiyani C, Williams J, Bozio CH, Blanton L, Link-Gelles R, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning of vaccine effectiveness against moderate and severe covid-19 among adults in the US from the VISION network: test negative, case-control study. BMJ 2022; 379:e072141. [PMID: 36191948 PMCID: PMC9527398 DOI: 10.1136/bmj-2022-072141] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To estimate the effectiveness of mRNA vaccines against moderate and severe covid-19 in adults by time since second, third, or fourth doses, and by age and immunocompromised status. DESIGN Test negative case-control study. SETTING Hospitals, emergency departments, and urgent care clinics in 10 US states, 17 January 2021 to 12 July 2022. PARTICIPANTS 893 461 adults (≥18 years) admitted to one of 261 hospitals or to one of 272 emergency department or 119 urgent care centers for covid-like illness tested for SARS-CoV-2. MAIN OUTCOME MEASURES The main outcome was waning of vaccine effectiveness with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine during the omicron and delta periods, and the period before delta was dominant using logistic regression conditioned on calendar week and geographic area while adjusting for age, race, ethnicity, local virus circulation, immunocompromised status, and likelihood of being vaccinated. RESULTS 45 903 people admitted to hospital with covid-19 (cases) were compared with 213 103 people with covid-like illness who tested negative for SARS-CoV-2 (controls), and 103 287 people admitted to emergency department or urgent care with covid-19 (cases) were compared with 531 168 people with covid-like illness who tested negative for SARS-CoV-2. In the omicron period, vaccine effectiveness against covid-19 requiring admission to hospital was 89% (95% confidence interval 88% to 90%) within two months after dose 3 but waned to 66% (63% to 68%) by four to five months. Vaccine effectiveness of three doses against emergency department or urgent care visits was 83% (82% to 84%) initially but waned to 46% (44% to 49%) by four to five months. Waning was evident in all subgroups, including young adults and individuals who were not immunocompromised; although waning was morein people who were immunocompromised. Vaccine effectiveness increased among most groups after a fourth dose in whom this booster was recommended. CONCLUSIONS Effectiveness of mRNA vaccines against moderate and severe covid-19 waned with time after vaccination. The findings support recommendations for a booster dose after a primary series and consideration of additional booster doses.
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Affiliation(s)
- Jill M Ferdinands
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | | | | | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Toan C Ong
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | | | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Jeremiah Williams
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Catherine H Bozio
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Lenee Blanton
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Ruth Link-Gelles
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Michelle A Barron
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
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Schrag SJ, Verani JR, Dixon BE, Page JM, Butterfield KA, Gaglani M, Vazquez-Benitez G, Zerbo O, Natarajan K, Ong TC, Lazariu V, Rao S, Beaver R, Ellington SR, Klein NP, Irving SA, Grannis SJ, Kiduko S, Barron MA, Midturi J, Dickerson M, Lewis N, Stockwell MS, Stenehjem E, Fadel WF, Link-Gelles R, Murthy K, Goddard K, Grisel N, Valvi NR, Fireman B, Arndorfer J, Konatham D, Ball S, Thompson MG, Naleway AL. Estimation of COVID-19 mRNA Vaccine Effectiveness Against Medically Attended COVID-19 in Pregnancy During Periods of Delta and Omicron Variant Predominance in the United States. JAMA Netw Open 2022; 5:e2233273. [PMID: 36156146 PMCID: PMC9513651 DOI: 10.1001/jamanetworkopen.2022.33273] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Pregnant people are at high risk for severe COVID-19 but were excluded from mRNA vaccine trials; data on COVID-19 vaccine effectiveness (VE) are needed. OBJECTIVE To evaluate the estimated effectiveness of mRNA vaccination against medically attended COVID-19 among pregnant people during Delta and Omicron predominance. DESIGN, SETTING, AND PARTICIPANTS This test-negative, case-control study was conducted from June 2021 to June 2022 in a network of 306 hospitals and 164 emergency department and urgent care (ED/UC) facilities across 10 US states, including 4517 ED/UC encounters and 975 hospitalizations among pregnant people with COVID-19-like illness (CLI) who underwent SARS-CoV-2 molecular testing. EXPOSURES Two doses (14-149 and ≥150 days prior) and 3 doses (7-119 and ≥120 days prior) of COVID-19 mRNA vaccine (≥1 dose received during pregnancy) vs unvaccinated. MAIN OUTCOMES AND MEASURES Estimated VE against laboratory-confirmed COVID-19-associated ED/UC encounter or hospitalization, based on the adjusted odds ratio (aOR) for prior vaccination; VE was calculated as (1 - aOR) × 100%. RESULTS Among 4517 eligible CLI-associated ED/UC encounters and 975 hospitalizations, 885 (19.6%) and 334 (34.3%) were SARS-CoV-2 positive, respectively; the median (IQR) patient age was 28 (24-32) years and 31 (26-35) years, 537 (12.0%) and 118 (12.0%) were non-Hispanic Black and 1189 (26.0%) and 240 (25.0%) were Hispanic. During Delta predominance, the estimated VE against COVID-19-associated ED/UC encounters was 84% (95% CI, 69% to 92%) for 2 doses within 14 to 149 days, 75% (95% CI, 5% to 93%) for 2 doses 150 or more days prior, and 81% (95% CI, 30% to 95%) for 3 doses 7 to 119 days prior; estimated VE against COVID-19-associated hospitalization was 99% (95% CI, 96% to 100%), 96% (95% CI, 86% to 99%), and 97% (95% CI, 79% to 100%), respectively. During Omicron predominance, for ED/UC encounters, the estimated VE of 2 doses within 14 to 149 days, 2 doses 150 or more days, 3 doses within 7 to 119 days, and 3 doses 120 or more days prior was 3% (95% CI, -49% to 37%), 42% (95% CI, -16% to 72%), 79% (95% CI, 59% to 89%), and -124% (95% CI, -414% to 2%), respectively; for hospitalization, estimated VE was 86% (95% CI, 41% to 97%), 64% (95% CI, -102% to 93%), 86% (95% CI, 28% to 97%), and -53% (95% CI, -1254% to 83%), respectively. CONCLUSIONS AND RELEVANCE In this study, maternal mRNA COVID-19 vaccination, including booster dose, was associated with protection against medically attended COVID-19. VE estimates were higher against COVID-19-associated hospitalization than ED/UC visits and lower against the Omicron variant than the Delta variant. Protection waned over time, particularly during Omicron predominance.
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Affiliation(s)
| | | | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Jessica M. Page
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | | | - Manjusha Gaglani
- Baylor Scott & White Health Temple, Texas
- Texas A&M University College of Medicine, Temple
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
- NewYork-Presbyterian Hospital, New York
| | - Toan C. Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Suchitra Rao
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | | | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Indiana University School of Medicine, Indianapolis
| | | | - Michelle A. Barron
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Melissa S. Stockwell
- NewYork-Presbyterian Hospital, New York
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Edward Stenehjem
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | - William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis
| | | | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Nancy Grisel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Julie Arndorfer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | | | | | | | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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18
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Gaglani M, Kim SS, Naleway AL, Levine MZ, Edwards L, Murthy K, Dunnigan K, Zunie T, Groom H, Ball S, Jeddy Z, Hunt D, Wesley MG, Sambhara S, Gangappa S, Grant L, Cao W, Gross FL, Mishina M, Fry AM, Thompson MG, Dawood FS, Flannery B. Effect of Repeat Vaccination on Immunogenicity of Quadrivalent Cell-Culture and Recombinant Influenza Vaccines Among Healthcare Personnel Aged 18-64 Years: A Randomized, Open-Label Trial. Clin Infect Dis 2022; 76:e1168-e1176. [PMID: 36031405 PMCID: PMC9907492 DOI: 10.1093/cid/ciac683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibody responses to non-egg-based standard-dose cell-culture influenza vaccine (containing 15 µg hemagglutinin [HA]/component) and recombinant vaccine (containing 45 µg HA/component) during consecutive seasons have not been studied in the United States. METHODS In a randomized trial of immunogenicity of quadrivalent influenza vaccines among healthcare personnel (HCP) aged 18-64 years over 2 consecutive seasons, HCP who received recombinant-HA influenza vaccine (RIV) or cell culture-based inactivated influenza vaccine (ccIIV) during the first season (year 1) were re-randomized the second season of 2019-2020 (year 2 [Y2]) to receive ccIIV or RIV, resulting in 4 ccIIV/RIV combinations. In Y2, hemagglutination inhibition antibody titers against reference cell-grown vaccine viruses were compared in each ccIIV/RIV group with titers among HCP randomized both seasons to receive egg-based, standard-dose inactivated influenza vaccine (IIV) using geometric mean titer (GMT) ratios of Y2 post-vaccination titers. RESULTS Y2 data from 414 HCP were analyzed per protocol. Compared with 60 IIV/IIV recipients, 74 RIV/RIV and 106 ccIIV/RIV recipients showed significantly elevated GMT ratios (Bonferroni corrected P < .007) against all components except A(H3N2). Post-vaccination GMT ratios for ccIIV/ccIIV and RIV/ccIIV were not significantly elevated compared with IIV/IIV except for RIV/ccIIV against A(H1N1)pdm09. CONCLUSIONS In adult HCP, receipt of RIV in 2 consecutive seasons or the second season was more immunogenic than consecutive egg-based IIV for 3 of the 4 components of quadrivalent vaccine. Immunogenicity of ccIIV/ccIIV was similar to that of IIV/IIV. Differences in HA antigen content may play a role in immunogenicity of influenza vaccination in consecutive seasons. CLINICAL TRIALS REGISTRATION NCT03722589.
