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Wei WQ, Rowley R, Wood A, MacArthur J, Embi PJ, Denaxas S. Improving reporting standards for phenotyping algorithm in biomedical research: 5 fundamental dimensions. J Am Med Inform Assoc 2024; 31:1036-1041. [PMID: 38269642 PMCID: PMC10990558 DOI: 10.1093/jamia/ocae005] [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: 10/03/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Phenotyping algorithms enable the interpretation of complex health data and definition of clinically relevant phenotypes; they have become crucial in biomedical research. However, the lack of standardization and transparency inhibits the cross-comparison of findings among different studies, limits large scale meta-analyses, confuses the research community, and prevents the reuse of algorithms, which results in duplication of efforts and the waste of valuable resources. RECOMMENDATIONS Here, we propose five independent fundamental dimensions of phenotyping algorithms-complexity, performance, efficiency, implementability, and maintenance-through which researchers can describe, measure, and deploy any algorithms efficiently and effectively. These dimensions must be considered in the context of explicit use cases and transparent methods to ensure that they do not reflect unexpected biases or exacerbate inequities.
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Affiliation(s)
- Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Robb Rowley
- National Human Genome Research Institute, Bethesda, MD 20892, United States
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 1TN, United Kingdom
| | - Jacqueline MacArthur
- British Heart Foundation Data Science Center, Health Data Research, London, NW1 2BE, United Kingdom
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Spiros Denaxas
- British Heart Foundation Data Science Center, Health Data Research, London, NW1 2BE, United Kingdom
- Institute of Health Informatics, University College London, London, WC1E 6BT, United Kingdom
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Adams K, Weber ZA, Yang DH, Klein NP, DeSilva MB, Dascomb K, Irving SA, Naleway AL, Rao S, Gaglani M, Flannery B, Garg S, Kharbanda AB, Grannis SJ, Ong TC, Embi PJ, Natarajan K, Fireman B, Zerbo O, Goddard K, Timbol J, Hansen JR, Grisel N, Arndorfer J, Ball SW, Dunne MM, Kirshner L, Chung JR, Tenforde MW. Vaccine Effectiveness Against Pediatric Influenza-A-Associated Urgent Care, Emergency Department, and Hospital Encounters During the 2022-2023 Season: VISION Network. Clin Infect Dis 2024; 78:746-755. [PMID: 37972288 PMCID: PMC10954409 DOI: 10.1093/cid/ciad704] [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: 09/12/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND During the 2022-2023 influenza season, the United States experienced the highest influenza-associated pediatric hospitalization rate since 2010-2011. Influenza A/H3N2 infections were predominant. METHODS We analyzed acute respiratory illness (ARI)-associated emergency department or urgent care (ED/UC) encounters or hospitalizations at 3 health systems among children and adolescents aged 6 months-17 years who had influenza molecular testing during October 2022-March 2023. We estimated influenza A vaccine effectiveness (VE) using a test-negative approach. The odds of vaccination among influenza-A-positive cases and influenza-negative controls were compared after adjusting for confounders and applying inverse-propensity-to-be-vaccinated weights. We developed overall and age-stratified VE models. RESULTS Overall, 13 547 of 44 787 (30.2%) eligible ED/UC encounters and 263 of 1862 (14.1%) hospitalizations were influenza-A-positive cases. Among ED/UC patients, 15.2% of influenza-positive versus 27.1% of influenza-negative patients were vaccinated; VE was 48% (95% confidence interval [CI], 44-52%) overall, 53% (95% CI, 47-58%) among children aged 6 months-4 years, and 38% (95% CI, 30-45%) among those aged 9-17 years. Among hospitalizations, 17.5% of influenza-positive versus 33.4% of influenza-negative patients were vaccinated; VE was 40% (95% CI, 6-61%) overall, 56% (95% CI, 23-75%) among children ages 6 months-4 years, and 46% (95% CI, 2-70%) among those 5-17 years. CONCLUSIONS During the 2022-2023 influenza season, vaccination reduced the risk of influenza-associated ED/UC encounters and hospitalizations by almost half (overall VE, 40-48%). Influenza vaccination is a critical tool to prevent moderate-to-severe influenza illness in children and adolescents.
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Affiliation(s)
- Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary A Weber
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Duck-Hye Yang
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Malini B DeSilva
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Stephanie A Irving
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Allison L Naleway
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Manjusha Gaglani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health and Baylor College of Medicine, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Toan C Ong
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Julius Timbol
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - John R Hansen
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Sarah W Ball
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Margaret M Dunne
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Lindsey Kirshner
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Jessie R Chung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Levy ME, Yang D, Dunne MM, Miley K, Irving SA, Grannis SJ, Weber ZA, Griggs EP, Spark TL, Bassett E, Embi PJ, Gaglani M, Natarajan K, Valvi NR, Ong TC, Naleway AL, Stenehjem E, Klein NP, Link‐Gelles R, DeSilva MB, Kharbanda AB, Raiyani C, Beaton MA, Dixon BE, Rao S, Dascomb K, Patel P, Mamawala M, Han J, Fadel WF, Barron MA, Grisel N, Dickerson M, Liao I, Arndorfer J, Najdowski M, Murthy K, Ray C, Tenforde MW, Ball SW. Risk of COVID-19 Hospitalization and Protection Associated With mRNA Vaccination Among US Adults With Psychiatric Disorders. Influenza Other Respir Viruses 2024; 18:e13269. [PMID: 38494192 PMCID: PMC10944689 DOI: 10.1111/irv.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Although psychiatric disorders have been associated with reduced immune responses to other vaccines, it remains unknown whether they influence COVID-19 vaccine effectiveness (VE). This study evaluated risk of COVID-19 hospitalization and estimated mRNA VE stratified by psychiatric disorder status. METHODS In a retrospective cohort analysis of the VISION Network in four US states, the rate of laboratory-confirmed COVID-19-associated hospitalization between December 2021 and August 2022 was compared across psychiatric diagnoses and by monovalent mRNA COVID-19 vaccination status using Cox proportional hazards regression. RESULTS Among 2,436,999 adults, 22.1% had ≥1 psychiatric disorder. The incidence of COVID-19-associated hospitalization was higher among patients with any versus no psychiatric disorder (394 vs. 156 per 100,000 person-years, p < 0.001). Any psychiatric disorder (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.18-1.37) and mood (aHR, 1.25; 95% CI, 1.15-1.36), anxiety (aHR, 1.33, 95% CI, 1.22-1.45), and psychotic (aHR, 1.41; 95% CI, 1.14-1.74) disorders were each significant independent predictors of hospitalization. Among patients with any psychiatric disorder, aHRs for the association between vaccination and hospitalization were 0.35 (95% CI, 0.25-0.49) after a recent second dose, 0.08 (95% CI, 0.06-0.11) after a recent third dose, and 0.33 (95% CI, 0.17-0.66) after a recent fourth dose, compared to unvaccinated patients. Corresponding VE estimates were 65%, 92%, and 67%, respectively, and were similar among patients with no psychiatric disorder (68%, 92%, and 79%). CONCLUSION Psychiatric disorders were associated with increased risk of COVID-19-associated hospitalization. However, mRNA vaccination provided similar protection regardless of psychiatric disorder status, highlighting its benefit for individuals with psychiatric disorders.
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Affiliation(s)
| | | | | | | | | | - Shaun J. Grannis
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- School of MedicineIndiana UniversityIndianapolisIndianaUSA
| | | | - Eric P. Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | - Peter J. Embi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Manjusha Gaglani
- Baylor Scott & White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Karthik Natarajan
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
- New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Nimish R. Valvi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Toan C. Ong
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study CenterKaiser Permanente Northern California Division of ResearchOaklandCaliforniaUSA
| | - Ruth Link‐Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Maura A. Beaton
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Brian E. Dixon
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | - Suchitra Rao
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Jungmi Han
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - William F. Fadel
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | - Michelle A. Barron
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Morgan Najdowski
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Caitlin Ray
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Wright AP, Embi PJ, Nelson SD, Smith JC, Turchin A, Mize DE. Development and Validation of Inpatient Hypoglycemia Models Centered Around the Insulin Ordering Process. J Diabetes Sci Technol 2024; 18:423-429. [PMID: 36047538 PMCID: PMC10973866 DOI: 10.1177/19322968221119788] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The insulin ordering process is an opportunity to provide clinicians with hypoglycemia risk predictions, but few hypoglycemia models centered around the insulin ordering process exist. METHODS We used data on adult patients, admitted in 2019 to non-ICU floors of a large teaching hospital, who had orders for subcutaneous insulin. Our outcome was hypoglycemia, defined as a blood glucose (BG) <70 mg/dL within 24 hours after ordering insulin. We trained and evaluated models to predict hypoglycemia at the time of placing an insulin order, using logistic regression, random forest, and extreme gradient boosting (XGBoost). We compared performance using area under the receiver operating characteristic curve (AUCs) and precision-recall curves. We determined recall at our goal precision of 0.30. RESULTS Of 21 052 included insulin orders, 1839 (9%) were followed by a hypoglycemic event within 24 hours. Logistic regression, random forest, and XGBoost models had AUCs of 0.81, 0.80, and 0.79, and recall of 0.44, 0.49, and 0.32, respectively. The most significant predictor was the lowest BG value in the 24 hours preceding the order. Predictors related to the insulin order being placed at the time of the prediction were useful to the model but less important than the patient's history of BG values over time. CONCLUSIONS Hypoglycemia within the next 24 hours can be predicted at the time an insulin order is placed, providing an opportunity to integrate decision support into the medication ordering process to make insulin therapy safer.
