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Rosenblum HG, Gargano JW, Cleveland AA, Dahl RM, Park IU, Whitney E, Castilho JL, Sackey E, Niccolai LM, Brackney M, Debess E, Ehlers S, Bennett NM, Kurtz R, Unger ER, Markowitz LE. U.S. Women with Invasive Cervical Cancer: Characteristics and Potential Barriers to Prevention. J Womens Health (Larchmt) 2024. [PMID: 38608239 DOI: 10.1089/jwh.2023.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Objectives: Although invasive cervical cancer (ICC) rates have declined since the advent of screening, the annual age-adjusted ICC rate in the United States remains 7.5 per 100,000 women. Failure of recommended screening and management often precedes ICC diagnoses. The study aimed to evaluate characteristics of women with incident ICC, including potential barriers to accessing preventive care. Materials and Methods: We abstracted medical records for patients with ICC identified during 2008-2020 in five U.S. population-based surveillance sites covering 1.5 million women. We identified evidence of adverse social and medical conditions, including uninsured/underinsured, language barrier, substance use disorder, incarceration, serious mental illness, severe obesity, or pregnancy at diagnosis. We calculated descriptive frequencies and compared potential barriers by race/ethnicity, and among women with and without symptoms at diagnosis using chi-square tests. Results: Among 1,606 women with ICC (median age: 49 years; non-White: 47.4%; stage I: 54.7%), the majority (68.8%) presented with symptoms. Forty-six percent of women had at least one identified potential barrier; 15% had multiple barriers. The most common potential barriers among all women were being underinsured/uninsured (17.3%), and language (17.1%). Presence of any potential barrier was more frequent among non-White women and women with than without symptoms (p < 0.05). Conclusions: In this population-based descriptive study of women with ICC, we identified adverse circumstances that might have prevented women from seeking screening and treatment to prevent cancer. Interventions to increase appropriate cervical cancer screening and management are critical for reducing cervical cancer rates.
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Affiliation(s)
- Hannah G Rosenblum
- Epidemic Intelligence Service, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia W Gargano
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela A Cleveland
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca M Dahl
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ina U Park
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Erin Whitney
- California Emerging Infections Program, Oakland, California, USA
| | - Jessica L Castilho
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emmanuel Sackey
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Linda M Niccolai
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Monica Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Emilio Debess
- Oregon Department of Human Services, Portland, Oregon, USA
| | - Sara Ehlers
- Oregon Department of Human Services, Portland, Oregon, USA
| | - Nancy M Bennett
- Center for Community Health and Prevention, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - RaeAnne Kurtz
- Center for Community Health and Prevention, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Elizabeth R Unger
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Abstract
The 4 common types of human coronaviruses (HCoVs)-2 alpha (HCoV-NL63 and HCoV-229E) and 2 beta (HCoV-HKU1 and HCoV-OC43)-generally cause mild upper respiratory illness. Seasonal patterns and annual variation in predominant types of HCoVs are known, but parameters of expected seasonality have not been defined. We defined seasonality of HCoVs during July 2014-November 2021 in the United States by using a retrospective method applied to National Respiratory and Enteric Virus Surveillance System data. In the 6 HCoV seasons before 2020-21, season onsets occurred October 21-November 12, peaks January 6-February 13, and offsets April 18-June 27; most (>93%) HCoV detection was within the defined seasonal onsets and offsets. The 2020-21 HCoV season onset was 11 weeks later than in prior seasons, probably associated with COVID-19 mitigation efforts. Better definitions of HCoV seasonality can be used for clinical preparedness and for determining expected patterns of emerging coronaviruses.
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Bajema KL, Dahl RM, Evener SL, Prill MM, Rodriguez-Barradas MC, Marconi VC, Beenhouwer DO, Holodniy M, Lucero-Obusan C, Brown ST, Tremarelli M, Epperson M, Mills L, Park SH, Rivera-Dominguez G, Morones RG, Ahmadi-Izadi G, Deovic R, Mendoza C, Jeong C, Schrag SJ, Meites E, Hall AJ, Kobayashi M, McMorrow M, Verani JR, Thornburg NJ, Surie D. Comparative Effectiveness and Antibody Responses to Moderna and Pfizer-BioNTech COVID-19 Vaccines among Hospitalized Veterans - Five Veterans Affairs Medical Centers, United States, February 1-September 30, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1700-1705. [PMID: 34882654 PMCID: PMC8659185 DOI: 10.15585/mmwr.mm7049a2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech) provide strong protection against severe COVID-19, including hospitalization, for at least several months after receipt of the second dose (1,2). However, studies examining immune responses and differences in protection against COVID-19-associated hospitalization in real-world settings, including by vaccine product, are limited. To understand how vaccine effectiveness (VE) might change with time, CDC and collaborators assessed the comparative effectiveness of Moderna and Pfizer-BioNTech vaccines in preventing COVID-19-associated hospitalization at two periods (14-119 days and ≥120 days) after receipt of the second vaccine dose among 1,896 U.S. veterans at five Veterans Affairs medical centers (VAMCs) during February 1-September 30, 2021. Among 234 U.S. veterans fully vaccinated with an mRNA COVID-19 vaccine and without evidence of current or prior SARS-CoV-2 infection, serum antibody levels (anti-spike immunoglobulin G [IgG] and anti-receptor binding domain [RBD] IgG) to SARS-CoV-2 were also compared. Adjusted VE 14-119 days following second Moderna vaccine dose was 89.6% (95% CI = 80.1%-94.5%) and after the second Pfizer-BioNTech dose was 86.0% (95% CI = 77.6%-91.3%); at ≥120 days VE was 86.1% (95% CI = 77.7%-91.3%) for Moderna and 75.1% (95% CI = 64.6%-82.4%) for Pfizer-BioNTech. Antibody levels were significantly higher among Moderna recipients than Pfizer-BioNTech recipients across all age groups and periods since vaccination; however, antibody levels among recipients of both products declined between 14-119 days and ≥120 days. These findings from a cohort of older, hospitalized veterans with high prevalences of underlying conditions suggest the importance of booster doses to help maintain long-term protection against severe COVID-19.†.