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Affiliation(s)
- Manjusha Gaglani
- Correspondence: M. Gaglani, 2401 S. 31st St, MS-CK-300, Temple, TX 76508 ()
| | - Sara S Kim
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Min Z Levine
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Kempapura Murthy
- Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
| | - Kayan Dunnigan
- Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
| | - Tnelda Zunie
- Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
| | - Holly Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | | | | | | | - Suryaprakash Sambhara
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shivaprakash Gangappa
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Grant
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Weiping Cao
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - F Liaini Gross
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margarita Mishina
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tyner HL, Burgess JL, Grant L, Gaglani M, Kuntz JL, Naleway AL, Thornburg NJ, Caban-Martinez AJ, Yoon SK, Herring MK, Beitel SC, Blanton L, Nikolich-Zugich J, Thiese MS, Pleasants JF, Fowlkes AL, Lutrick K, Dunnigan K, Yoo YM, Rose S, Groom H, Meece J, Wesley MG, Schaefer-Solle N, Louzado-Feliciano P, Edwards LJ, Olsho LEW, Thompson MG. Neutralizing Antibody Response to Pseudotype Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Differs Between mRNA-1273 and BNT162b2 Coronavirus Disease 2019 (COVID-19) Vaccines and by History of SARS-CoV-2 Infection. Clin Infect Dis 2022; 75:e827-e837. [PMID: 34928334 PMCID: PMC8755309 DOI: 10.1093/cid/ciab1038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Data on the development of neutralizing antibodies (nAbs) against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with mRNA COVID-19 vaccines are limited. METHODS From a prospective cohort of 3975 adult essential and frontline workers tested weekly from August 2020 to March 2021 for SARS-CoV-2 infection by reverse transcription-polymerase chain reaction assay irrespective of symptoms, 497 participants had sera drawn after infection (170), vaccination (327), and after both infection and vaccination (50 from the infection population). Serum was collected after infection and each vaccine dose. Serum-neutralizing antibody titers against USA-WA1/2020-spike pseudotype virus were determined by the 50% inhibitory dilution. Geometric mean titers (GMTs) and corresponding fold increases were calculated using t tests and linear mixed-effects models. RESULTS Among 170 unvaccinated participants with SARS-CoV-2 infection, 158 (93%) developed nAbs with a GMT of 1003 (95% confidence interval, 766-1315). Among 139 previously uninfected participants, 138 (99%) developed nAbs after mRNA vaccine dose 2 with a GMT of 3257 (2596-4052). GMT was higher among those receiving mRNA-1273 vaccine (GMT, 4698; 3186-6926) compared with BNT162b2 vaccine (GMT, 2309; 1825-2919). Among 32 participants with prior SARS-CoV-2 infection, GMT was 21 655 (14 766-31 756) after mRNA vaccine dose 1, without further increase after dose 2. CONCLUSIONS A single dose of mRNA vaccine after SARS-CoV-2 infection resulted in the highest observed nAb response. Two doses of mRNA vaccine in previously uninfected participants resulted in higher nAbs to SARS-CoV-2 than after 1 dose of vaccine or SARS-CoV-2 infection alone. nAb response also differed by mRNA vaccine product.
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Affiliation(s)
- Harmony L Tyner
- St. Luke’s Regional Health Care System, Duluth, Minnesota, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Natalie J Thornburg
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Sarang K Yoon
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Shawn C Beitel
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lenee Blanton
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Janko Nikolich-Zugich
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Matthew S Thiese
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Ashley L Fowlkes
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Karen Lutrick
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Young M Yoo
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Spencer Rose
- Baylor Scott and White Health, Temple, Texas, USA
| | - Holly Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Jennifer Meece
- the Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | | | | | | | | | | | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
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20
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Burns J, Rivers P, LeClair LB, Jovel KS, Rai RP, Lowe AA, Edwards LJ, Khan SM, Mathenge C, Ferraris M, Kuntz JL, Lamberte JM, Hegmann KT, Odean MJ, McLeland-Wieser H, Beitel S, Odame-Bamfo L, Schaefer Solle N, Mak J, Phillips AL, Sokol BE, Hollister J, Ochoa JS, Grant L, Thiese MS, Jacoby KB, Lutrick K, Pubillones FA, Yoo YM, Rentz Hunt D, Ellingson K, Berry MC, Gerald JK, Lopez J, Gerald LB, Wesley MG, Krupp K, Herring MK, Madhivanan P, Caban-Martinez AJ, Tyner HL, Meece JK, Yoon SK, Fowlkes AL, Naleway AL, Gwynn L, Burgess JL, Thompson MG, Olsho LE, Gaglani M. Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study. JMIR Res Protoc 2022; 11:e37929. [PMID: 35635842 PMCID: PMC9377426 DOI: 10.2196/37929] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2. OBJECTIVE This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years, as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents. METHODS The PROTECT multisite network was initiated in July 2021, which aims to enroll approximately 2305 children across four US locations and collect data over a 2-year surveillance period. The enrollment target was based on prospective power calculations and accounts for expected attrition and nonresponse. Study sites recruit parents and legal guardians of age-eligible children participating in the existing Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (HEROES)-Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and parents/legal guardians' knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self-collected or collected by parents/legal guardians weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza, or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with permission of their parents/legal guardians, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical record (EMR) linkages where available, and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries. RESULTS Data collection began in July 2021 and is expected to continue through the spring of 2023. As of April 13, 2022, 2371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites. CONCLUSIONS As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/37929.
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Affiliation(s)
- Joy Burns
- Abt Associates, Atlanta, GA, United States
| | - Patrick Rivers
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Krystal S Jovel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Ashley A Lowe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Clare Mathenge
- College of Medicine, Texas A&M University, Temple, TX, United States
| | - Maria Ferraris
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Julie Mayo Lamberte
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Marilyn J Odean
- St. Luke's Regional Health Care System, Duluth, MN, United States
- Whiteside Institute for Clinical Research, St. Luke's, Duluth, MN, United States
| | | | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leah Odame-Bamfo
- College of Medicine, Texas A&M University, Temple, TX, United States
| | | | - Josephine Mak
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jezahel S Ochoa
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lauren Grant
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Felipe A Pubillones
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Young M Yoo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Katherine Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Karl Krupp
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Purnima Madhivanan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Harmony L Tyner
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | - Jennifer K Meece
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Ashley L Fowlkes
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Lisa Gwynn
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Mark G Thompson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Manjusha Gaglani
- College of Medicine, Texas A&M University, Temple, TX, United States
- Baylor Scott and White Health, Temple, TX, United States
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21
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Link-Gelles R, Levy ME, Gaglani M, Irving SA, Stockwell M, Dascomb K, DeSilva MB, Reese SE, Liao IC, Ong TC, Grannis SJ, McEvoy C, Patel P, Klein NP, Hartmann E, Stenehjem E, Natarajan K, Naleway AL, Murthy K, Rao S, Dixon BE, Kharbanda AB, Akinseye A, Dickerson M, Lewis N, Grisel N, Han J, Barron MA, Fadel WF, Dunne MM, Goddard K, Arndorfer J, Konatham D, Valvi NR, Currey JC, Fireman B, Raiyani C, Zerbo O, Sloan-Aagard C, Ball SW, Thompson MG, Tenforde MW. Effectiveness of 2, 3, and 4 COVID-19 mRNA Vaccine Doses Among Immunocompetent Adults During Periods when SARS-CoV-2 Omicron BA.1 and BA.2/BA.2.12.1 Sublineages Predominated - VISION Network, 10 States, December 2021-June 2022. MMWR Morb Mortal Wkly Rep 2022; 71:931-939. [PMID: 35862287 PMCID: PMC9310634 DOI: 10.15585/mmwr.mm7129e1] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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22
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Caban-Martinez AJ, Gaglani M, Olsho LEW, Grant L, Schaefer-Solle N, Thompson MG, Burgess JL. COVID-19 Vaccination Perspectives and Illnesses Among Law Enforcement Officers, Firefighters, and Other First Responders in the US, January to September 2021. JAMA Netw Open 2022; 5:e2222640. [PMID: 35852804 PMCID: PMC9297116 DOI: 10.1001/jamanetworkopen.2022.22640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study assesses attitudes toward COVID-19 vaccination and illness burden among vaccinated and unvaccinated law enforcement officers, firefighters, and other first responders in the US.
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Affiliation(s)
- Alberto J. Caban-Martinez
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple
| | | | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Natasha Schaefer-Solle
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Mark G. Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
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23
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Chung JR, Kim SS, Flannery B, Smith ME, Dunnigan K, Raiyani C, Murthy K, Gaglani M, Jackson ML, Jackson LA, Bear T, Moehling Geffel K, Nowalk MP, Zimmerman RK, Martin ET, Lamerato L, McLean HQ, King JP, Belongia EA, Thompson MG, Patel M. Vaccine-associated attenuation of subjective severity among outpatients with influenza. Vaccine 2022; 40:4322-4327. [PMID: 35710506 PMCID: PMC9638984 DOI: 10.1016/j.vaccine.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 11/18/2022]
Abstract
Influenza vaccines can mitigate illness severity, including reduced risk of ICU admission and death, in people with breakthrough infection. Less is known about vaccine attenuation of mild/moderate influenza illness. We compared subjective severity scores in vaccinated and unvaccinated persons with medically attended illness and laboratory-confirmed influenza. Participants were prospectively recruited when presenting for care at five US sites over nine seasons. Participants aged ≥ 16 years completed the EQ-5D-5L visual analog scale (VAS) at enrollment. After controlling for potential confounders in a multivariable model, including age and general health status, VAS scores were significantly higher among 2,830 vaccinated participants compared with 3,459 unvaccinated participants, indicating vaccinated participants felt better at the time of presentation for care. No differences in VAS scores were observed by the type of vaccine received among persons aged ≥ 65 years. Our findings suggest vaccine-associated attenuation of milder influenza illness is possible.
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Affiliation(s)
- Jessie R Chung
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, United States.