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Affiliation(s)
- Aileen P. Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter J. Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott D. Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua C. Smith
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander Turchin
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dara E. Mize
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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5
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Griggs EP, Mitchell PK, Lazariu V, Gaglani M, McEvoy C, Klein NP, Valvi NR, Irving SA, Kojima N, Stenehjem E, Crane B, Rao S, Grannis SJ, Embi PJ, Kharbanda AB, Ong TC, Natarajan K, Dascomb K, Naleway AL, Bassett E, DeSilva MB, Dickerson M, Konatham D, Fireman B, Allen KS, Barron MA, Beaton M, Arndorfer J, Vazquez-Benitez G, Garg S, Murthy K, Goddard K, Dixon BE, Han J, Grisel N, Raiyani C, Lewis N, Fadel WF, Stockwell MS, Mamawala M, Hansen J, Zerbo O, Patel P, Link-Gelles R, Adams K, Tenforde MW. Clinical Epidemiology and Risk Factors for Critical Outcomes Among Vaccinated and Unvaccinated Adults Hospitalized With COVID-19-VISION Network, 10 States, June 2021-March 2023. Clin Infect Dis 2024; 78:338-348. [PMID: 37633258 DOI: 10.1093/cid/ciad505] [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: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The epidemiology of coronavirus disease 2019 (COVID-19) continues to develop with emerging variants, expanding population-level immunity, and advances in clinical care. We describe changes in the clinical epidemiology of COVID-19 hospitalizations and risk factors for critical outcomes over time. METHODS We included adults aged ≥18 years from 10 states hospitalized with COVID-19 June 2021-March 2023. We evaluated changes in demographics, clinical characteristics, and critical outcomes (intensive care unit admission and/or death) and evaluated critical outcomes risk factors (risk ratios [RRs]), stratified by COVID-19 vaccination status. RESULTS A total of 60 488 COVID-19-associated hospitalizations were included in the analysis. Among those hospitalized, median age increased from 60 to 75 years, proportion vaccinated increased from 18.2% to 70.1%, and critical outcomes declined from 24.8% to 19.4% (all P < .001) between the Delta (June-December, 2021) and post-BA.4/BA.5 (September 2022-March 2023) periods. Hospitalization events with critical outcomes had a higher proportion of ≥4 categories of medical condition categories assessed (32.8%) compared to all hospitalizations (23.0%). Critical outcome risk factors were similar for unvaccinated and vaccinated populations; presence of ≥4 medical condition categories was most strongly associated with risk of critical outcomes regardless of vaccine status (unvaccinated: adjusted RR, 2.27 [95% confidence interval {CI}, 2.14-2.41]; vaccinated: adjusted RR, 1.73 [95% CI, 1.56-1.92]) across periods. CONCLUSIONS The proportion of adults hospitalized with COVID-19 who experienced critical outcomes decreased with time, and median patient age increased with time. Multimorbidity was most strongly associated with critical outcomes.
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Affiliation(s)
- Eric P Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Victoria Lazariu
- Department of Clinical Research, Westat, Inc, Rockville, Maryland, USA
| | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Charlene McEvoy
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Stephanie A Irving
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Noah Kojima
- Influenza Division, National Center for Immunization and Respiratory Diseases, 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
| | - Bradley Crane
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Suchitra Rao
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Department of Family Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Toan C Ong
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, 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
| | - Allison L Naleway
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Elizabeth Bassett
- Department of Clinical Research, Westat, Inc, Rockville, Maryland, USA
| | - Malini B DeSilva
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deepika Konatham
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Katie S Allen
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Michelle A Barron
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maura Beaton
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kempapura Murthy
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Chandni Raiyani
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Melissa S Stockwell
- Division of Child & Adolescent Health, Department of Pediatrics, New York-Presbyterian Hospital, New York, New York, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Mufaddal Mamawala
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - John Hansen
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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6
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Tachinardi U, Grannis SJ, Michael SG, Misquitta L, Dahlin J, Sheikh U, Kho A, Phua J, Rogovin SS, Amor B, Choudhury M, Sparks P, Mannaa A, Ljazouli S, Saltz J, Prior F, Baghal A, Gersing K, Embi PJ. Privacy-preserving record linkage across disparate institutions and datasets to enable a learning health system: The national COVID cohort collaborative (N3C) experience. Learn Health Syst 2024; 8:e10404. [PMID: 38249841 PMCID: PMC10797567 DOI: 10.1002/lrh2.10404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Research driven by real-world clinical data is increasingly vital to enabling learning health systems, but integrating such data from across disparate health systems is challenging. As part of the NCATS National COVID Cohort Collaborative (N3C), the N3C Data Enclave was established as a centralized repository of deidentified and harmonized COVID-19 patient data from institutions across the US. However, making this data most useful for research requires linking it with information such as mortality data, images, and viral variants. The objective of this project was to establish privacy-preserving record linkage (PPRL) methods to ensure that patient-level EHR data remains secure and private when governance-approved linkages with other datasets occur. Methods Separate agreements and approval processes govern N3C data contribution and data access. The Linkage Honest Broker (LHB), an independent neutral party (the Regenstrief Institute), ensures data linkages are robust and secure by adding an extra layer of separation between protected health information and clinical data. The LHB's PPRL methods (including algorithms, processes, and governance) match patient records using "deidentified tokens," which are hashed combinations of identifier fields that define a match across data repositories without using patients' clear-text identifiers. Results These methods enable three linkage functions: Deduplication, Linking Multiple Datasets, and Cohort Discovery. To date, two external repositories have been cross-linked. As of March 1, 2023, 43 sites have signed the LHB Agreement; 35 sites have sent tokens generated for 9 528 998 patients. In this initial cohort, the LHB identified 135 037 matches and 68 596 duplicates. Conclusion This large-scale linkage study using deidentified datasets of varying characteristics established secure methods for protecting the privacy of N3C patient data when linked for research purposes. This technology has potential for use with registries for other diseases and conditions.
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Affiliation(s)
- Umberto Tachinardi
- Department of Biomedical InformaticsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief InstituteDepartment of Family Medicine, IU School of MedicineRegenstrief Institute, Inc. and Indiana University School of MedicineIndianapolisIndianaUSA
| | - Sam G. Michael
- National Center for Advancing Translational ScienceNIHBethesdaMarylandUSA
| | - Leonie Misquitta
- National Center for Advancing Translational ScienceNIHBethesdaMarylandUSA
| | - Jayme Dahlin
- National Center for Advancing Translational ScienceNIHBethesdaMarylandUSA
| | - Usman Sheikh
- National Center for Advancing Translational ScienceNIHBethesdaMarylandUSA
| | - Abel Kho
- Department of MedicineNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
- Public SectorDatavant, IncSan FranciscoCaliforniaUSA
| | - Jasmin Phua
- Public SectorDatavant, IncSan FranciscoCaliforniaUSA
| | | | - Benjamin Amor
- Federal HealthPalantir TechnologiesDenverColoradoUSA
| | | | - Philip Sparks
- Federal HealthPalantir TechnologiesDenverColoradoUSA
| | - Amin Mannaa
- Federal HealthPalantir TechnologiesDenverColoradoUSA
| | - Saad Ljazouli
- Federal HealthPalantir TechnologiesDenverColoradoUSA
| | - Joel Saltz
- School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Fred Prior
- COM Biomedical InformaticsUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Ahmen Baghal
- COM Biomedical InformaticsUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Kenneth Gersing
- National Center for Advancing Translational ScienceNIHBethesdaMarylandUSA
| | - Peter J. Embi
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
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7
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Payne AB, Ciesla AA, Rowley EAK, Weber ZA, Reese SE, Ong TC, Vazquez-Benitez G, Naleway AL, Klein NP, Embi PJ, Grannis SJ, Kharbanda AB, Gaglani M, Tenforde MW, Link-Gelles R. Impact of accounting for correlation between COVID-19 and influenza vaccination in a COVID-19 vaccine effectiveness evaluation using a test-negative design. Vaccine 2023; 41:7581-7586. [PMID: 38000964 DOI: 10.1016/j.vaccine.2023.11.025] [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: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023]
Abstract
Test-negative-design COVID-19 vaccine effectiveness (VE) studies use symptomatic SARS-CoV-2-positive individuals as cases and symptomatic SARS-CoV-2-negative individuals as controls to evaluate COVID-19 VE. To evaluate the potential bias introduced by the correlation of COVID-19 and influenza vaccination behaviors, we assessed changes in estimates of VE of bivalent vaccines against COVID-19-associated hospitalizations and emergency department/urgent care (ED/UC) encounters when considering influenza vaccination status or including or excluding influenza-positive controls using data from the multi-state VISION vaccine effectiveness network. Analyses included encounters during October 2022 - February 2023, a period of SARS-CoV-2 and influenza cocirculation. When considering influenza vaccination status or including or excluding influenza-positive controls, COVID-19 VE estimates were robust, with most VE estimates against COVID-19-associated hospitalization and ED/UC encounters changing less than 5 percentage points. Higher proportions of influenza-positive patients among controls, influenza vaccination coverage, or VE could impact these findings; the potential bias should continue to be assessed.