| | - Sara S Kim
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, United States
| | - Brendan Flannery
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, United States
| | | | | | | | | | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, United States; Texas A&M University College of Medicine, Temple, TX, United States
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Todd Bear
- University of Pittsburgh, United States
| | | | | | | | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Lois Lamerato
- Henry Ford Health System, Detroit, MI, United States
| | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Jennifer P King
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | | | - Mark G Thompson
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, United States
| | - Manish Patel
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, United States
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24
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Yoon SK, Hegmann KT, Thiese MS, Burgess JL, Ellingson K, Lutrick K, Olsho LEW, Edwards LJ, Sokol B, Caban-Martinez AJ, Schaefer-Solle N, Jones JM, Tyner H, Hunt A, Respet K, Gaglani M, Dunnigan K, Rose S, Naleway A, Groom H, Kuntz J, Fowlkes AL, Thompson MG, Yoo YM. Protection with a Third Dose of mRNA Vaccine against SARS-CoV-2 Variants in Frontline Workers. N Engl J Med 2022; 386:1855-1857. [PMID: 35385628 PMCID: PMC9006784 DOI: 10.1056/nejmc2201821] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Hunt
- St. Luke's Regional Health Care System, Duluth, MN
| | | | | | | | | | | | | | | | | | | | - Young M Yoo
- Centers for Disease Control and Prevention, Atlanta, GA
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25
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Naleway AL, Grant L, Caban‐Martinez AJ, Wesley MG, Burgess JL, Groover K, Gaglani M, Yoon SK, Tyner HL, Meece J, Kuntz JL, Yoo YM, Schaefer‐Solle N, Olsho LEW, Gerald JK, Rose S, Thiese MS, Lundgren J, Groom HC, Mak J, Louzado Feliciano P, Edwards LJ, Lutrick K, Dunnigan K, Phillips AL, Lamberte JM, Noriega R, Sokol BE, Odean M, Ellingson KD, Smith M, Hegmann KT, Respet K, Dickerson M, Cruz A, Fleary DE, Murthy K, Hunt A, Azziz‐Baumgartner E, Gallimore‐Wilson D, Harder JA, Odame‐Bamfo L, Viergutz J, Arvay M, Jones JM, Mistry P, Thompson MG, Fowlkes AL. Incidence of SARS-CoV-2 infection among COVID-19 vaccinated and unvaccinated healthcare personnel, first responders, and other essential and frontline workers: Eight US locations, January-September 2021. Influenza Other Respir Viruses 2022; 16:585-593. [PMID: 35023288 PMCID: PMC8983896 DOI: 10.1111/irv.12956] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2. METHODS We analyzed data from a prospective frontline worker cohort to estimate the incidence of COVID-19 by month as well as the association of COVID-19 vaccination, occupation, demographics, physical distancing, and mask use with infection risk. Participants completed baseline and quarterly surveys, and each week self-collected mid-turbinate nasal swabs and reported symptoms. RESULTS Among 1018 unvaccinated and 3531 fully vaccinated workers, the monthly incidence of laboratory-confirmed SARS-CoV-2 infection in January 2021 was 13.9 (95% confidence interval [CI]: 10.4-17.4), declining to 0.5 (95% CI -0.4-1.4) per 1000 person-weeks in June. By September 2021, when the Delta variant predominated, incidence had once again risen to 13.6 (95% CI 7.8-19.4) per 1000 person-weeks. In contrast, there was no reportable incidence among fully vaccinated participants at the end of January 2021, and incidence remained low until September 2021 when it rose modestly to 4.1 (95% CI 1.9-3.8) per 1000. Below average facemask use was associated with a higher risk of infection for unvaccinated participants during exposure to persons who may have COVID-19 and vaccinated participants during hours in the community. CONCLUSIONS COVID-19 vaccination was significantly associated with a lower risk of SARS-CoV-2 infection despite Delta variant predominance. Our data demonstrate the added protective benefit of facemask use among both unvaccinated and vaccinated frontline workers.
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Affiliation(s)
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | | | - Manjusha Gaglani
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Sarang K. Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Jennifer Meece
- Marshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Jennifer L. Kuntz
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Young M. Yoo
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Joe K. Gerald
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Spencer Rose
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Kayan Dunnigan
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Andrew L. Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Roger Noriega
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Marilyn Odean
- Whiteside Institute for Clinical Research, St. Luke'sDuluthMinnesotaUSA
| | | | | | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Karley Respet
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Alexandra Cruz
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | | | - Angela Hunt
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | | | | | | | | | | | - Melissa Arvay
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - John M. Jones
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Mark G. Thompson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Ashley L. Fowlkes
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
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26
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Natarajan K, Prasad N, Dascomb K, Irving SA, Yang DH, Gaglani M, Klein NP, DeSilva MB, Ong TC, Grannis SJ, Stenehjem E, Link-Gelles R, Rowley EA, Naleway AL, Han J, Raiyani C, Benitez GV, Rao S, Lewis N, Fadel WF, Grisel N, Griggs EP, Dunne MM, Stockwell MS, Mamawala M, McEvoy C, Barron MA, Goddard K, Valvi NR, Arndorfer J, Patel P, Mitchell PK, Smith M, Kharbanda AB, Fireman B, Embi PJ, Dickerson M, Davis JM, Zerbo O, Dalton AF, Wondimu MH, Azziz-Baumgartner E, Bozio CH, Reynolds S, Ferdinands J, Williams J, Schrag SJ, Verani JR, Ball S, Thompson MG, Dixon BE. Effectiveness of Homologous and Heterologous COVID-19 Booster Doses Following 1 Ad.26.COV2.S (Janssen [Johnson & Johnson]) Vaccine Dose Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults - VISION Network, 10 States, December 2021-March 2022. MMWR Morb Mortal Wkly Rep 2022; 71:495-502. [PMID: 35358170 PMCID: PMC8979598 DOI: 10.15585/mmwr.mm7113e2] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CDC recommends that all persons aged ≥18 years receive a single COVID-19 vaccine booster dose ≥2 months after receipt of an Ad.26.COV2.S (Janssen [Johnson & Johnson]) adenovirus vector-based primary series vaccine; a heterologous COVID-19 mRNA vaccine is preferred over a homologous (matching) Janssen vaccine for booster vaccination. This recommendation was made in light of the risks for rare but serious adverse events following receipt of a Janssen vaccine, including thrombosis with thrombocytopenia syndrome and Guillain-Barré syndrome† (1), and clinical trial data indicating similar or higher neutralizing antibody response following heterologous boosting compared with homologous boosting (2). Data on real-world vaccine effectiveness (VE) of different booster strategies following a primary Janssen vaccine dose are limited, particularly during the period of Omicron variant predominance. The VISION Network§ determined real-world VE of 1 Janssen vaccine dose and 2 alternative booster dose strategies: 1) a homologous booster (i.e., 2 Janssen doses) and 2) a heterologous mRNA booster (i.e., 1 Janssen dose/1 mRNA dose). In addition, VE of these booster strategies was compared with VE of a homologous booster following mRNA primary series vaccination (i.e., 3 mRNA doses). The study examined 80,287 emergency department/urgent care (ED/UC) visits¶ and 25,244 hospitalizations across 10 states during December 16, 2021-March 7, 2022, when Omicron was the predominant circulating variant.** VE against laboratory-confirmed COVID-19-associated ED/UC encounters was 24% after 1 Janssen dose, 54% after 2 Janssen doses, 79% after 1 Janssen/1 mRNA dose, and 83% after 3 mRNA doses. VE for the same vaccination strategies against laboratory-confirmed COVID-19-associated hospitalizations were 31%, 67%, 78%, and 90%, respectively. All booster strategies provided higher protection than a single Janssen dose against ED/UC visits and hospitalizations during Omicron variant predominance. Vaccination with 1 Janssen/1 mRNA dose provided higher protection than did 2 Janssen doses against COVID-19-associated ED/UC visits and was comparable to protection provided by 3 mRNA doses during the first 120 days after a booster dose. However, 3 mRNA doses provided higher protection against COVID-19-associated hospitalizations than did other booster strategies during the same time interval since booster dose. All adults who have received mRNA vaccines for their COVID-19 primary series vaccination should receive an mRNA booster dose when eligible. Adults who received a primary Janssen vaccine dose should preferentially receive a heterologous mRNA vaccine booster dose ≥2 months later, or a homologous Janssen vaccine booster dose if mRNA vaccine is contraindicated or unavailable. Further investigation of the durability of protection afforded by different booster strategies is warranted.
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27
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Fowlkes AL, Yoon SK, Lutrick K, Gwynn L, Burns J, Grant L, Phillips AL, Ellingson K, Ferraris MV, LeClair LB, Mathenge C, Yoo YM, Thiese MS, Gerald LB, Solle NS, Jeddy Z, Odame-Bamfo L, Mak J, Hegmann KT, Gerald JK, Ochoa JS, Berry M, Rose S, Lamberte JM, Madhivanan P, Pubillones FA, Rai RP, Dunnigan K, Jones JT, Krupp K, Edwards LJ, Bedrick EJ, Sokol BE, Lowe A, McLeland-Wieser H, Jovel KS, Fleary DE, Khan SM, Poe B, Hollister J, Lopez J, Rivers P, Beitel S, Tyner HL, Naleway AL, Olsho LE, Caban-Martinez AJ, Burgess JL, Thompson MG, Gaglani M. Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years - PROTECT Cohort, July 2021-February 2022. MMWR Morb Mortal Wkly Rep 2022; 71:422-428. [PMID: 35298453 PMCID: PMC8942308 DOI: 10.15585/mmwr.mm7111e1] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Chi Y, Huang J, Zhang Z, Mao J, Zhou Z, Chen X, Zhai C, Bao J, Dai T, Yuan H, Zhang M, Dai D, Tang B, Yang Y, Li Z, Ding Y, Oxenløwe LK, Thompson MG, O'Brien JL, Li Y, Gong Q, Wang J. A programmable qudit-based quantum processor. Nat Commun 2022; 13:1166. [PMID: 35246519 PMCID: PMC8897515 DOI: 10.1038/s41467-022-28767-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/11/2022] [Indexed: 11/09/2022] Open
Abstract
Controlling and programming quantum devices to process quantum information by the unit of quantum dit, i.e., qudit, provides the possibilities for noise-resilient quantum communications, delicate quantum molecular simulations, and efficient quantum computations, showing great potential to enhance the capabilities of qubit-based quantum technologies. Here, we report a programmable qudit-based quantum processor in silicon-photonic integrated circuits and demonstrate its enhancement of quantum computational parallelism. The processor monolithically integrates all the key functionalities and capabilities of initialisation, manipulation, and measurement of the two quantum quart (ququart) states and multi-value quantum-controlled logic gates with high-level fidelities. By reprogramming the configuration of the processor, we implemented the most basic quantum Fourier transform algorithms, all in quaternary, to benchmark the enhancement of quantum parallelism using qudits, which include generalised Deutsch-Jozsa and Bernstein-Vazirani algorithms, quaternary phase estimation and fast factorization algorithms. The monolithic integration and high programmability have allowed the implementations of more than one million high-fidelity preparations, operations and projections of qudit states in the processor. Our work shows an integrated photonic quantum technology for qudit-based quantum computing with enhanced capacity, accuracy, and efficiency, which could lead to the acceleration of building a large-scale quantum computer.
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Affiliation(s)
- Yulin Chi
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Jieshan Huang
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Zhanchuan Zhang
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Jun Mao
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Zinan Zhou
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Xiaojiong Chen
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Chonghao Zhai
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Jueming Bao
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Tianxiang Dai
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China
| | - Huihong Yuan
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China.,Beijing Academy of Quantum Information Sciences, 100193, Beijing, China
| | - Ming Zhang
- State Key Laboratory for Modern Optical Instrumentation, College of Optical Science and Engineering, Ningbo Research Institute, International Research Center for Advanced Photonics, Zhejiang University, 310058, Hangzhou, China
| | - Daoxin Dai
- State Key Laboratory for Modern Optical Instrumentation, College of Optical Science and Engineering, Ningbo Research Institute, International Research Center for Advanced Photonics, Zhejiang University, 310058, Hangzhou, China
| | - Bo Tang
- Institute of Microelectronics, Chinese Academy of Sciences, 100029, Beijing, China
| | - Yan Yang
- Institute of Microelectronics, Chinese Academy of Sciences, 100029, Beijing, China
| | - Zhihua Li
- Institute of Microelectronics, Chinese Academy of Sciences, 100029, Beijing, China
| | - Yunhong Ding
- Department of Photonics Engineering, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark.,Center for Silicon Photonics for Optical Communication (SPOC), Technical University of Denmark, 2800, Kgs. Lyngby, Denmark
| | - Leif K Oxenløwe
- Department of Photonics Engineering, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark.,Center for Silicon Photonics for Optical Communication (SPOC), Technical University of Denmark, 2800, Kgs. Lyngby, Denmark
| | - Mark G Thompson
- Quantum Engineering Technology Labs, H. H. Wills Physics Laboratory and Department of Electrical and Electronic Engineering, University of Bristol, BS8 1FD, Bristol, United Kingdom
| | - Jeremy L O'Brien
- Department of Physics, The University of Western Australia, Perth, 6009, Australia
| | - Yan Li
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China.,Frontiers Science Center for Nano-optoelectronics & Collaborative Innovation Center of Quantum Matter, Peking University, 100871, Beijing, China.,Collaborative Innovation Center of Extreme Optics, Shanxi University, 030006, Taiyuan, Shanxi, China.,Peking University Yangtze Delta Institute of Optoelectronics, Nantong, 226010, Jiangsu, China
| | - Qihuang Gong
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China.,Beijing Academy of Quantum Information Sciences, 100193, Beijing, China.,Frontiers Science Center for Nano-optoelectronics & Collaborative Innovation Center of Quantum Matter, Peking University, 100871, Beijing, China.,Collaborative Innovation Center of Extreme Optics, Shanxi University, 030006, Taiyuan, Shanxi, China.,Peking University Yangtze Delta Institute of Optoelectronics, Nantong, 226010, Jiangsu, China
| | - Jianwei Wang
- State Key Laboratory for Mesoscopic Physics, School of Physics, Peking University, 100871, Beijing, China. .,Beijing Academy of Quantum Information Sciences, 100193, Beijing, China. .,Frontiers Science Center for Nano-optoelectronics & Collaborative Innovation Center of Quantum Matter, Peking University, 100871, Beijing, China. .,Collaborative Innovation Center of Extreme Optics, Shanxi University, 030006, Taiyuan, Shanxi, China. .,Peking University Yangtze Delta Institute of Optoelectronics, Nantong, 226010, Jiangsu, China.
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29
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Klein NP, Stockwell MS, Demarco M, Gaglani M, Kharbanda AB, Irving SA, Rao S, Grannis SJ, Dascomb K, Murthy K, Rowley EA, Dalton AF, DeSilva MB, Dixon BE, Natarajan K, Stenehjem E, Naleway AL, Lewis N, Ong TC, Patel P, Konatham D, Embi PJ, Reese SE, Han J, Grisel N, Goddard K, Barron MA, Dickerson M, Liao IC, Fadel WF, Yang DH, Arndorfer J, Fireman B, Griggs EP, Valvi NR, Hallowell C, Zerbo O, Reynolds S, Ferdinands J, Wondimu MH, Williams J, Bozio CH, Link-Gelles R, Azziz-Baumgartner E, Schrag SJ, Thompson MG, Verani JR. Effectiveness of COVID-19 Pfizer-BioNTech BNT162b2 mRNA Vaccination in Preventing COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Nonimmunocompromised Children and Adolescents Aged 5-17 Years - VISION Network, 10 States, April 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:352-358. [PMID: 35239634 PMCID: PMC8893336 DOI: 10.15585/mmwr.mm7109e3] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The efficacy of the BNT162b2 (Pfizer-BioNTech) vaccine against laboratory-confirmed COVID-19 exceeded 90% in clinical trials that included children and adolescents aged 5-11, 12-15, and 16-17 years (1-3). Limited real-world data on 2-dose mRNA vaccine effectiveness (VE) in persons aged 12-17 years (referred to as adolescents in this report) have also indicated high levels of protection against SARS-CoV-2 (the virus that causes COVID-19) infection and COVID-19-associated hospitalization (4-6); however, data on VE against the SARS-CoV-2 B.1.1.529 (Omicron) variant and duration of protection are limited. Pfizer-BioNTech VE data are not available for children aged 5-11 years. In partnership with CDC, the VISION Network* examined 39,217 emergency department (ED) and urgent care (UC) encounters and 1,699 hospitalizations† among persons aged 5-17 years with COVID-19-like illness across 10 states during April 9, 2021-January 29, 2022,§ to estimate VE using a case-control test-negative design. Among children aged 5-11 years, VE against laboratory-confirmed COVID-19-associated ED and UC encounters 14-67 days after dose 2 (the longest interval after dose 2 in this age group) was 46%. Among adolescents aged 12-15 and 16-17 years, VE 14-149 days after dose 2 was 83% and 76%, respectively; VE ≥150 days after dose 2 was 38% and 46%, respectively. Among adolescents aged 16-17 years, VE increased to 86% ≥7 days after dose 3 (booster dose). VE against COVID-19-associated ED and UC encounters was substantially lower during the Omicron predominant period than the B.1.617.2 (Delta) predominant period among adolescents aged 12-17 years, with no significant protection ≥150 days after dose 2 during Omicron predominance. However, in adolescents aged 16-17 years, VE during the Omicron predominant period increased to 81% ≥7 days after a third booster dose. During the full study period, including pre-Delta, Delta, and Omicron predominant periods, VE against laboratory-confirmed COVID-19-associated hospitalization among children aged 5-11 years was 74% 14-67 days after dose 2, with wide CIs that included zero. Among adolescents aged 12-15 and 16-17 years, VE 14-149 days after dose 2 was 92% and 94%, respectively; VE ≥150 days after dose 2 was 73% and 88%, respectively. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations, including a booster dose for those aged 12-17 years.
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Konatham D, Kharbanda AB, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Liao IC, Birch R, Valvi NR, Reynolds S, Arndorfer J, Zerbo O, Dickerson M, Murthy K, Williams J, Bozio CH, Blanton L, Verani JR, Schrag SJ, Dalton AF, Wondimu MH, Link-Gelles R, Azziz-Baumgartner E, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022. [PMID: 35176007 DOI: 10.1558/mmwr.mm7107e2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
CDC recommends that all persons aged ≥12 years receive a booster dose of COVID-19 mRNA vaccine ≥5 months after completion of a primary mRNA vaccination series and that immunocompromised persons receive a third primary dose.* Waning of vaccine protection after 2 doses of mRNA vaccine has been observed during the period of the SARS-CoV-2 B.1.617.2 (Delta) variant predominance† (1-5), but little is known about durability of protection after 3 doses during periods of Delta or SARS-CoV-2 B.1.1.529 (Omicron) variant predominance. A test-negative case-control study design using data from eight VISION Network sites§ examined vaccine effectiveness (VE) against COVID-19 emergency department/urgent care (ED/UC) visits and hospitalizations among U.S. adults aged ≥18 years at various time points after receipt of a second or third vaccine dose during two periods: Delta variant predominance and Omicron variant predominance (i.e., periods when each variant accounted for ≥50% of sequenced isolates).¶ Persons categorized as having received 3 doses included those who received a third dose in a primary series or a booster dose after a 2 dose primary series (including the reduced-dosage Moderna booster). The VISION Network analyzed 241,204 ED/UC encounters** and 93,408 hospitalizations across 10 states during August 26, 2021-January 22, 2022. VE after receipt of both 2 and 3 doses was lower during the Omicron-predominant than during the Delta-predominant period at all time points evaluated. During both periods, VE after receipt of a third dose was higher than that after a second dose; however, VE waned with increasing time since vaccination. During the Omicron period, VE against ED/UC visits was 87% during the first 2 months after a third dose and decreased to 66% among those vaccinated 4-5 months earlier; VE against hospitalizations was 91% during the first 2 months following a third dose and decreased to 78% ≥4 months after a third dose. For both Delta- and Omicron-predominant periods, VE was generally higher for protection against hospitalizations than against ED/UC visits. All eligible persons should remain up to date with recommended COVID-19 vaccinations to best protect against COVID-19-associated hospitalizations and ED/UC visits.
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Konatham D, Kharbanda AB, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Liao IC, Birch R, Valvi NR, Reynolds S, Arndorfer J, Zerbo O, Dickerson M, Murthy K, Williams J, Bozio CH, Blanton L, Verani JR, Schrag SJ, Dalton AF, Wondimu MH, Link-Gelles R, Azziz-Baumgartner E, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:255-263. [PMID: 35176007 PMCID: PMC8853475 DOI: 10.15585/mmwr.mm7107e2] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thompson MG, Natarajan K, Irving SA, Rowley EA, Griggs EP, Gaglani M, Klein NP, Grannis SJ, DeSilva MB, Stenehjem E, Reese SE, Dickerson M, Naleway AL, Han J, Konatham D, McEvoy C, Rao S, Dixon BE, Dascomb K, Lewis N, Levy ME, Patel P, Liao IC, Kharbanda AB, Barron MA, Fadel WF, Grisel N, Goddard K, Yang DH, Wondimu MH, Murthy K, Valvi NR, Arndorfer J, Fireman B, Dunne MM, Embi P, Azziz-Baumgartner E, Zerbo O, Bozio CH, Reynolds S, Ferdinands J, Williams J, Link-Gelles R, Schrag SJ, Verani JR, Ball S, Ong TC. Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:139-145. [PMID: 35085224 PMCID: PMC9351525 DOI: 10.15585/mmwr.mm7104e3] [Citation(s) in RCA: 268] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Estimates of COVID-19 mRNA vaccine effectiveness (VE) have declined in recent months (1,2) because of waning vaccine induced immunity over time,* possible increased immune evasion by SARS-CoV-2 variants (3), or a combination of these and other factors. CDC recommends that all persons aged ≥12 years receive a third dose (booster) of an mRNA vaccine ≥5 months after receipt of the second mRNA vaccine dose and that immunocompromised individuals receive a third primary dose.† A third dose of BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine increases neutralizing antibody levels (4), and three recent studies from Israel have shown improved effectiveness of a third dose in preventing COVID-19 associated with infections with the SARS-CoV-2 B.1.617.2 (Delta) variant (5-7). Yet, data are limited on the real-world effectiveness of third doses of COVID-19 mRNA vaccine in the United States, especially since the SARS-CoV-2 B.1.1.529 (Omicron) variant became predominant in mid-December 2021. The VISION Network§ examined VE by analyzing 222,772 encounters from 383 emergency departments (EDs) and urgent care (UC) clinics and 87,904 hospitalizations from 259 hospitals among adults aged ≥18 years across 10 states from August 26, 2021¶ to January 5, 2022. Analyses were stratified by the period before and after the Omicron variant became the predominant strain (>50% of sequenced viruses) at each study site. During the period of Delta predominance across study sites in the United States (August-mid-December 2021), VE against laboratory-confirmed COVID-19-associated ED and UC encounters was 86% 14-179 days after dose 2, 76% ≥180 days after dose 2, and 94% ≥14 days after dose 3. Estimates of VE for the same intervals after vaccination during Omicron variant predominance were 52%, 38%, and 82%, respectively. During the period of Delta variant predominance, VE against laboratory-confirmed COVID-19-associated hospitalizations was 90% 14-179 days after dose 2, 81% ≥180 days after dose 2, and 94% ≥14 days after dose 3. During Omicron variant predominance, VE estimates for the same intervals after vaccination were 81%, 57%, and 90%, respectively. The highest estimates of VE against COVID-19-associated ED and UC encounters or hospitalizations during both Delta- and Omicron-predominant periods were among adults who received a third dose of mRNA vaccine. All unvaccinated persons should get vaccinated as soon as possible. All adults who have received mRNA vaccines during their primary COVID-19 vaccination series should receive a third dose when eligible, and eligible persons should stay up to date with COVID-19 vaccinations.