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Affiliation(s)
- Amanda B Payne
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Allison Avrich Ciesla
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Eagle Health Analytics, San Antonio, TX, USA
| | | | | | | | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Peter J Embi
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Center for Research in Vaccines and Infections, Baylor Scott & White Health and Baylor College of Medicine, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA
| | - Mark W Tenforde
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; United States Public Health Service Commissioned Corps, Rockville, MD, USA
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8
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Tenforde MW, Weber ZA, Yang DH, DeSilva MB, Dascomb K, Irving SA, Naleway AL, Gaglani M, Fireman B, Lewis N, Zerbo O, Goddard K, Timbol J, Hansen JR, Grisel N, Arndorfer J, McEvoy CE, Essien IJ, Rao S, Grannis SJ, Kharbanda AB, Natarajan K, Ong TC, Embi PJ, Ball SW, Dunne MM, Kirshner L, Wiegand RE, Dickerson M, Patel P, Ray C, Flannery B, Garg S, Adams K, Klein NP. Influenza vaccine effectiveness against influenza-A-associated emergency department, urgent care, and hospitalization encounters among U.S. adults, 2022-2023. J Infect Dis 2023:jiad542. [PMID: 38041853 DOI: 10.1093/infdis/jiad542] [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: 08/08/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND The 2022-2023 United States influenza season had unusually early influenza activity with high hospitalization rates. Vaccine-matched A(H3N2) viruses predominated, with lower levels of A(H1N1)pdm09 activity also observed. METHODS Using the test-negative design, we evaluated influenza vaccine effectiveness (VE) during the 2022-2023 season against influenza-A-associated emergency department/urgent care (ED/UC) visits and hospitalizations from October 2022-March 2023 among adults (age ≥18 years) with acute respiratory illness (ARI). VE was estimated by comparing odds of seasonal influenza vaccination among case-patients (influenza A test-positive by molecular assay) and controls (influenza test-negative), applying inverse-propensity-to-be-vaccinated weights. RESULTS The analysis included 85,389 ED/UC ARI encounters (17.0% influenza-A-positive; 37.8% vaccinated overall) and 19,751 hospitalizations (9.5% influenza-A-positive; 52.8% vaccinated overall). VE against influenza-A-associated ED/UC encounters was 44% (95% confidence interval [95%CI]: 40-47%) overall and 45% and 41% among adults aged 18-64 and ≥65 years, respectively. VE against influenza-A-associated hospitalizations was 35% (95%CI: 27-43%) overall and 23% and 41% among adults aged 18-64 and ≥65 years, respectively. CONCLUSIONS VE was moderate during the 2022-2023 influenza season, a season characterized with increased burden of influenza and co-circulation with other respiratory viruses. Vaccination is likely to substantially reduce morbidity, mortality, and strain on healthcare resources.
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Affiliation(s)
- Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | | | | | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Stephanie A Irving
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States
| | - Allison L Naleway
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States
| | - Manjusha Gaglani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health and Baylor College of Medicine, Temple, Texas, United States
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, United States
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States
| | - Julius Timbol
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States
| | - John R Hansen
- 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
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, United States
| | | | - Inih J Essien
- HealthPartners Institute, Minneapolis, Minnesota, United States
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States
- School of Medicine, Indiana University, Indianapolis, Indiana, United States
| | | | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, United States
- New York Presbyterian Hospital, New York, New York, United States
| | - Toan C Ong
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Peter J Embi
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | | | | | - Ryan E Wiegand
- Coronavirus and other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Monica Dickerson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Palak Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Caitlin Ray
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States
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9
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Patel P, Schrader KE, Rice CE, Rowley E, Cree RA, DeSilva MB, Embi PJ, Gaglani M, Grannis SJ, Ong TC, Stenehjem E, Naleway AL, Ball S, Natarajan K, Klein NP, Adams K, Kharbanda A, Ray C, Link-Gelles R, Tenforde MW. Effectiveness of the Original Monovalent Coronavirus Disease 2019 Vaccines in Preventing Emergency Department or Urgent Care Encounters and Hospitalizations Among Adults With Disabilities: VISION Network, June 2021-September 2022. Open Forum Infect Dis 2023; 10:ofad474. [PMID: 37965644 PMCID: PMC10642729 DOI: 10.1093/ofid/ofad474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/18/2023] [Indexed: 11/16/2023] Open
Abstract
Adults with disabilities are at increased risk for severe coronavirus disease 2019 (COVID-19). Using data across 9 states during Delta- and Omicron-predominant periods (June 2021-September 2022), we evaluated the effectiveness of the original monovalent COVID-19 messenger RNA vaccines among 521 206 emergency department/urgent care encounters (11 471 [2%] in patients with a documented disability) and 139 548 hospitalizations (16 569 [12%] in patients with a disability) for laboratory-confirmed COVID-19 illness in adults (aged ≥18 years). Across variant periods and for the primary series or booster doses, vaccine effectiveness was similar in those with and those without a disability. These findings highlight the importance of adults with disabilities staying up to date with COVID-19 vaccinations.
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Affiliation(s)
- Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Catherine E Rice
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Rowley
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Robyn A Cree
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Malini B DeSilva
- Department of Research, Health Partners Institute, Minneapolis, Minnesota, USA
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Allison L Naleway
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Sarah Ball
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, NewYork, New York, USA
- Medical Informatics Services, NewYork-Presbyterian Hospital, NewYork, New York, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anupam Kharbanda
- Department of Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota, USA
| | - Caitlin Ray
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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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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11
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Link-Gelles R, Ciesla AA, Rowley EA, Klein NP, Naleway AL, Payne AB, Kharbanda A, Natarajan K, DeSilva MB, Dascomb K, Irving SA, Zerbo O, Reese SE, Wiegand RE, Najdowski M, Ong TC, Rao S, Stockwell MS, Stephens A, Goddard K, Martinez YC, Weber ZA, Fireman B, Hansen J, Timbol J, Grannis SJ, Barron MA, Embi PJ, Ball SW, Gaglani M, Grisel N, Arndorfer J, Tenforde MW, Fleming-Dutra KE. Effectiveness of Monovalent and Bivalent mRNA Vaccines in Preventing COVID-19-Associated Emergency Department and Urgent Care Encounters Among Children Aged 6 Months-5 Years - VISION Network, United States, July 2022-June 2023. MMWR Morb Mortal Wkly Rep 2023; 72:886-892. [PMID: 37590187 PMCID: PMC10441825 DOI: 10.15585/mmwr.mm7233a2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
On June 19, 2022, the original monovalent mRNA COVID-19 vaccines were approved as a primary series for children aged 6 months-4 years (Pfizer-BioNTech) and 6 months-5 years (Moderna) based on safety, immunobridging, and limited efficacy data from clinical trials. On December 9, 2022, CDC expanded recommendations for use of updated bivalent vaccines to children aged ≥6 months. mRNA COVID-19 vaccine effectiveness (VE) against emergency department or urgent care (ED/UC) encounters was evaluated within the VISION Network during July 4, 2022-June 17, 2023, among children with COVID-19-like illness aged 6 months-5 years. Among children aged 6 months-5 years who received molecular SARS-CoV-2 testing during August 1, 2022-June 17, 2023, VE of 2 monovalent Moderna doses against ED/UC encounters was 29% (95% CI = 12%-42%) ≥14 days after dose 2 (median = 100 days after dose 2; IQR = 63-155 days). Among children aged 6 months-4 years with a COVID-19-like illness who received molecular testing during September 19, 2022-June 17, 2023, VE of 3 monovalent Pfizer-BioNTech doses was 43% (95% CI = 17%-61%) ≥14 days after dose 3 (median = 75 days after dose 3; IQR = 40-139 days). Effectiveness of ≥1 bivalent dose, comparing children with at least a complete primary series and ≥1 bivalent dose to unvaccinated children, irrespective of vaccine manufacturer, was 80% (95% CI = 42%-96%) among children aged 6 months-5 years a median of 58 days (IQR = 32-83 days) after the dose. All children should stay up to date with recommended COVID-19 vaccines, including initiation of COVID-19 vaccination immediately when they are eligible.
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12
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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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13
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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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14
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Link-Gelles R, Weber ZA, Reese SE, Payne AB, Gaglani M, Adams K, Kharbanda AB, Natarajan K, DeSilva MB, Dascomb K, Irving SA, Klein NP, Grannis SJ, Ong TC, Embi PJ, Dunne MM, Dickerson M, McEvoy C, Arndorfer J, Naleway AL, Goddard K, Dixon BE, Griggs EP, Hansen J, Valvi N, Najdowski M, Timbol J, Rogerson C, Fireman B, Fadel WF, Patel P, Ray CS, Wiegand R, Ball S, Tenforde MW. Estimates of Bivalent mRNA Vaccine Durability in Preventing COVID-19-Associated Hospitalization and Critical Illness Among Adults with and Without Immunocompromising Conditions - VISION Network, September 2022-April 2023. Am J Transplant 2023; 23:1062-1076. [PMID: 37394267 DOI: 10.1016/j.ajt.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC.
| | | | | | - Amanda B Payne
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor Scott & White Health, Temple, Texas; Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York; NewYork-Presbyterian Hospital, New York, New York
| | | | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; School of Medicine, Indiana University, Indianapolis, Indiana
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Peter J Embi
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Eric P Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - John Hansen
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Nimish Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Morgan Najdowski
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Julius Timbol
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Colin Rogerson
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Caitlin S Ray
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Ryan Wiegand
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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15
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Link-Gelles R, Weber ZA, Reese SE, Payne AB, Gaglani M, Adams K, Kharbanda AB, Natarajan K, DeSilva MB, Dascomb K, Irving SA, Klein NP, Grannis SJ, Ong TC, Embi PJ, Dunne MM, Dickerson M, McEvoy C, Arndorfer J, Naleway AL, Goddard K, Dixon BE, Griggs EP, Hansen J, Valvi N, Najdowski M, Timbol J, Rogerson C, Fireman B, Fadel WF, Patel P, Ray CS, Wiegand R, Ball S, Tenforde MW. Estimates of Bivalent mRNA Vaccine Durability in Preventing COVID-19-Associated Hospitalization and Critical Illness Among Adults with and Without Immunocompromising Conditions - VISION Network, September 2022-April 2023. MMWR Morb Mortal Wkly Rep 2023; 72:579-588. [PMID: 37227984 DOI: 10.15585/mmwr.mm7221a3] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
On September 1, 2022, CDC's Advisory Committee on Immunization Practices (ACIP) recommended a single bivalent mRNA COVID-19 booster dose for persons aged ≥12 years who had completed at least a monovalent primary series. Early vaccine effectiveness (VE) estimates among adults aged ≥18 years showed receipt of a bivalent booster dose provided additional protection against COVID-19-associated emergency department and urgent care visits and hospitalizations compared with that in persons who had received only monovalent vaccine doses (1); however, insufficient time had elapsed since bivalent vaccine authorization to assess the durability of this protection. The VISION Network* assessed VE against COVID-19-associated hospitalizations by time since bivalent vaccine receipt during September 13, 2022-April 21, 2023, among adults aged ≥18 years with and without immunocompromising conditions. During the first 7-59 days after vaccination, compared with no vaccination, VE for receipt of a bivalent vaccine dose among adults aged ≥18 years was 62% (95% CI = 57%-67%) among adults without immunocompromising conditions and 28% (95% CI = 10%-42%) among adults with immunocompromising conditions. Among adults without immunocompromising conditions, VE declined to 24% (95% CI = 12%-33%) among those aged ≥18 years by 120-179 days after vaccination. VE was generally lower for adults with immunocompromising conditions. A bivalent booster dose provided the highest protection, and protection was sustained through at least 179 days against critical outcomes, including intensive care unit (ICU) admission or in-hospital death. These data support updated recommendations allowing additional optional bivalent COVID-19 vaccine doses for certain high-risk populations. All eligible persons should stay up to date with recommended COVID-19 vaccines.
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16
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Dalton AF, Weber ZA, Allen KS, Stenehjem E, Irving SA, Spark TL, Adams K, Zerbo O, Lazariu V, Dixon BE, Dascomb K, Hartmann E, Kharbanda AB, Ong TC, DeSilva MB, Beaton M, Gaglani M, Patel P, Naleway AL, Kish MNS, Grannis SJ, Grisel N, Sloan-Aagard C, Rao S, Raiyani C, Dickerson M, Bassett E, Fadel WF, Arndorfer J, Nanez J, Barron MA, Vazquez-Benitez G, Liao IC, Griggs EP, Reese SE, Valvi NR, Murthy K, Rowley EAK, Embi PJ, Ball S, Link-Gelles R, Tenforde MW. Relationships Between Social Vulnerability and Coronavirus Disease 2019 Vaccination Coverage and Vaccine Effectiveness. Clin Infect Dis 2023; 76:1615-1625. [PMID: 36611252 PMCID: PMC10949185 DOI: 10.1093/cid/ciad003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) vaccination coverage remains lower in communities with higher social vulnerability. Factors such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure risk and access to healthcare are often correlated with social vulnerability and may therefore contribute to a relationship between vulnerability and observed vaccine effectiveness (VE). Understanding whether these factors impact VE could contribute to our understanding of real-world VE. METHODS We used electronic health record data from 7 health systems to assess vaccination coverage among patients with medically attended COVID-19-like illness. We then used a test-negative design to assess VE for 2- and 3-dose messenger RNA (mRNA) adult (≥18 years) vaccine recipients across Social Vulnerability Index (SVI) quartiles. SVI rankings were determined by geocoding patient addresses to census tracts; rankings were grouped into quartiles for analysis. RESULTS In July 2021, primary series vaccination coverage was higher in the least vulnerable quartile than in the most vulnerable quartile (56% vs 36%, respectively). In February 2022, booster dose coverage among persons who had completed a primary series was higher in the least vulnerable quartile than in the most vulnerable quartile (43% vs 30%). VE among 2-dose and 3-dose recipients during the Delta and Omicron BA.1 periods of predominance was similar across SVI quartiles. CONCLUSIONS COVID-19 vaccination coverage varied substantially by SVI. Differences in VE estimates by SVI were minimal across groups after adjusting for baseline patient factors. However, lower vaccination coverage among more socially vulnerable groups means that the burden of illness is still disproportionately borne by the most socially vulnerable populations.
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Affiliation(s)
- Alexandra F Dalton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Katie S Allen
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Katherine Adams
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | | | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Emily Hartmann
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas, USA
| | - Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Malini B DeSilva
- Division of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Maura Beaton
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Palak Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas, USA
- Brigham Young University Department of Public Health, Provo, Utah, USA
| | - Suchitra Rao
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Monica Dickerson
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Juan Nanez
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas, USA
| | - Michelle A Barron
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - I Chia Liao
- Baylor Scott & White Health, Temple, Texas, USA
| | - Eric P Griggs
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | | | | | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Mark W Tenforde
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
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17
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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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18
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Tenforde MW, Weber ZA, Natarajan K, Klein NP, Kharbanda AB, Stenehjem E, Embi PJ, Reese SE, Naleway AL, Grannis SJ, DeSilva MB, Ong TC, Gaglani M, Han J, Dickerson M, Fireman B, Dascomb K, Irving SA, Vazquez-Benitez G, Rao S, Konatham D, Patel P, Schrader KE, Lewis N, Grisel N, McEvoy C, Murthy K, Griggs EP, Rowley EAK, Zerbo O, Arndorfer J, Dunne MM, Goddard K, Ray C, Zhuang Y, Timbol J, Najdowski M, Yang DH, Hansen J, Ball SW, Link-Gelles R. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Emergency Department or Urgent Care Encounters and Hospitalizations Among Immunocompetent Adults - VISION Network, Nine States, September-November 2022. MMWR Morb Mortal Wkly Rep 2023; 71:1637-1646. [PMID: 36921274 PMCID: PMC10027383 DOI: 10.15585/mmwr.mm7153a1] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
During June-October 2022, the SARS-CoV-2 Omicron BA.5 sublineage accounted for most of the sequenced viral genomes in the United States, with further Omicron sublineage diversification through November 2022.* Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the Omicron BA.4/BA.5 sublineages. On September 1, 2022, a single bivalent booster dose was recommended for adults who had completed a primary vaccination series (with or without subsequent booster doses), with the last dose administered ≥2 months earlier (1). During September 13-November 18, the VISION Network evaluated vaccine effectiveness (VE) of a bivalent mRNA booster dose (after 2, 3, or 4 monovalent doses) compared with 1) no previous vaccination and 2) previous receipt of 2, 3, or 4 monovalent-only mRNA vaccine doses, among immunocompetent adults aged ≥18 years with an emergency department/urgent care (ED/UC) encounter or hospitalization for a COVID-19-like illness.† VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated ED/UC encounters was 56% compared with no vaccination, 32% compared with monovalent vaccination only with last dose 2-4 months earlier, and 50% compared with monovalent vaccination only with last dose ≥11 months earlier. VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated hospitalizations was 59% compared with no vaccination, 42% compared with monovalent vaccination only with last dose 5-7 months earlier, and 48% compared with monovalent vaccination only with last dose ≥11 months earlier. Bivalent vaccines administered after 2, 3, or 4 monovalent doses were effective in preventing medically attended COVID-19 compared with no vaccination and provided additional protection compared with past monovalent vaccination only, with relative protection increasing with time since receipt of the last monovalent dose. All eligible persons should stay up to date with recommended COVID-19 vaccinations, including receiving a bivalent booster dose. Persons should also consider taking additional precautions to avoid respiratory illness this winter season, such as masking in public indoor spaces, especially in areas where COVID-19 community levels are high.
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19
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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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20
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Rodriguez-Watson CV, Sheils NE, Louder AM, Eldridge EH, Lin ND, Pollock BD, Gatz JL, Grannis SJ, Vashisht R, Ghauri K, Valo G, Chakravarty AG, Lasky T, Jung M, Lovell SL, Major JM, Kabelac C, Knepper C, Leonard S, Embi PJ, Jenkinson WG, Klesh R, Garner OB, Patel A, Dahm L, Barin A, Cooper DM, Andriola T, Byington CL, Crews BO, Butte AJ, Allen J. Real-world utilization of SARS-CoV-2 serological testing in RNA positive patients across the United States. PLoS One 2023; 18:e0281365. [PMID: 36763574 PMCID: PMC9916659 DOI: 10.1371/journal.pone.0281365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/22/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND As diagnostic tests for COVID-19 were broadly deployed under Emergency Use Authorization, there emerged a need to understand the real-world utilization and performance of serological testing across the United States. METHODS Six health systems contributed electronic health records and/or claims data, jointly developed a master protocol, and used it to execute the analysis in parallel. We used descriptive statistics to examine demographic, clinical, and geographic characteristics of serology testing among patients with RNA positive for SARS-CoV-2. RESULTS Across datasets, we observed 930,669 individuals with positive RNA for SARS-CoV-2. Of these, 35,806 (4%) were serotested within 90 days; 15% of which occurred <14 days from the RNA positive test. The proportion of people with a history of cardiovascular disease, obesity, chronic lung, or kidney disease; or presenting with shortness of breath or pneumonia appeared higher among those serotested compared to those who were not. Even in a population of people with active infection, race/ethnicity data were largely missing (>30%) in some datasets-limiting our ability to examine differences in serological testing by race. In datasets where race/ethnicity information was available, we observed a greater distribution of White individuals among those serotested; however, the time between RNA and serology tests appeared shorter in Black compared to White individuals. Test manufacturer data was available in half of the datasets contributing to the analysis. CONCLUSION Our results inform the underlying context of serotesting during the first year of the COVID-19 pandemic and differences observed between claims and EHR data sources-a critical first step to understanding the real-world accuracy of serological tests. Incomplete reporting of race/ethnicity data and a limited ability to link test manufacturer data, lab results, and clinical data challenge the ability to assess the real-world performance of SARS-CoV-2 tests in different contexts and the overall U.S. response to current and future disease pandemics.