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Embi PJ, Levy ME, Naleway AL, Patel P, Gaglani M, Natarajan K, Dascomb K, Ong TC, Klein NP, Liao IC, Grannis SJ, Han J, Stenehjem E, Dunne MM, Lewis N, Irving SA, Rao S, McEvoy C, Bozio CH, Murthy K, Dixon BE, Grisel N, Yang DH, Goddard K, Kharbanda AB, Reynolds S, Raiyani C, Fadel WF, Arndorfer J, Rowley EA, Fireman B, Ferdinands J, Valvi NR, Ball SW, Zerbo O, Griggs EP, Mitchell PK, Porter RM, Kiduko SA, Blanton L, Zhuang Y, Steffens A, Reese SE, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron MA, Thompson MG, DeSilva MB. Effectiveness of two-dose vaccination with mRNA COVID-19 vaccines against COVID-19-associated hospitalizations among immunocompromised adults-Nine States, January-September 2021. Am J Transplant 2022; 22:306-314. [PMID: 34967121 PMCID: PMC9805402 DOI: 10.1111/ajt.16641] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Peter J. Embi
- Regenstrief Institute, Indianapolis, Indiana, USA,Indiana University School of Medicine, Indianapolis, Indiana, USA,Correspondence Peter J. Embi, Regenstrief Institute, Indianapolis, IN, USA.
| | | | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, New York,New York Presbyterian Hospital, New York New, York
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Toan C. Ong
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Shaun J. Grannis
- Indiana University School of Medicine, Indianapolis, Indiana, USA,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Suchitra Rao
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | - Chandni Raiyani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle A. Barron
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Wesley MG, Tinoco Y, Patel A, Suntarratiwong P, Hunt D, Sinthuwattanawibool C, Soto G, Kittikraisak W, Das PK, Arriola CS, Hombroek D, Mott J, Kurhe K, Bhargav S, Prakash A, Florian R, Gonzales O, Cabrera S, Llajaruna E, Brummer T, Malek P, Saha S, Garg S, Azziz-Baumgartner E, Thompson MG, Dawood FS. Performance of Symptom-Based Case Definitions to Identify Influenza Virus Infection Among Pregnant Women in Middle-Income Countries: Findings From the Pregnancy and Influenza Multinational Epidemiologic (PRIME) Study. Clin Infect Dis 2021; 73:e4321-e4328. [PMID: 33173947 PMCID: PMC10563868 DOI: 10.1093/cid/ciaa1697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends case definitions for influenza surveillance that are also used in public health research, although their performance has not been assessed in many risk groups, including pregnant women in whom influenza may manifest differently. We evaluated the performance of symptom-based definitions to detect influenza in a cohort of pregnant women in India, Peru, and Thailand. METHODS In 2017 and 2018, we contacted 11 277 pregnant women twice weekly during the influenza season to identify illnesses with new or worsened cough, runny nose, sore throat, difficulty breathing, or myalgia and collected data on other symptoms and nasal swabs for influenza real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. We calculated sensitivity, specificity, positive-predictive value, and negative-predictive value of each symptom predictor, WHO respiratory illness case definitions, and a de novo definition derived from results of multivariable modeling. RESULTS Of 5444 eligible illness episodes among 3965 participants, 310 (6%) were positive for influenza. In a multivariable model, measured fever ≥38°C (adjusted odds ratio [95% confidence interval], 4.6 [3.1-6.8]), myalgia (3.0 [2.2-4.0]), cough (2.7 [1.9-3.9]), and chills (1.6 [1.1-2.4]) were independently associated with influenza illness. A definition based on these 4 (measured fever, cough, chills, or myalgia) was 95% sensitive and 27% specific. The WHO influenza-like illness (ILI) definition was 16% sensitive and 98% specific. CONCLUSIONS The current WHO ILI case definition was highly specific but had low sensitivity. The intended use of case definitions should be considered when evaluating the tradeoff between sensitivity and specificity.
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Affiliation(s)
- Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yeny Tinoco
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Sawangi, India
| | - Piyarat Suntarratiwong
- Queen Sirikit National Institute of Child Health, Thailand Ministry of Public Health, Bangkok, Thailand
| | | | | | - Giselle Soto
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Wanitchaya Kittikraisak
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Carmen Sofia Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Joshua Mott
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
| | | | | | | | | | | | | | | | | | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Edwards LJ, Fowlkes AL, Wesley MG, Kuntz JL, Odean MJ, Caban-Martinez AJ, Dunnigan K, Phillips AL, Grant L, Herring MK, Groom HC, Respet K, Beitel S, Zunie T, Hegmann KT, Kumar A, Joseph G, Poe B, Louzado-Feliciano P, Smith ME, Thiese MS, Schaefer-Solle N, Yoo YM, Silvera CA, Mayo Lamberte J, Mak J, McDonald LC, Stuckey MJ, Kutty P, Arvay ML, Yoon SK, Tyner HL, Burgess JL, Hunt DR, Meece J, Gaglani M, Naleway AL, Thompson MG. Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study. JMIR Res Protoc 2021; 10:e31574. [PMID: 34662287 PMCID: PMC8647972 DOI: 10.2196/31574] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. OBJECTIVE The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. METHODS The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19-like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR-confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. RESULTS The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. CONCLUSIONS Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31574.
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Affiliation(s)
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Marilyn J Odean
- Whiteside Institute for Clinical Research, Duluth, MN, United States
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | | | - Kayan Dunnigan
- Baylor Scott and White Health, Temple, TX, United States
| | | | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Holly C Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Karley Respet
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | - Shawn Beitel
- University of Arizona, Tucson, AZ, United States
| | - Tnelda Zunie
- Baylor Scott and White Health, Temple, TX, United States
| | | | - Archana Kumar
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gregory Joseph
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brandon Poe
- Abt Associates, Inc, Atlanta, GA, United States
| | | | | | | | | | - Young M Yoo
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Josephine Mak
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Matthew J Stuckey
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Preeta Kutty
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Melissa L Arvay
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarang K Yoon
- University of Utah, Salt Lake City, UT, United States
| | - Harmony L Tyner
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | | | | | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, TX, United States
- Texas A&M University College of Medicine, Temple, TX, United States
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Spencer S, Chung JR, Belongia EA, Sundaram M, Meece J, Coleman LA, Zimmerman RK, Nowalk MP, Moehling Geffel K, Ross T, Carter CE, Shay D, Levine M, Liepkalns J, Kim JH, Sambhara S, Thompson MG, Flannery B. Impact of diabetes status on immunogenicity of trivalent inactivated influenza vaccine in older adults. Influenza Other Respir Viruses 2021; 16:562-567. [PMID: 34859584 PMCID: PMC8983908 DOI: 10.1111/irv.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022] Open
Abstract
Individuals with type 2 diabetes mellitus experience high rates of influenza virus infection and complications. We compared the magnitude and duration of serologic response to trivalent influenza vaccine in adults aged 50–80 with and without type 2 diabetes mellitus. Serologic response to influenza vaccination was similar in both groups: greater fold‐increases in antibody titer occurred among participants with lower pre‐vaccination antibody titers. Waning of antibody titers was not influenced by diabetes status.
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Affiliation(s)
- Sarah Spencer
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessie R Chung
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Maria Sundaram
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Jennifer Meece
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Laura A Coleman
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland.,Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Richard K Zimmerman
- Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Patricia Nowalk
- Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Krissy Moehling Geffel
- Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ted Ross
- Center for Vaccines and Immunology, Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA.,Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chalise E Carter
- Center for Vaccines and Immunology, Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA.,Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Shay
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Levine
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Justine Liepkalns
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Biology, University of Washington, Seattle, Washington, USA
| | - Jin Hyang Kim
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Translational Medicine, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Suryaprakash Sambhara
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Naleway AL, Groom HC, Crawford PM, Salas SB, Henninger ML, Donald JL, Smith N, Thompson MG, Blanton LH, Bozio CH, Azziz-Baumgartner E. Incidence of SARS-CoV-2 Infection, Emergency Department Visits, and Hospitalizations Because of COVID-19 Among Persons Aged ≥12 Years, by COVID-19 Vaccination Status - Oregon and Washington, July 4-September 25, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1608-1612. [PMID: 34793417 PMCID: PMC8601415 DOI: 10.15585/mmwr.mm7046a4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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Bozio CH, Grannis SJ, Naleway AL, Ong TC, Butterfield KA, DeSilva MB, Natarajan K, Yang DH, Rao S, Klein NP, Irving SA, Dixon BE, Dascomb K, Liao IC, Reynolds S, McEvoy C, Han J, Reese SE, Lewis N, Fadel WF, Grisel N, Murthy K, Ferdinands J, Kharbanda AB, Mitchell PK, Goddard K, Embi PJ, Arndorfer J, Raiyani C, Patel P, Rowley EA, Fireman B, Valvi NR, Griggs EP, Levy ME, Zerbo O, Porter RM, Birch RJ, Blanton L, Ball SW, Steffens A, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron M, Gaglani M, Thompson MG, Stenehjem E. Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1539-1544. [PMID: 34735425 PMCID: PMC8568091 DOI: 10.15585/mmwr.mm7044e1] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Previous infection with SARS-CoV-2 (the virus that causes COVID-19) or COVID-19 vaccination can provide immunity and protection from subsequent SARS-CoV-2 infection and illness. CDC used data from the VISION Network* to examine hospitalizations in adults with COVID-19-like illness and compared the odds of receiving a positive SARS-CoV-2 test result, and thus having laboratory-confirmed COVID-19, between unvaccinated patients with a previous SARS-CoV-2 infection occurring 90-179 days before COVID-19-like illness hospitalization, and patients who were fully vaccinated with an mRNA COVID-19 vaccine 90-179 days before hospitalization with no previous documented SARS-CoV-2 infection. Hospitalized adults aged ≥18 years with COVID-19-like illness were included if they had received testing at least twice: once associated with a COVID-19-like illness hospitalization during January-September 2021 and at least once earlier (since February 1, 2020, and ≥14 days before that hospitalization). Among COVID-19-like illness hospitalizations in persons whose previous infection or vaccination occurred 90-179 days earlier, the odds of laboratory-confirmed COVID-19 (adjusted for sociodemographic and health characteristics) among unvaccinated, previously infected adults were higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine with no previous documented infection (adjusted odds ratio [aOR] = 5.49; 95% confidence interval [CI] = 2.75-10.99). These findings suggest that among hospitalized adults with COVID-19-like illness whose previous infection or vaccination occurred 90-179 days earlier, vaccine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19. All eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2.