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Affiliation(s)
| | | | | | | | - Nancy D. Lin
- Health Catalyst, Salt Lake City, Utah, United States of America
| | | | - Jennifer L. Gatz
- Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Shaun J. Grannis
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Informatics and Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Rohit Vashisht
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
| | - Kanwal Ghauri
- Reagan-Udall Foundation for the FDA, Washington, District of Columbia, United States of America
| | - Gina Valo
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Aloka G. Chakravarty
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Tamar Lasky
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Mary Jung
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Stephen L. Lovell
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Jacqueline M. Major
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Carly Kabelac
- Aetion, New York, New York, United States of America
| | | | - Sandy Leonard
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Peter J. Embi
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Informatics and Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | - Reyna Klesh
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, California, United States of America
| | - Ayan Patel
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Lisa Dahm
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Aiden Barin
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Dan M. Cooper
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Pediatric Exercise and Genomics Research Center, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Tom Andriola
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Office of Data and Information Technology, University of California, Irvine, California, United States of America
| | - Carrie L. Byington
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Bridgit O. Crews
- Department of Pathology and Laboratory Medicine, University of California, Irvine, California, United States of America
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Jeff Allen
- Friends of Cancer Research, Washington, District of Columbia, United States of America
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21
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Rodriguez-Watson CV, Louder AM, Kabelac C, Frederick CM, Sheils NE, Eldridge EH, Lin ND, Pollock BD, Gatz JL, Grannis SJ, Vashisht R, Ghauri K, Knepper C, Leonard S, Embi PJ, Jenkinson G, Klesh R, Garner OB, Patel A, Dahm L, Barin A, Cooper DM, Andriola T, Byington CL, Crews BO, Butte AJ, Allen J. Real-world performance of SARS-Cov-2 serology tests in the United States, 2020. PLoS One 2023; 18:e0279956. [PMID: 36735683 PMCID: PMC9897562 DOI: 10.1371/journal.pone.0279956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/19/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Real-world performance of COVID-19 diagnostic tests under Emergency Use Authorization (EUA) must be assessed. We describe overall trends in the performance of serology tests in the context of real-world implementation. METHODS Six health systems estimated the odds of seropositivity and positive percent agreement (PPA) of serology test among people with confirmed SARS-CoV-2 infection by molecular test. In each dataset, we present the odds ratio and PPA, overall and by key clinical, demographic, and practice parameters. RESULTS A total of 15,615 people were observed to have at least one serology test 14-90 days after a positive molecular test for SARS-CoV-2. We observed higher PPA in Hispanic (PPA range: 79-96%) compared to non-Hispanic (60-89%) patients; in those presenting with at least one COVID-19 related symptom (69-93%) as compared to no such symptoms (63-91%); and in inpatient (70-97%) and emergency department (93-99%) compared to outpatient (63-92%) settings across datasets. PPA was highest in those with diabetes (75-94%) and kidney disease (83-95%); and lowest in those with auto-immune conditions or who are immunocompromised (56-93%). The odds ratios (OR) for seropositivity were higher in Hispanics compared to non-Hispanics (OR range: 2.59-3.86), patients with diabetes (1.49-1.56), and obesity (1.63-2.23); and lower in those with immunocompromised or autoimmune conditions (0.25-0.70), as compared to those without those comorbidities. In a subset of three datasets with robust information on serology test name, seven tests were used, two of which were used in multiple settings and met the EUA requirement of PPA ≥87%. Tests performed similarly across datasets. CONCLUSION Although the EUA requirement was not consistently met, more investigation is needed to understand how serology and molecular tests are used, including indication and protocol fidelity. Improved data interoperability of test and clinical/demographic data are needed to enable rapid assessment of the real-world performance of in vitro diagnostic tests.
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Affiliation(s)
- Carla V. Rodriguez-Watson
- Reagan-Udall Foundation for the FDA, Washington, District of Columbia, United States of America
- * E-mail:
| | | | - Carly Kabelac
- Aetion, New York, New York, United States of America
| | | | | | | | - Nancy D. Lin
- Health Catalyst, Salt Lake City, Utah, United States of America
| | | | - Jennifer L. Gatz
- Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Shaun J. Grannis
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Rohit Vashisht
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, United States of America
| | - Kanwal Ghauri
- Reagan-Udall Foundation for the FDA, Washington, District of Columbia, United States of America
| | | | - Sandy Leonard
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Peter J. Embi
- Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | | | - Reyna Klesh
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, California, United States of America
| | - Ayan Patel
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Lisa Dahm
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Aiden Barin
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Dan M. Cooper
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Pediatric Exercise and Genomics Research Center, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Tom Andriola
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Office of Data and Information Technology, University of California, Irvine, Irvine, California, United States of America
| | - Carrie L. Byington
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Bridgit O. Crews
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, California, United States of America
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, United States of America
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Jeff Allen
- Friends of Cancer Research, Washington, District of Columbia, United States of America
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22
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Tenforde MW, Weber ZA, Natarajan K, Klein NP, Kharbanda AB, Stenehjem E, Embi PJ, Reese SE, Naleway AL, Grannis SJ, DeSilva MB, Ong TC, Gaglani M, Han J, Dickerson M, Fireman B, Dascomb K, Irving SA, Vazquez-Benitez G, Rao S, Konatham D, Patel P, Schrader KE, Lewis N, Grisel N, McEvoy C, Murthy K, Griggs EP, Rowley EAK, Zerbo O, Arndorfer J, Dunne MM, Goddard K, Ray C, Zhuang Y, Timbol J, Najdowski M, Yang DH, Hansen J, Ball SW, Link-Gelles R. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Emergency Department or Urgent Care Encounters and Hospitalizations Among Immunocompetent Adults - VISION Network, Nine States, September-November 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1616-1624. [PMID: 36580430 PMCID: PMC9812442 DOI: 10.15585/mmwr.mm715152e1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
During June-October 2022, the SARS-CoV-2 Omicron BA.5 sublineage accounted for most of the sequenced viral genomes in the United States, with further Omicron sublineage diversification through November 2022.* Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the Omicron BA.4/BA.5 sublineages. On September 1, 2022, a single bivalent booster dose was recommended for adults who had completed a primary vaccination series (with or without subsequent booster doses), with the last dose administered ≥2 months earlier (1). During September 13-November 18, the VISION Network evaluated vaccine effectiveness (VE) of a bivalent mRNA booster dose (after 2, 3, or 4 monovalent doses) compared with 1) no previous vaccination and 2) previous receipt of 2, 3, or 4 monovalent-only mRNA vaccine doses, among immunocompetent adults aged ≥18 years with an emergency department/urgent care (ED/UC) encounter or hospitalization for a COVID-19-like illness.† VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated ED/UC encounters was 56% compared with no vaccination, 31% compared with monovalent vaccination only with last dose 2-4 months earlier, and 50% compared with monovalent vaccination only with last dose ≥11 months earlier. VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated hospitalizations was 57% compared with no vaccination, 38% compared with monovalent vaccination only with last dose 5-7 months earlier, and 45% compared with monovalent vaccination only with last dose ≥11 months earlier. Bivalent vaccines administered after 2, 3, or 4 monovalent doses were effective in preventing medically attended COVID-19 compared with no vaccination and provided additional protection compared with past monovalent vaccination only, with relative protection increasing with time since receipt of the last monovalent dose. All eligible persons should stay up to date with recommended COVID-19 vaccinations, including receiving a bivalent booster dose. Persons should also consider taking additional precautions to avoid respiratory illness this winter season, such as masking in public indoor spaces, especially in areas where COVID-19 community levels are high.
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23
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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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Britton A, Embi PJ, Levy ME, Gaglani M, DeSilva MB, Dixon BE, Dascomb K, Patel P, Schrader KE, Klein NP, Ong TC, Natarajan K, Hartmann E, Kharbanda AB, Irving SA, Dickerson M, Dunne MM, Raiyani C, Grannis SJ, Stenehjem E, Zerbo O, Rao S, Han J, Sloan-Aagard C, Griggs EP, Weber ZA, Murthy K, Fadel WF, Grisel N, McEvoy C, Lewis N, Barron MA, Nanez J, Reese SE, Mamawala M, Valvi NR, Arndorfer J, Goddard K, Yang DH, Fireman B, Ball SW, Link-Gelles R, Naleway AL, Tenforde MW. Effectiveness of COVID-19 mRNA Vaccines Against COVID-19-Associated Hospitalizations Among Immunocompromised Adults During SARS-CoV-2 Omicron Predominance - VISION Network, 10 States, December 2021-August 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1335-1342. [PMID: 36264840 PMCID: PMC9590295 DOI: 10.15585/mmwr.mm7142a4] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Persons with moderate-to-severe immunocompromising conditions might have reduced protection after COVID-19 vaccination, compared with persons without immunocompromising conditions (1-3). On August 13, 2021, the Advisory Committee on Immunization Practices (ACIP) recommended that adults with immunocompromising conditions receive an expanded primary series of 3 doses of an mRNA COVID-19 vaccine. ACIP followed with recommendations on September 23, 2021, for a fourth (booster) dose and on September 1, 2022, for a new bivalent mRNA COVID-19 vaccine booster dose, containing components of the BA.4 and BA.5 sublineages of the Omicron (B.1.1.529) variant (4). Data on vaccine effectiveness (VE) of monovalent COVID-19 vaccines among persons with immunocompromising conditions since the emergence of the Omicron variant in December 2021 are limited. In the multistate VISION Network,§ monovalent 2-, 3-, and 4-dose mRNA VE against COVID-19-related hospitalization were estimated among adults with immunocompromising conditions¶ hospitalized with COVID-19-like illness,** using a test-negative design comparing odds of previous vaccination among persons with a positive or negative molecular test result (case-patients and control-patients) for SARS-CoV-2 (the virus that causes COVID-19). During December 16, 2021-August 20, 2022, among SARS-CoV-2 test-positive case-patients, 1,815 (36.3%), 1,387 (27.7%), 1,552 (31.0%), and 251 (5.0%) received 0, 2, 3, and 4 mRNA COVID-19 vaccine doses, respectively. Among test-negative control-patients during this period, 6,928 (23.7%), 7,411 (25.4%), 12,734 (43.6%), and 2,142 (7.3%) received these respective doses. Overall, VE against COVID-19-related hospitalization among adults with immunocompromising conditions hospitalized for COVID-like illness during Omicron predominance was 36% ≥14 days after dose 2, 69% 7-89 days after dose 3, and 44% ≥90 days after dose 3. Restricting the analysis to later periods when Omicron sublineages BA.2/BA.2.12.1 and BA.4/BA.5 were predominant and 3-dose recipients were eligible to receive a fourth dose, VE was 32% ≥90 days after dose 3 and 43% ≥7 days after dose 4. Protection offered by vaccination among persons with immunocompromising conditions during Omicron predominance was moderate even after a 3-dose monovalent primary series or booster dose. Given the incomplete protection against hospitalization afforded by monovalent COVID-19 vaccines, persons with immunocompromising conditions might benefit from updated bivalent vaccine booster doses that target recently circulating Omicron sublineages, in line with ACIP recommendations. Further, additional protective recommendations for persons with immunocompromising conditions, including the use of prophylactic antibody therapy, early access to and use of antivirals, and enhanced nonpharmaceutical interventions such as well-fitting masks or respirators, should also be considered.