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Embi PJ, Levy ME, Naleway AL, Patel P, Gaglani M, Natarajan K, Dascomb K, Ong TC, Klein NP, Liao IC, Grannis SJ, Han J, Stenehjem E, Dunne MM, Lewis N, Irving SA, Rao S, McEvoy C, Bozio CH, Murthy K, Dixon BE, Grisel N, Yang DH, Goddard K, Kharbanda AB, Reynolds S, Raiyani C, Fadel WF, Arndorfer J, Rowley EA, Fireman B, Ferdinands J, Valvi NR, Ball SW, Zerbo O, Griggs EP, Mitchell PK, Porter RM, Kiduko SA, Blanton L, Zhuang Y, Steffens A, Reese SE, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron MA, Thompson MG, DeSilva MB. Effectiveness of 2-Dose Vaccination with mRNA COVID-19 Vaccines Against COVID-19-Associated Hospitalizations Among Immunocompromised Adults - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1553-1559. [PMID: 34735426 PMCID: PMC8568092 DOI: 10.15585/mmwr.mm7044e3] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Immunocompromised persons, defined as those with suppressed humoral or cellular immunity resulting from health conditions or medications, account for approximately 3% of the U.S. adult population (1). Immunocompromised adults are at increased risk for severe COVID-19 outcomes (2) and might not acquire the same level of protection from COVID-19 mRNA vaccines as do immunocompetent adults (3,4). To evaluate vaccine effectiveness (VE) among immunocompromised adults, data from the VISION Network* on hospitalizations among persons aged ≥18 years with COVID-19-like illness from 187 hospitals in nine states during January 17-September 5, 2021 were analyzed. Using selected discharge diagnoses,† VE against COVID-19-associated hospitalization conferred by completing a 2-dose series of an mRNA COVID-19 vaccine ≥14 days before the index hospitalization date§ (i.e., being fully vaccinated) was evaluated using a test-negative design comparing 20,101 immunocompromised adults (10,564 [53%] of whom were fully vaccinated) and 69,116 immunocompetent adults (29,456 [43%] of whom were fully vaccinated). VE of 2 doses of mRNA COVID-19 vaccine against COVID-19-associated hospitalization was lower among immunocompromised patients (77%; 95% confidence interval [CI] = 74%-80%) than among immunocompetent patients (90%; 95% CI = 89%-91%). This difference persisted irrespective of mRNA vaccine product, age group, and timing of hospitalization relative to SARS-CoV-2 (the virus that causes COVID-19) B.1.617.2 (Delta) variant predominance in the state of hospitalization. VE varied across immunocompromising condition subgroups, ranging from 59% (organ or stem cell transplant recipients) to 81% (persons with a rheumatologic or inflammatory disorder). Immunocompromised persons benefit from mRNA COVID-19 vaccination but are less protected from severe COVID-19 outcomes than are immunocompetent persons, and VE varies among immunocompromised subgroups. Immunocompromised persons receiving mRNA COVID-19 vaccines should receive 3 doses and a booster, consistent with CDC recommendations (5), practice nonpharmaceutical interventions, and, if infected, be monitored closely and considered early for proven therapies that can prevent severe outcomes.
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Ellingson KD, Gerald JK, Sun X, Hollister J, Lutrick K, Parker J, Rivers P, Beitel SC, Baccam Z, Lamberte JM, Grant L, Kim E, Bhattarai R, Komatsu K, Meece J, Kutty PK, Thompson MG, Burgess JL. Incidence of SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential Workers During a Prevaccination COVID-19 Surge in Arizona. JAMA Health Forum 2021; 2:e213318. [PMID: 35977166 PMCID: PMC8727035 DOI: 10.1001/jamahealthforum.2021.3318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Question Before COVID-19 vaccine availability, how comparable were rates of SARS-CoV-2 infection among health care personnel, first responders, and other essential workers? Findings This prospective cohort study of 1766 unvaccinated seronegative Arizona workers using self-administered reverse-transcription polymerase chain reaction testing found that first responders had a significantly higher incidence of SARS-CoV-2 infection than health care personnel, even after controlling for sociodemographic characteristics and underlying health and exposure indicators. Meaning The findings of this cohort study indicate that first responders warrant greater public health attention in context of the COVID-19 pandemic given their higher rates of SARS-CoV-2 infection. Importance Understanding the relative risk of SARS-CoV-2 infection across occupations can inform guidance to protect workers and communities. Less is known about infection risk for first responders and other essential workers than for health care personnel. Objective To compare the prevaccination incidence of SARS-CoV-2 infection among first responders and other essential workers with incidence among health care personnel. Design, Setting, and Participants This was a prospective cohort study of health care personnel, first responders, and other essential workers in Arizona from July 20, 2020, to March 14, 2021. Participants were seronegative at enrollment, had frequent direct contact with others at work, worked at least 20 hours per week, and submitted weekly nasal swab specimens for real-time reverse transcriptase polymerase chain reaction analysis. Data analyses were performed from April 19, 2021, to June 4, 2021. Exposures Occupation was the primary exposure of interest. Confounders assessed were sociodemographic characteristics, health status, community exposure, and work exposure. Main Outcomes and Measures Crude incidence of SARS-CoV-2 infection was defined as the sum of first positive SARS-CoV-2 infections in participants divided by person-weeks at risk. Negative binomial regression was used to model SARS-CoV-2 infection by occupation to estimate unadjusted and adjusted incidence rate ratios (IRRs). The least absolute shrinkage and selection operator (LASSO) method was used to generate a parsimonious multivariable model. Results The study cohort comprised 1766 Arizona workers (mean age [SD], 43.8 [11.1] years; 1093 [61.9%] female; 401 [22.7%] were Hispanic and 1530 [86.6%] were White individuals) of whom 44.2% were health care personnel, 22.4% first responders, and 33.4% other essential workers. The cohort was followed up for 23 393 person-weeks. Crude incidence of SARS-CoV-2 infection was 6.7, 13.2, and 7.4 per 1000 person-weeks at risk for health care personnel, first responders, and other essential workers, respectively. In unadjusted models, first responders had twice the incidence of infection as health care personnel (IRRs, 2.01; 95% CI, 1.44-2.79). While attenuated, this risk remained elevated in adjusted LASSO-optimized models (IRR, 1.60; 95% CI, 1.07-2.38). Risk of infection among other essential workers was no different than for health care personnel in unadjusted or adjusted models. Conclusions and Relevance This prospective cohort study found that first responders had a higher incidence of SARS-CoV-2 infection than health care personnel, even after adjusting for potential confounding factors. Given their frequent contact with each other and with the public and their high rates of SARS-CoV-2 infection, the safety challenges for first responders warrant greater public health attention and research.
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Affiliation(s)
- Katherine D. Ellingson
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Joe K. Gerald
- Department of Community, Environment and Policy, University of Arizona, Tucson
| | - Xiaoxiao Sun
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - James Hollister
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Karen Lutrick
- Department of Family and Community Medicine, University of Arizona, Tucson
| | - Joel Parker
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Patrick Rivers
- Department of Health Promotion Sciences, University of Arizona, Tucson
| | - Shawn C. Beitel
- Department of Community, Environment and Policy, University of Arizona, Tucson
| | - Zoe Baccam
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | | | - Lauren Grant
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Preeta K. Kutty
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jefferey L. Burgess
- Department of Community, Environment and Policy, University of Arizona, Tucson
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Thompson MG, Stenehjem E, Grannis S, Ball SW, Naleway AL, Ong TC, DeSilva MB, Natarajan K, Bozio CH, Lewis N, Dascomb K, Dixon BE, Birch RJ, Irving SA, Rao S, Kharbanda E, Han J, Reynolds S, Goddard K, Grisel N, Fadel WF, Levy ME, Ferdinands J, Fireman B, Arndorfer J, Valvi NR, Rowley EA, Patel P, Zerbo O, Griggs EP, Porter RM, Demarco M, Blanton L, Steffens A, Zhuang Y, Olson N, Barron M, Shifflett P, Schrag SJ, Verani JR, Fry A, Gaglani M, Azziz-Baumgartner E, Klein NP. Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings. N Engl J Med 2021; 385:1355-1371. [PMID: 34496194 PMCID: PMC8451184 DOI: 10.1056/nejmoa2110362] [Citation(s) in RCA: 269] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. METHODS We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. RESULTS The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. CONCLUSIONS Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Mark G Thompson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Edward Stenehjem
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Shaun Grannis
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Sarah W Ball
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Allison L Naleway
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Toan C Ong
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Malini B DeSilva
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Karthik Natarajan
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Catherine H Bozio
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Ned Lewis
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Kristin Dascomb
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Brian E Dixon
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Rebecca J Birch
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Stephanie A Irving
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Suchitra Rao
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Elyse Kharbanda
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Jungmi Han
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Sue Reynolds
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Kristin Goddard
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Nancy Grisel
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - William F Fadel
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Matthew E Levy
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Jill Ferdinands
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Bruce Fireman
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Julie Arndorfer
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Nimish R Valvi
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Elizabeth A Rowley
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Palak Patel
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Ousseny Zerbo
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Eric P Griggs
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Rachael M Porter
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Maria Demarco
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Lenee Blanton
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Andrea Steffens
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Yan Zhuang
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Natalie Olson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Michelle Barron
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Patricia Shifflett
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Stephanie J Schrag
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Jennifer R Verani
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Alicia Fry
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Manjusha Gaglani
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Eduardo Azziz-Baumgartner
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Nicola P Klein
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
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Grannis SJ, Rowley EA, Ong TC, Stenehjem E, Klein NP, DeSilva MB, Naleway AL, Natarajan K, Thompson MG. Interim Estimates of COVID-19 Vaccine Effectiveness Against COVID-19-Associated Emergency Department or Urgent Care Clinic Encounters and Hospitalizations Among Adults During SARS-CoV-2 B.1.617.2 (Delta) Variant Predominance - Nine States, June-August 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1291-1293. [PMID: 34529642 PMCID: PMC8445373 DOI: 10.15585/mmwr.mm7037e2] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Chen L, Zhou S, Bao L, Millman AJ, Zhang Z, Wang Y, Tan Y, Song Y, Cui P, Pang Y, Liu C, Qin J, Zhang P, Thompson MG, Iuliano AD, Zhang R, Greene CM, Zhang J. Incidence rates of influenza illness during pregnancy in Suzhou, China, 2015-2018. Influenza Other Respir Viruses 2021; 16:14-23. [PMID: 34323381 PMCID: PMC8692813 DOI: 10.1111/irv.12888] [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: 05/28/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Data on influenza incidence during pregnancy in China are limited. Methods From October 2015 to September 2018, we conducted active surveillance for acute respiratory illness (ARI) among women during pregnancy. Nurses conducted twice weekly phone and text message follow‐up upon enrollment until delivery to identify new episodes of ARI. Nasal and throat swabs were collected ≤10 days from illness onset to detect influenza. Results In total, we enrolled 18 724 pregnant women median aged 28 years old, 37% in first trimester, 48% in second trimester, and 15% in third trimester, with seven self‐reported influenza vaccination during pregnancy. In the 18‐week epidemic period during October 2015 to September 2016, influenza incidence was 0.7/100 person‐months (95% CI: 0.5–0.9). In the cumulative 29‐week‐long epidemic during October 2016 to September 2017, influenza incidence was 1.0/100 person‐months (95% CI: 0.8–1.2). In the 11‐week epidemic period during October 2017 to September 2018, influenza incidence was 2.1/100 person‐months (95% CI: 1.9–2.4). Influenza incidence was similar by trimester. More than half of the total influenza illnesses had no elevated temperature and cough. Most influenza‐associated ARIs were mild, and <5.1% required hospitalization. Conclusions Influenza illness in all trimesters of pregnancy was common. These data may help inform decisions regarding the use of influenza vaccine to prevent influenza during pregnancy.
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Affiliation(s)
- Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Suizan Zhou
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lin Bao
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | | | | | - Yan Wang
- Wuzhong Maternal and Child Health Care Institute, Suzhou, China
| | - Yayun Tan
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Ying Song
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pengwei Cui
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Yuanyuan Pang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Cheng Liu
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Jiangchun Qin
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Ping Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Mark G Thompson
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ran Zhang
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn M Greene
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
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Thompson MG, Burgess JL, Naleway AL, Tyner H, Yoon SK, Meece J, Olsho LEW, Caban-Martinez AJ, Fowlkes AL, Lutrick K, Groom HC, Dunnigan K, Odean MJ, Hegmann K, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Kuntz JL, Zunie T, Thiese MS, Ivacic L, Wesley MG, Mayo Lamberte J, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Poe BP, Lynch B, Zhou Y, Zhang J, Kelleher A, Li Y, Dickerson M, Hanson E, Guenther K, Tong S, Bateman A, Reisdorf E, Barnes J, Azziz-Baumgartner E, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines. N Engl J Med 2021; 385:320-329. [PMID: 34192428 PMCID: PMC8262622 DOI: 10.1056/nejmoa2107058] [Citation(s) in RCA: 315] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Information is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions. METHODS We conducted a prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers. From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs for qualitative and quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis. The formula for calculating vaccine effectiveness was 100% × (1 - hazard ratio for SARS-CoV-2 infection in vaccinated vs. unvaccinated participants), with adjustments for the propensity to be vaccinated, study site, occupation, and local viral circulation. RESULTS SARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated (≥14 days after dose 2), 11 partially vaccinated (≥14 days after dose 1 and <14 days after dose 2), and 156 unvaccinated; the 32 participants with indeterminate vaccination status (<14 days after dose 1) were excluded. Adjusted vaccine effectiveness was 91% (95% confidence interval [CI], 76 to 97) with full vaccination and 81% (95% CI, 64 to 90) with partial vaccination. Among participants with SARS-CoV-2 infection, the mean viral RNA load was 40% lower (95% CI, 16 to 57) in partially or fully vaccinated participants than in unvaccinated participants. In addition, the risk of febrile symptoms was 58% lower (relative risk, 0.42; 95% CI, 0.18 to 0.98) and the duration of illness was shorter, with 2.3 fewer days spent sick in bed (95% CI, 0.8 to 3.7). CONCLUSIONS Authorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Mark G Thompson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Jefferey L Burgess
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Allison L Naleway
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Harmony Tyner
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Sarang K Yoon
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Jennifer Meece
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Lauren E W Olsho
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Alberto J Caban-Martinez
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Ashley L Fowlkes
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Karen Lutrick
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Holly C Groom
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Kayan Dunnigan
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Marilyn J Odean
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Kurt Hegmann
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Elisha Stefanski
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Laura J Edwards
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Natasha Schaefer-Solle
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Lauren Grant
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Katherine Ellingson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Jennifer L Kuntz
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Tnelda Zunie
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Matthew S Thiese
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Lynn Ivacic
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Meredith G Wesley
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Julie Mayo Lamberte
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Xiaoxiao Sun
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Michael E Smith
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Andrew L Phillips
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Kimberly D Groover
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Young M Yoo
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Joseph Gerald
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Rachel T Brown
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Meghan K Herring
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Gregory Joseph
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Shawn Beitel
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Tyler C Morrill
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Josephine Mak
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Patrick Rivers
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Brandon P Poe
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Brian Lynch
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Yingtao Zhou
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Jing Zhang
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Anna Kelleher
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Yan Li
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Monica Dickerson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Erika Hanson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Kyley Guenther
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Suxiang Tong
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Allen Bateman
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Erik Reisdorf
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - John Barnes
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Eduardo Azziz-Baumgartner
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Danielle R Hunt
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Melissa L Arvay
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Preeta Kutty
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Alicia M Fry
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
| | - Manjusha Gaglani
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas
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Dawood FS, Naleway AL, Flannery B, Levine MZ, Murthy K, Sambhara S, Gangappa S, Edwards L, Ball S, Beacham L, Belongia E, Bounds K, Cao W, Gross FL, Groom H, Fry AM, Hunt D, Jeddy Z, Mishina M, Kim SS, Wesley MG, Spencer S, Thompson MG, Gaglani M. Comparison of the Immunogenicity of Cell Culture-Based and Recombinant Quadrivalent Influenza Vaccines to Conventional Egg-Based Quadrivalent Influenza Vaccines among Healthcare Personnel Aged 18-64 Years: A Randomized Open-Label Trial. Clin Infect Dis 2021; 73:1973-1981. [PMID: 34245243 PMCID: PMC8499731 DOI: 10.1093/cid/ciab566] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 02/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background RIV4 and cell-culture based inactivated influenza vaccine (ccIIV4) have not been compared to egg-based IIV4 in healthcare personnel, a population with frequent influenza vaccination that may blunt vaccine immune responses over time. We conducted a randomized trial among healthcare personnel (HCP) aged 18–64 years to compare humoral immune responses to ccIIV4 and RIV4 to IIV4. Methods During the 2018–2019 season, participants were randomized to receive ccIIV4, RIV4, or IIV4 and had serum samples collected prevaccination, 1 and 6 months postvaccination. Serum samples were tested by hemagglutination inhibition (HI) for influenza A/H1N1, B/Yamagata, and B/Victoria and microneutralization (MN) for A/H3N2 against cell-grown vaccine reference viruses. Primary outcomes at 1 month were seroconversion rate (SCR), geometric mean titers (GMT), GMT ratio, and mean fold rise (MFR) in the intention-to-treat population. Results In total, 727 participants were included (283 ccIIV4, 202 RIV4, and 242 IIV4). At 1 month, responses to ccIIV4 were similar to IIV4 by SCR, GMT, GMT ratio, and MFR. RIV4 induced higher SCRs, GMTs, and MFRs than IIV4 against A/H1N1, A/H3N2, and B/Yamagata. The GMT ratio of RIV4 to egg-based vaccines was 1.5 (95% confidence interval [CI] 1.2–1.9) for A/H1N1, 3.0 (95% CI: 2.4–3.7) for A/H3N2, 1.1 (95% CI: .9–1.4) for B/Yamagata, and 1.1 (95% CI: .9–1.3) for B/Victoria. At 6 months, ccIIV4 recipients had similar GMTs to IIV4, whereas RIV4 recipients had higher GMTs against A/H3N2 and B/Yamagata. Conclusions RIV4 resulted in improved antibody responses by HI and MN compared to egg-based vaccines against 3 of 4 cell-grown vaccine strains 1 month postvaccination, suggesting a possible additional benefit from RIV4.