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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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Vest JR, Cash-Goldwasser S, Peters Bergquist E, Embi PJ, Caine V, Halverson PK. Indoor Public Mask-Wearing Behavior Changes in Response to National, State, and Local COVID-19 Policies. J Public Health Manag Pract 2022; 28:292-298. [PMID: 34939598 PMCID: PMC8963438 DOI: 10.1097/phh.0000000000001467] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate changes in public mask-wearing behavior in response to public health policies during COVID-19. DESIGN Panel of observed public mask-wearing. SETTING Counts of adult behavior in Marion County, Indiana, between November 15, 2020, and May 31, 2021. DETERMINANTS OF INTEREST (1) Removal of state masking requirement; (2) introduction of the National Strategy for the COVID-19 Response and Pandemic Preparedness; (3) the Centers for Disease Control and Prevention (CDC) recommendation that vaccinated individuals did not need to wear masks in public; and (4) COVID-19 vaccine availability. OUTCOME Percent observed with correct mask-wearing. ANALYSES Fixed-effects models estimated the association between policies and mask-wearing. RESULTS Ending Indiana's mask requirement was not associated with changes in correct mask-wearing. The CDC's recommendation was associated with a decrease of 12.3 percentage points in correct mask-wearing (95% CI, -23.47 to -1.05; P = .032). CONCLUSIONS Behavior encouraged by local mask requirements appeared to be resilient to changes in state policy. CDC recommendations appeared influential.
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Affiliation(s)
- Joshua R. Vest
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Vest and Halverson); Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana (Drs Vest and Embi); Resolve to Save Lives, New York City, New York (Drs Cash-Goldwasser and Peters Bergquist); Marion County Public Health Department, Indianapolis, Indiana (Dr Caine); and Indiana University School of Medicine, Indianapolis, Indiana (Dr Embi)
| | - Shama Cash-Goldwasser
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Vest and Halverson); Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana (Drs Vest and Embi); Resolve to Save Lives, New York City, New York (Drs Cash-Goldwasser and Peters Bergquist); Marion County Public Health Department, Indianapolis, Indiana (Dr Caine); and Indiana University School of Medicine, Indianapolis, Indiana (Dr Embi)
| | - Eleanor Peters Bergquist
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Vest and Halverson); Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana (Drs Vest and Embi); Resolve to Save Lives, New York City, New York (Drs Cash-Goldwasser and Peters Bergquist); Marion County Public Health Department, Indianapolis, Indiana (Dr Caine); and Indiana University School of Medicine, Indianapolis, Indiana (Dr Embi)
| | - Peter J. Embi
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Vest and Halverson); Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana (Drs Vest and Embi); Resolve to Save Lives, New York City, New York (Drs Cash-Goldwasser and Peters Bergquist); Marion County Public Health Department, Indianapolis, Indiana (Dr Caine); and Indiana University School of Medicine, Indianapolis, Indiana (Dr Embi)
| | - Virginia Caine
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Vest and Halverson); Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana (Drs Vest and Embi); Resolve to Save Lives, New York City, New York (Drs Cash-Goldwasser and Peters Bergquist); Marion County Public Health Department, Indianapolis, Indiana (Dr Caine); and Indiana University School of Medicine, Indianapolis, Indiana (Dr Embi)
| | - Paul K. Halverson
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Vest and Halverson); Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana (Drs Vest and Embi); Resolve to Save Lives, New York City, New York (Drs Cash-Goldwasser and Peters Bergquist); Marion County Public Health Department, Indianapolis, Indiana (Dr Caine); and Indiana University School of Medicine, Indianapolis, Indiana (Dr Embi)
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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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Payne PR, Wilcox AB, Embi PJ, Longhurst CA. Better together: Integrating biomedical informatics and healthcare
IT
operations to create a learning health system during the
COVID
‐19 pandemic. Learn Health Syst 2022; 6:e10309. [PMID: 35434359 PMCID: PMC9006527 DOI: 10.1002/lrh2.10309] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/10/2022] Open
Abstract
The growing availability of multi‐scale biomedical data sources that can be used to enable research and improve healthcare delivery has brought about what can be described as a healthcare “data age.” This new era is defined by the explosive growth in bio‐molecular, clinical, and population‐level data that can be readily accessed by researchers, clinicians, and decision‐makers, and utilized for systems‐level approaches to hypothesis generation and testing as well as operational decision‐making. However, taking full advantage of these unprecedented opportunities presents an opportunity to revisit the alignment between traditionally academic biomedical informatics (BMI) and operational healthcare information technology (HIT) personnel and activities in academic health systems. While the history of the academic field of BMI includes active engagement in the delivery of operational HIT platforms, in many contemporary settings these efforts have grown distinct. Recent experiences during the COVID‐19 pandemic have demonstrated greater coordination of BMI and HIT activities that have allowed organizations to respond to pandemic‐related changes more effectively, with demonstrable and positive impact as a result. In this position paper, we discuss the challenges and opportunities associated with driving alignment between BMI and HIT, as viewed from the perspective of a learning healthcare system. In doing so, we hope to illustrate the benefits of coordination between BMI and HIT in terms of the quality, safety, and outcomes of care provided to patients and populations, demonstrating that these two groups can be “better together.”
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Affiliation(s)
- Philip R.O. Payne
- Washington University School of Medicine Institute for Informatics St. Louis Missouri USA
| | - Adam B. Wilcox
- Washington University School of Medicine Institute for Informatics St. Louis Missouri USA
| | - Peter J. Embi
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville Tennessee USA
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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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Bastarache L, Brown JS, Cimino JJ, Dorr DA, Embi PJ, Payne PR, Wilcox AB, Weiner MG. Developing real-world evidence from real-world data: Transforming raw data into analytical datasets. Learn Health Syst 2022; 6:e10293. [PMID: 35036557 PMCID: PMC8753316 DOI: 10.1002/lrh2.10293] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
Development of evidence-based practice requires practice-based evidence, which can be acquired through analysis of real-world data from electronic health records (EHRs). The EHR contains volumes of information about patients-physical measurements, diagnoses, exposures, and markers of health behavior-that can be used to create algorithms for risk stratification or to gain insight into associations between exposures, interventions, and outcomes. But to transform real-world data into reliable real-world evidence, one must not only choose the correct analytical methods but also have an understanding of the quality, detail, provenance, and organization of the underlying source data and address the differences in these characteristics across sites when conducting analyses that span institutions. This manuscript explores the idiosyncrasies inherent in the capture, formatting, and standardization of EHR data and discusses the clinical domain and informatics competencies required to transform the raw clinical, real-world data into high-quality, fit-for-purpose analytical data sets used to generate real-world evidence.
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Affiliation(s)
- Lisa Bastarache
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jeffrey S. Brown
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMassachusettsUSA
| | - James J. Cimino
- Informatics Institute, University of Alabama at BirminghamBirminghamAlabamaUSA
| | - David A. Dorr
- Department of Medical Informatics and Clinical EpidemiologyOregon Health Sciences UniversityPortlandOregonUSA
| | - Peter J. Embi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Philip R.O. Payne
- Institute for Informatics, Washington University in St. LouisSt. LouisMissouriUSA
| | - Adam B. Wilcox
- Institute for InformaticsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | - Mark G. Weiner
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
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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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Embi PJ, Payne PRO, Friedman CP. Learning from data: A recurring feature on the science and practice of data-driven learning health systems. Learn Health Syst 2022; 6:e10302. [PMID: 35036559 PMCID: PMC8753296 DOI: 10.1002/lrh2.10302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter J. Embi
- Department of Biomedical Informatics and MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Philip R. O. Payne
- Institute for InformaticsWashington University in St. LouisSt. LouisMissouriUSA
| | - Charles P. Friedman
- Josiah Macy Jr. Professor of Medical Education, Department of Learning Health Sciences, Medical SchoolUniversity of MichiganAnn ArborMichiganUSA
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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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Abstract
This cross-sectional study examines the mask-wearing behavior of attendees at the 2021 NCAA men’s basketball tournament in an attempt to help other venues prepare for future events during the pandemic.
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Affiliation(s)
- Joshua R. Vest
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis
- Regenstrief Institute Inc, Indianapolis, Indiana
| | - Justin Blackburn
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis
| | | | | | - Peter J. Embi
- Regenstrief Institute Inc, Indianapolis, Indiana
- Indiana University School of Medicine, Indianapolis
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Aalsma MC, Aarons GA, Adams ZW, Alton MD, Boustani M, Dir AL, Embi PJ, Grannis S, Hulvershorn LA, Huntsinger D, Lewis CC, Monahan P, Saldana L, Schwartz K, Simon KI, Terry N, Wiehe SE, Zapolski TC. Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities. J Subst Abuse Treat 2021; 128:108368. [PMID: 33867210 PMCID: PMC8883586 DOI: 10.1016/j.jsat.2021.108368] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/27/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. METHODS/DESIGN ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DISCUSSION Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.