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Affiliation(s)
- Fatimah S Dawood
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison L Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Brendan Flannery
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Z Levine
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University, College of Medicine, Temple, Texas, USA
| | | | | | | | - Sarah Ball
- Abt Associates, Atlanta, GA, USA.,Westat, Rockville, MD, USA
| | - Lauren Beacham
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edward Belongia
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Kelsey Bounds
- Baylor Scott & White Health, Texas A&M University, College of Medicine, Temple, Texas, USA
| | - Weiping Cao
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - F Liaini Gross
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly Groom
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Sara S Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith G Wesley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Abt Associates, Atlanta, GA, USA
| | - Sarah Spencer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University, College of Medicine, Temple, Texas, USA
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Arriola CS, Suntarattiwong P, Dawood FS, Soto G, Das P, Hunt DR, Sinthuwattanawibool C, Kurhe K, Thompson MG, Wesley MG, Saha S, Hombroek D, Brummer T, Kittikraisak W, Kaoiean S, Neyra J, Romero C, Patel A, Bhargav S, Khedikar V, Garg S, Mott JA, Gonzales O, Cabrera S, Florian R, Parvekar S, Tomyabatra K, Prakash A, Tinoco YO. What do pregnant women think about influenza disease and vaccination practices in selected countries. Hum Vaccin Immunother 2021; 17:2176-2184. [PMID: 33499708 PMCID: PMC8189050 DOI: 10.1080/21645515.2020.1851536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/11/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction: We evaluated knowledge, attitudes, and practices (KAP) related to influenza and influenza vaccination among pregnant women in three selected countries.Methods: During 2017, pregnant women seeking antenatal care at hospitals at participating sites were enrolled. We described characteristics and responses to KAP questions. We also evaluated predictors associated with influenza vaccination during pregnancy at sites with substantial influenza vaccine uptake by multivariable logistic regression.Results: Overall, 4,648 pregnant women completed the survey. There were substantial differences among the three survey populations; only 8% of the women in Nagpur had heard of influenza, compared to 90% in Lima and 96% in Bangkok (p-value<0.01). Despite significant differences in sociodemographic characteristics in the three populations, most participants across sites who were aware of influenza prior to study enrollment believe they and their infants are at risk of influenza and related complications and believe influenza vaccination is safe and effective. Half of women in Lima had verified receipt of influenza vaccine compared to <5% in Bangkok and Nagpur (p < .05). For further analysis conducted among women in Lima only, household income above the poverty line (aOR: 1.38; 95%CI: 1.01, 1.88), having 8+ antenatal visits, compared to 0-4 (aOR: 2.41; 95%CI: 1.39, 2.87, respectively), having 0 children, compared to 2+ (aOR: 1.96; 95%CIs: 1.23, 3.12), and vaccination recommended by a health-care provider (aOR: 8.25; 95%CI: 6.11, 11.14) were strongly associated with receipt of influenza vaccine during pregnancy.Conclusions: Our findings identify opportunities for targeted interventions to improve influenza vaccine uptake among pregnant women in these settings.
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Affiliation(s)
- Carmen S. Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Thailand Ministry of Public Health, Bangkok, Thailand
| | - Fatimah S. Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India
| | | | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
| | - Mark G. Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meredith G. Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Wanitchaya Kittikraisak
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Surasak Kaoiean
- Rajavithi Hospital, Thailand Ministry of Public Health, Bangkok, Thailand
| | - Joan Neyra
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Candice Romero
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | | | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Mott
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | | | | | - Krissada Tomyabatra
- Nopparat Rajathanee Hospital, Thailand Ministry of Public Health, Bangkok, Thailand
| | | | - Yeny O. Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
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47
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Ferdinands JM, Thompson MG, Blanton L, Spencer S, Grant L, Fry AM. Does influenza vaccination attenuate the severity of breakthrough infections? A narrative review and recommendations for further research. Vaccine 2021; 39:3678-3695. [PMID: 34090700 DOI: 10.1016/j.vaccine.2021.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 01/05/2023]
Abstract
The effect of influenza vaccination on influenza severity remains uncertain. We reviewed the literature for evidence to inform the question of whether influenza illness is less severe among individuals who received influenza vaccination compared with individuals with influenza illness who were unvaccinated prior to their illnesses. We conducted a narrative review to identify published findings comparing severity of influenza outcomes by vaccination status among community-dwelling adults and children ≥ 6 months of age with laboratory-confirmed influenza illness. When at least four effect estimates of the same type (e.g., odds ratio) were available for a specific outcome and age category (children versus adults), data were pooled with meta-analysis to generate a summary effect estimate. We identified 38 published articles reporting ≥ 1 association between influenza vaccination status and one of 21 indicators of severity of influenza illness among individuals with laboratory-confirmed influenza. Study methodologies and effect estimates were highly heterogenous, with only five severity indicators meeting criteria for calculating a combined effect. Among eight studies, influenza vaccination was associated with 26% reduction in odds of ICU admission among adults with influenza-associated hospitalization (OR = 0.74, 95% CI 0.58, 0.93). Among five studies of adults with influenza-associated hospitalization, vaccinated patients had 31% reduced risk of death compared with unvaccinated patients (OR = 0.69, 95% CI 0.52, 0.92). Among four studies of children with influenza virus infection, vaccination was associated with an estimated 45% reduction in the odds of manifesting fever (OR = 0.55, 95% CI 0.42, 0.71). Vaccination was not significantly associated with receiving a clinical diagnosis of pneumonia among adults hospitalized with influenza (OR = 0.92, 95% CI 0.82, 1.04) or with risk of hospitalization following outpatient influenza illness among adults (OR = 0.60, 95% CI 0.28, 1.28). Overall, our findings support the hypothesis that influenza vaccination may attenuate the course of disease among individuals with breakthrough influenza virus infection.
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Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauren Grant
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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48
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Lutrick K, Ellingson KD, Baccam Z, Rivers P, Beitel S, Parker J, Hollister J, Sun X, Gerald JK, Komatsu K, Kim E, LaFleur B, Grant L, Yoo YM, Kumar A, Mayo Lamberte J, Cowling BJ, Cobey S, Thornburg NJ, Meece JK, Kutty P, Nikolich-Zugich J, Thompson MG, Burgess JL. COVID-19 Infection, Reinfection, and Vaccine Effectiveness in a Prospective Cohort of Arizona Frontline/Essential Workers: The AZ HEROES Research Protocol. JMIR Res Protoc 2021; 10:e28925. [PMID: 34057904 PMCID: PMC8386365 DOI: 10.2196/28925] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/09/2021] [Accepted: 05/26/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Arizona Healthcare, Emergency Response, and Other Essential workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. OBJECTIVE Study objectives include estimating incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of rRT-PCR-positivity, and examining post-vaccine immunologic response. METHODS Eligible participants include Arizona residents aged 18-85 years who work at least 20 hours per week in an occupation involving regular direct contact (within three feet) with others. Recruitment goals are stratified by demographic characteristics (50% aged 40 or older, 50% women, and 50% Hispanic or American Indian), by occupation (40% healthcare personnel, 30% first responders, and 30% other essential workers), and by prior SARS-CoV-2 infection (with up to 50% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-19-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (rRT-PCR) assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics and by seropositivity status and infection and vaccination history. RESULTS The AZ HEROES study was funded by the Centers for Disease Control and Prevention. Enrollment began July 27, 2020 and as of May 1, 2021 a total of 3,165 participants have been enrolled in the study. CONCLUSIONS AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and prospectively following strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/28925.
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Affiliation(s)
- Karen Lutrick
- University of Arizona, College of Medicine - Tucson, 655 N Alvernon WaySuite 228, Tucson, US
| | | | - Zoe Baccam
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Patrick Rivers
- University of Arizona, College of Medicine - Tucson, 655 N Alvernon WaySuite 228, Tucson, US
| | - Shawn Beitel
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Joel Parker
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - James Hollister
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Xiaoxiao Sun
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Joe K Gerald
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | | | | | | | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, US
| | - Young M Yoo
- Centers for Disease Control and Prevention, Atlanta, US
| | - Archana Kumar
- Centers for Disease Control and Prevention, Atlanta, US
| | | | | | - Sarah Cobey
- University of Chicago, Ecology and Evolution, Chicago, US
| | | | | | - Preeta Kutty
- Centers for Disease Control and Prevention, Atlanta, US
| | - Janko Nikolich-Zugich
- University of Arizona, College of Medicine - Tucson, 655 N Alvernon WaySuite 228, Tucson, US
| | | | - Jefferey L Burgess
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
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49
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Cowling BJ, Perera RAPM, Valkenburg SA, Leung NHL, Iuliano AD, Tam YH, Wong JHF, Fang VJ, Li APY, So HC, Ip DKM, Azziz-Baumgartner E, Fry AM, Levine MZ, Gangappa S, Sambhara S, Barr IG, Skowronski DM, Peiris JSM, Thompson MG. Comparative Immunogenicity of Several Enhanced Influenza Vaccine Options for Older Adults: A Randomized, Controlled Trial. Clin Infect Dis 2021; 71:1704-1714. [PMID: 31828291 DOI: 10.1093/cid/ciz1034] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [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: 07/15/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Enhanced influenza vaccines may improve protection for older adults, but comparative immunogenicity data are limited. Our objective was to examine immune responses to enhanced influenza vaccines, compared to standard-dose vaccines, in community-dwelling older adults. METHODS Community-dwelling older adults aged 65-82 years in Hong Kong were randomly allocated (October 2017-January 2018) to receive 2017-2018 Northern hemisphere formulations of a standard-dose quadrivalent vaccine, MF59-adjuvanted trivalent vaccine, high-dose trivalent vaccine, or recombinant-hemagglutinin (rHA) quadrivalent vaccine. Sera collected from 200 recipients of each vaccine before and at 30-days postvaccination were assessed for antibodies to egg-propagated vaccine strains by hemagglutination inhibition (HAI) and to cell-propagated A/Hong Kong/4801/2014(H3N2) virus by microneutralization (MN). Influenza-specific CD4+ and CD8+ T cell responses were assessed in 20 participants per group. RESULTS Mean fold rises (MFR) in HAI titers to egg-propagated A(H1N1) and A(H3N2) and the MFR in MN to cell-propagated A(H3N2) were statistically significantly higher in the enhanced vaccine groups, compared to the standard-dose vaccine. The MFR in MN to cell-propagated A(H3N2) was highest among rHA recipients (4.7), followed by high-dose (3.4) and MF59-adjuvanted (2.9) recipients, compared to standard-dose recipients (2.3). Similarly, the ratio of postvaccination MN titers among rHA recipients to cell-propagated A(H3N2) recipients was 2.57-fold higher than the standard-dose vaccine, which was statistically higher than the high-dose (1.33-fold) and MF59-adjuvanted (1.43-fold) recipient ratios. Enhanced vaccines also resulted in the boosting of T-cell responses. CONCLUSIONS In this head-to-head comparison, older adults receiving enhanced vaccines showed improved humoral and cell-mediated immune responses, compared to standard-dose vaccine recipients. CLINICAL TRIALS REGISTRATION NCT03330132.
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Affiliation(s)
- Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ranawaka A P M Perera
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Sophie A Valkenburg
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,The University of Hong Kong-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Nancy H L Leung
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yat Hung Tam
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Jennifer H F Wong
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Vicky J Fang
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Athena P Y Li
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,The University of Hong Kong-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Hau Chi So
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Dennis K M Ip
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | | | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shivaprakash Gangappa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suryaprakash Sambhara
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian G Barr
- World Health Organization Collaborating Centre for Reference and Research, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - J S Malik Peiris
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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50
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Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, Olsho LEW, Caban-Martinez AJ, Fowlkes A, Lutrick K, Kuntz JL, Dunnigan K, Odean MJ, Hegmann KT, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Groom HC, Zunie T, Thiese MS, Ivacic L, Wesley MG, Lamberte JM, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Harris KM, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:495-500. [PMID: 33793460 DOI: 10.15585/mmwr.mm7013e3externalicon] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
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