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Affiliation(s)
- Matthew C. Aalsma
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
| | - Zachary W. Adams
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Madison D. Alton
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Malaz Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Allyson L. Dir
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Peter J. Embi
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Shaun Grannis
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Leslie A. Hulvershorn
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | | | - Cara C. Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute – Seattle, Washington, United States of America
| | - Patrick Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, IN, United States of America
| | - Lisa Saldana
- Oregon Social Learning Center, Eugene, OR, United States of America
| | - Katherine Schwartz
- Department of Pediatrics - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Kosali I. Simon
- School of Public and Environmental Affairs, Indiana University Bloomington, Bloomington, IN, United States of America
| | - Nicolas Terry
- McKinney School of Law, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Sarah E. Wiehe
- Department of Pediatrics, Division of Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tamika C.B. Zapolski
- Department of Psychology - Adolescent Behavioral Health Research Program, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
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Dixon BE, Grannis SJ, McAndrews C, Broyles AA, Mikels-Carrasco W, Wiensch A, Williams JL, Tachinardi U, Embi PJ. Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: Application of public health informatics. J Am Med Inform Assoc 2021; 28:1363-1373. [PMID: 33480419 PMCID: PMC7928924 DOI: 10.1093/jamia/ocab004] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/07/2021] [Indexed: 01/28/2023] Open
Abstract
Objective We sought to support public health surveillance and response to coronavirus disease 2019 (COVID-19) through rapid development and implementation of novel visualization applications for data amalgamated across sectors. Materials and Methods We developed and implemented population-level dashboards that collate information on individuals tested for and infected with COVID-19, in partnership with state and local public health agencies as well as health systems. The dashboards are deployed on top of a statewide health information exchange. One dashboard enables authorized users working in public health agencies to surveil populations in detail, and a public version provides higher-level situational awareness to inform ongoing pandemic response efforts in communities. Results Both dashboards have proved useful informatics resources. For example, the private dashboard enabled detection of a local community outbreak associated with a meat packing plant. The public dashboard provides recent trend analysis to track disease spread and community-level hospitalizations. Combined, the tools were utilized 133 637 times by 74 317 distinct users between June 21 and August 22, 2020. The tools are frequently cited by journalists and featured on social media. Discussion Capitalizing on a statewide health information exchange, in partnership with health system and public health leaders, Regenstrief biomedical informatics experts rapidly developed and deployed informatics tools to support surveillance and response to COVID-19. Conclusions The application of public health informatics methods and tools in Indiana holds promise for other states and nations. Yet, development of infrastructure and partnerships will require effort and investment after the current pandemic in preparation for the next public health emergency.
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Affiliation(s)
- Brian E Dixon
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Connor McAndrews
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Andrea A Broyles
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | | | - Ashley Wiensch
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Jennifer L Williams
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Umberto Tachinardi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
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Dixon BE, Grannis SJ, Lembcke LR, Valvi N, Roberts AR, Embi PJ. The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America. PLoS One 2021; 16:e0255063. [PMID: 34297747 PMCID: PMC8301667 DOI: 10.1371/journal.pone.0255063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background Early studies on COVID-19 identified unequal patterns in hospitalization and mortality in urban environments for racial and ethnic minorities. These studies were primarily single center observational studies conducted within the first few weeks or months of the pandemic. We sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge. Methods Data were extracted from a statewide cohort of all adult residents in Indiana tested for SARS-CoV-2 infection between March 1 and December 31, 2020, linked to electronic health records. Primary measures were per capita rates of infection, hospitalization, and death. Age adjusted rates were calculated for multiple time periods corresponding to public health mitigation efforts. Comparisons across time within groups were compared using ANOVA. Results Morbidity and mortality increased over time with notable differences among sub-populations. Initially, hospitalization rates among racial minorities were 3–4 times higher than whites, and mortality rates among urban residents were twice those of rural residents. By fall 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Changes across time among demographic groups was significant for morbidity and hospitalization. Cumulative morbidity and mortality were highest among minority groups and in rural communities. Conclusions The synchronicity of disparities in COVID-19 by race and geography suggests that health officials should explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.
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Affiliation(s)
- Brian E. Dixon
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Bloomington, Indiana, United States of America
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Family Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Lauren R. Lembcke
- Research Data Services, Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Nimish Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Anna R. Roberts
- Research Data Services, Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Peter J. Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
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Schleyer T, Williams L, Gottlieb J, Weaver C, Saysana M, Azar J, Sadowski J, Frederick C, Hui S, Kara A, Ruppert L, Zappone S, Bushey M, Grout R, Embi PJ. The Indiana Learning Health System Initiative: Early experience developing a collaborative, regional learning health system. Learn Health Syst 2021; 5:e10281. [PMID: 34277946 PMCID: PMC8278436 DOI: 10.1002/lrh2.10281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Learning health systems (LHSs) are usually created and maintained by single institutions or healthcare systems. The Indiana Learning Health System Initiative (ILHSI) is a new multi-institutional, collaborative regional LHS initiative led by the Regenstrief Institute (RI) and developed in partnership with five additional organizations: two Indiana-based health systems, two schools at Indiana University, and our state-wide health information exchange. We report our experiences and lessons learned during the initial 2-year phase of developing and implementing the ILHSI. METHODS The initial goals of the ILHSI were to instantiate the concept, establish partnerships, and perform LHS pilot projects to inform expansion. We established shared governance and technical capabilities, conducted a literature review-based and regional environmental scan, and convened key stakeholders to iteratively identify focus areas, and select and implement six initial joint projects. RESULTS The ILHSI successfully collaborated with its partner organizations to establish a foundational governance structure, set goals and strategies, and prioritize projects and training activities. We developed and deployed strategies to effectively use health system and regional HIE infrastructure and minimize information silos, a frequent challenge for multi-organizational LHSs. Successful projects were diverse and included deploying a Fast Healthcare Interoperability Standards (FHIR)-based tool across emergency departments state-wide, analyzing free-text elements of cross-hospital surveys, and developing models to provide clinical decision support based on clinical and social determinants of health. We also experienced organizational challenges, including changes in key leadership personnel and varying levels of engagement with health system partners, which impacted initial ILHSI efforts and structures. Reflecting on these early experiences, we identified lessons learned and next steps. CONCLUSIONS Multi-organizational LHSs can be challenging to develop but present the opportunity to leverage learning across multiple organizations and systems to benefit the general population. Attention to governance decisions, shared goal setting and monitoring, and careful selection of projects are important for early success.
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Affiliation(s)
- Titus Schleyer
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Linda Williams
- Center for Health Services ResearchRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
- VA HSR&D EXTEND QUERIRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
| | - Jonathan Gottlieb
- Department of Health AdministrationUniversity of ProvidenceGreat FallsMontanaUSA
| | - Christopher Weaver
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
| | - Michele Saysana
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jose Azar
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Division of Quality and Patient SafetyIndiana University HealthIndianapolisIndianaUSA
| | - Josh Sadowski
- Department of Infection PreventionIndiana University HealthIndianapolisIndianaUSA
| | - Chris Frederick
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Siu Hui
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of Biostatistics & Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - Areeba Kara
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Laura Ruppert
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Sarah Zappone
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Michael Bushey
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of PsychiatryIndiana University HealthIndianapolisIndianaUSA
| | - Randall Grout
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
- InformaticsEskenazi HealthIndianapolisIndianaUSA
| | - Peter J. Embi
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
- AdministrationIndiana University HealthIndianapolisIndianaUSA
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Furmanchuk A, Liu M, Song X, Waitman LR, Meurer JR, Osinski K, Stoddard A, Chrischilles E, McClay JC, Cowell LG, Tachinardi U, Embi PJ, Mosa ASM, Mandhadi V, Shah RC, Garcia D, Angulo F, Patino A, Trick WE, Markossian TW, Rasmussen-Torvik LJ, Kho AN, Black BS. Effect of the Affordable Care Act on diabetes care at major health centers: newly detected diabetes and diabetes medication management. BMJ Open Diabetes Res Care 2021; 9:9/Suppl_1/e002205. [PMID: 34187842 PMCID: PMC8245434 DOI: 10.1136/bmjdrc-2021-002205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/13/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Al'ona Furmanchuk
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois, USA
| | - Mei Liu
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Xing Song
- Division of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Lemuel R Waitman
- Division of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - John R Meurer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kristen Osinski
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alexander Stoddard
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Chrischilles
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - James C McClay
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lindsay G Cowell
- Division of Biomedical Informatics, Department of Population and Data Sciences, Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Umberto Tachinardi
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter J Embi
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abu Saleh Mohammad Mosa
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Vasanthi Mandhadi
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Diana Garcia
- Health Research and Solutions Unit, Cook County Bureau of Health Services, Chicago, Illinois, USA
| | - Francisco Angulo
- Health Research and Solutions Unit, Cook County Bureau of Health Services, Chicago, Illinois, USA
| | - Alejandro Patino
- Health Research and Solutions Unit, Cook County Bureau of Health Services, Chicago, Illinois, USA
| | - William E Trick
- Department of Medicine, Cook County Bureau of Health Services, Chicago, Illinois, USA
| | - Talar W Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abel N Kho
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois, USA
| | - Bernard S Black
- Pritzker School of Law, Kellogg School of Management, Northwestern University, Chicago, Illinois, USA
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43
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Affiliation(s)
- Peter J Embi
- Regenstrief Institute Inc, Indiana University School of Medicine, Indianapolis
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44
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Madhavan S, Bastarache L, Brown JS, Butte AJ, Dorr DA, Embi PJ, Friedman CP, Johnson KB, Moore JH, Kohane IS, Payne PRO, Tenenbaum JD, Weiner MG, Wilcox AB, Ohno-Machado L. Use of electronic health records to support a public health response to the COVID-19 pandemic in the United States: a perspective from 15 academic medical centers. J Am Med Inform Assoc 2021; 28:393-401. [PMID: 33260207 PMCID: PMC7665546 DOI: 10.1093/jamia/ocaa287] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 09/18/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/12/2022] Open
Abstract
Our goal is to summarize the collective experience of 15 organizations in dealing with uncoordinated efforts that result in unnecessary delays in understanding, predicting, preparing for, containing, and mitigating the COVID-19 pandemic in the US. Response efforts involve the collection and analysis of data corresponding to healthcare organizations, public health departments, socioeconomic indicators, as well as additional signals collected directly from individuals and communities. We focused on electronic health record (EHR) data, since EHRs can be leveraged and scaled to improve clinical care, research, and to inform public health decision-making. We outline the current challenges in the data ecosystem and the technology infrastructure that are relevant to COVID-19, as witnessed in our 15 institutions. The infrastructure includes registries and clinical data networks to support population-level analyses. We propose a specific set of strategic next steps to increase interoperability, overall organization, and efficiencies.
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Affiliation(s)
- Subha Madhavan
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey S Brown
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Atul J Butte
- University of California Health System (UC Health), University of California, San Francisco, California, USA
| | - David A Dorr
- Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Peter J Embi
- Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Charles P Friedman
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jason H Moore
- Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Jessica D Tenenbaum
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Adam B Wilcox
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla, California, USA
- Division of Health Services Research & Development, VA San Diego Healthcare System, San Diego, California, USA
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45
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Dexter PR, Grout RW, Embi PJ. Transforming primary medical research knowledge into clinical decision. AMIA Annu Symp Proc 2021; 2020:358-362. [PMID: 33936408 PMCID: PMC8075430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While the utility of computerized clinical decision support (CCDS) for multiple select clinical domains has been clearly demonstrated, much less is known about the full breadth of domains to which CCDS approaches could be productively applied. To explore the applicability of CCDS to general medical knowledge, we sampled a total of 500 primary research articles from 4 high-impact medical journals. Employing rule-based templates, we created high-level CCDS rules for 72% (361/500) of primary medical research articles. We subsequently identified data sources needed to implement those rules. Ourfindings suggest that CCDS approaches, perhaps in the form of non-interruptive infobuttons, could be much more broadly applied. In addition, our analytic methods appear to provide a means of prioritizing and quantitating the relative utility of available data sources for purposes of CCDS.
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Affiliation(s)
- Paul R Dexter
- Regenstrief Institute, Inc., Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
| | - Randall W Grout
- Regenstrief Institute, Inc., Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
| | - Peter J Embi
- Regenstrief Institute, Inc., Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
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46
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Takesue BY, Tierney WM, Embi PJ, Mamlin BW, Warvel J, Litzelman DK. Regenstrief teaching electronic medical record (tEMR) platform: a novel tool for teaching and evaluating applied health information technology. JAMIA Open 2021; 4:ooab010. [PMID: 33758799 PMCID: PMC7966857 DOI: 10.1093/jamiaopen/ooab010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/04/2021] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
The objective of this study is to provide an overview of the Regenstrief Teaching Electronic Medical Record (tEMR), how the tEMR could be used, and how it is currently being used in health professions education. The tEMR is a derivative of a real-world electronic health record (EHR), a large, pseudonymized patient database, and a population health tool designed to support curricular goals. The tEMR has been successfully adopted at 12 health professional, public health, and health information technology (HIT) schools, with over 11 800 unique student users and more than 74 000 logins, for case presentation, to develop diagnostic and therapeutic plans, and to practice documentation skills. With the exponential growth of health-related data and the impact of HIT on work-life balance, it is critical for students to get early EHR skills practice and understand how EHR's work. The tEMR is a promising, scalable, flexible application to help health professional students learn about common HIT tools and issues.
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Affiliation(s)
- Blaine Y Takesue
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William M Tierney
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Global Health, Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Peter J Embi
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Burke W Mamlin
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeff Warvel
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Debra K Litzelman
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Center for Global Health, Indianapolis, Indiana, USA
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47
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Comer A, Apathy N, Waite C, Bestmann Z, Bradshaw J, Burchfield E, Harmon B, Legg R, Meyer S, O’Brien P, Sabec M, Sayeed J, Weaver A, D’Cruz L, Bartlett S, Marchand M, Zepeda I, Endri K, Finnell JT, Grannis S, Silverman RD, Embi PJ. Electric Scooters (e-scooters): Assessing the Threat to Public Health and Safety in Setting Policies: Assessing e-scooter policies. CHIA 2020. [DOI: 10.18060/24194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To determine self-reported incidences of health and safety hazards among persons who ride rentable electric scooters (e-scooters), knowledge of e-scooter laws, and attitudes and perceptions of the health and safety of e-scooter usage.
Methods: A cross-sectional survey of n= 561 e-scooter riders and non-riders was conducted during June of 2019.
Results: Almost half of respondents (44%) report that e-scooters pose a threat to the health and safety of riders. Riders and non-riders disagree regarding the hazards that e-scooters pose to pedestrians. Among riders, 15% report crashing or falling off an e-scooter. Only 2.5% of e-scooter riders self-report that they always wear a helmet while riding.
Conclusions: E-scooter riders report substantial rates of harmful behavior and injuries. Knowledge of e-scooter laws is limited, and e-scooters introduce threats to the health and safety of riders, pedestrians on sidewalks, and automobile drivers. Enhanced public health interventions are needed to educate about potential health risks and laws associated with e-scooter use and to ensure health in all policies. Additionally, greater consideration should be given to public health, safety, and injury prevention when passing relevant state and local e-scooter laws.
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48
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Embi PJ, Richesson R, Tenenbaum J, Kannry J, Friedman C, Sarkar IN, Smith J. Reimagining the research-practice relationship: policy recommendations for informatics-enabled evidence-generation across the US health system. JAMIA Open 2019; 2:2-9. [PMID: 31984339 PMCID: PMC6951885 DOI: 10.1093/jamiaopen/ooy056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/16/2018] [Accepted: 11/21/2018] [Indexed: 01/08/2023] Open
Abstract
The widespread adoption and use of electronic health records and their use to enable learning health systems (LHS) holds great promise to accelerate both evidence-generating medicine (EGM) and evidence-based medicine (EBM), thereby enabling a LHS. In 2016, AMIA convened its 10th annual Policy Invitational to discuss issues key to facilitating the EGM-EBM paradigm at points-of-care (nodes), across organizations (networks), and to ensure viability of this model at scale (sustainability). In this article, we synthesize discussions from the conference and supplements those deliberations with relevant context to inform ongoing policy development. Specifically, we explore and suggest public policies needed to facilitate EGM-EBM activities on a national scale, particularly those policies that can enable and improve clinical and health services research at the point-of-care, accelerate biomedical discovery, and facilitate translation of findings to improve the health of individuals and populations.
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Affiliation(s)
- Peter J Embi
- Regenstrief Institute, 1101 West 10th Street, Indianapolis, Indiana 46202, USA
| | - Rachel Richesson
- Duke University School of Nursing, 307 Trent Drive, Durham, North Carolina 27710, USA
| | - Jessica Tenenbaum
- Duke University School of Medicine, 2424 Erwin Road, Durham, North Carolina 27705, USA
| | - Joseph Kannry
- Icahn School of Medicine at Mount Sinai, Box 187, New York, New York 10029, USA
| | - Charles Friedman
- Department of Learning Health Sciences, University Michigan Medical School, 1111 E. Catherine, St. Ann Arbor, Michigan 48109-2054, USA
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Box G-R, Providence, Rhode Island 02912, USA
| | - Jeff Smith
- American Medical Informatics Association, 4720 Montgomery Ln., Suite 500, Bethesda, Maryland 20814, USA
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49
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Dixon BE, Embi PJ, Haggstrom DA. Information technologies that facilitate care coordination: provider and patient perspectives. Transl Behav Med 2018; 8:522-525. [PMID: 29800411 DOI: 10.1093/tbm/ibx086] [Citation(s) in RCA: 18] [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] [Indexed: 11/14/2022] Open
Abstract
Health information technology is a core infrastructure for the chronic care model, integrated care, and other organized care delivery models. From the provider perspective, health information exchange (HIE) helps aggregate and share information about a patient or population from several sources. HIE technologies include direct messages, transfer of care, and event notification services. From the patient perspective, personal health records, secure messaging, text messages, and other mHealth applications may coordinate patients and providers. Patient-reported outcomes and social media technologies enable patients to share health information with many stakeholders, including providers, caregivers, and other patients. An information architecture that integrates personal health record and mHealth applications, with HIEs that combine the electronic health records of multiple healthcare systems will create a rich, dynamic ecosystem for patient collaboration.
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Affiliation(s)
- Brian E Dixon
- Department of Epidemiology, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, IN, USA
| | - Peter J Embi
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - David A Haggstrom
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, IN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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50
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Petersen C, Berner ES, Embi PJ, Fultz Hollis K, Goodman KW, Koppel R, Lehmann CU, Lehmann H, Maulden SA, McGregor KA, Solomonides A, Subbian V, Terrazas E, Winkelstein P. AMIA's code of professional and ethical conduct 2018. J Am Med Inform Assoc 2018; 25:1579-1582. [PMID: 30329055 PMCID: PMC7646920 DOI: 10.1093/jamia/ocy092] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/08/2018] [Accepted: 06/18/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carolyn Petersen
- Global Business Solutions, Mayo Clinic, Rochester, Minnesota, USA
| | - Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter J Embi
- The Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kate Fultz Hollis
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kenneth W Goodman
- Department of Philosophy, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Health Informatics, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Electrical and Computer Engineering, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Anesthesiology, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
- School of Nursing and Health Studies, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ross Koppel
- Department of Sociology, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christoph U Lehmann
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Harold Lehmann
- Division of Health Services Informatics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kyle A McGregor
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Anthony Solomonides
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Vignesh Subbian
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona, USA
- Department of Systems & Industrial Engineering, The University of Arizona, Tucson, Arizona, USA
| | | | - Peter Winkelstein
- Institute for Healthcare Informatics, Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, Buffalo, New York, USA
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