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Shah M, Haynes AK, Dahl RM, Kniss K, Silk B, Killerby ME. 1331. Seasonality of Common Human Coronaviruses in the United States, 2014-2021. Open Forum Infect Dis 2021. [PMCID: PMC8689701 DOI: 10.1093/ofid/ofab466.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The four common human coronavirus (HCoV) types, including two alpha (NL63 and 229E) and two beta (HKU1 and OC43) coronaviruses, generally cause mild, upper respiratory illness. Common HCoV seroprevalence increases rapidly during the first five years of life and remains high throughout adulthood. HCoVs are known to have seasonal patterns, with variation in predominant types each year, but more defined measures of seasonality are needed. Methods We describe laboratory detection, percent positivity, and seasonality of the four common HCoVs during July 2014 to May 2021 in the United States reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS). We also describe age, sex, and co-detection with other respiratory viruses for a subset of specimens available through the Public Health Laboratory Interoperability Project (PHLIP). We used a method previously validated for respiratory syncytial virus, characterized by a centered 5-week moving average and normalization to peak, to define seasonal inflections, including season onset, peak, and offset. Results Any HCoV type was detected in 96,336 (3.4%) of 2,487,736 specimens. Predominant common HCoV types fluctuated by surveillance year (Figure 1) and were generally consistent across geographic regions. In a subset of 4,576 specimens with a common HCoV detection, those with type 229E had a higher median age compared to other HCoV types (30.8 versus 24.8 years, p< 0.001), but there were no differences by sex. Influenza was the most commonly co-detected virus. In the last six complete HCoV seasons, onsets ranged from October to November, peaks from January to February, and offsets from April to June; >95% of all HCoV detections occurred within these ranges. The 2020-2021 common HCoV season onset, dominated by types NL63 and OC43, was delayed by approximately two months compared to prior seasons. ![]()
Figure 1. The top panel represents total specimens tested and the bottom panel shows percent positivity of the four common human coronavirus (HCoV) types by week starting July 5, 2014 through May 8, 2021. Data are from the National Respiratory and Enteric Virus Surveillance System (NREVSS). Conclusion Common HCoVs demonstrate relatively consistent seasonal patterns. The delayed onset of the 2020-2021 season may be attributable to mitigation measures implemented across the US including masking, improved hand hygiene, and social distancing. Better defining HCoV seasonality can inform clinical preparedness and testing practices and may provide insights into the behavior of emerging coronaviruses. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Melisa Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
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5
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Rose EB, Dahl RM, Havers FP, Peacock G, Langley GE. Respiratory Syncytial Virus-Associated Hospitalizations in Children With Neurological Disorders, 2006-2015. J Pediatric Infect Dis Soc 2021; 10:951-957. [PMID: 34245307 PMCID: PMC11046416 DOI: 10.1093/jpids/piab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/04/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND We quantified the risk of respiratory syncytial virus (RSV) hospitalizations and severe outcomes among children with neurological disorders. METHODS We estimated RSV-specific and RSV-associated hospitalization rates using International Classification of Diseases, Ninth Revision (ICD-9) codes from 2 insurance claims IBM MarketScan Research Databases (Commercial and Multi-State Medicaid) from July 2006 through June 2015. For comparison, a simple random sample of 10% of all eligible children was selected to represent the general population. Relative rates (RRs) of RSV hospitalization were calculated by dividing rates for children with neurological disorders by rates for children in the general population by age group and season. RESULTS The RSV-specific hospitalization rate for children with any neurological condition was 4.2 (95% confidence interval [CI]: 4.1, 4.4) per 1000 person-years, and the RSV-associated hospitalization rate was 7.0 (95% CI: 6.9, 7.2) per 1000 person-years among children <19 years of age. Among privately insured children, the overall RR of RSV hospitalization in children with neurological disorders compared with the general population was 10.7 (95% CI: 10.0, 11.4) for RSV-specific hospitalization and 11.1 (95% CI: 10.5, 11.7) for RSV-associated hospitalizations. Among children in Medicaid, the RSV-specific hospitalization RR was 6.1 (95% CI: 5.8, 6.5) and the RSV-associated hospitalization RR was 6.4 (95% CI: 6.2, 6.7) compared with the general population. CONCLUSIONS Our population-based study of children with neurological disorders found that the risk of RSV hospitalization was 6 to 12 times higher among children with neurological disorders than among the general pediatric population. These findings should be considered when determining who should be targeted for current and future RSV interventions.
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Affiliation(s)
- Erica Billig Rose
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca M. Dahl
- Maximus Federal, Contracting Agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Fiona P. Havers
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Georgina Peacock
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Gayle E. Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
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6
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Bajema KL, Dahl RM, Prill MM, Meites E, Rodriguez-Barradas MC, Marconi VC, Beenhouwer DO, Brown ST, Holodniy M, Lucero-Obusan C, Rivera-Dominguez G, Morones RG, Whitmire A, Goldin EB, Evener SL, Tremarelli M, Tong S, Hall AJ, Schrag SJ, McMorrow M, Kobayashi M, Verani JR, Surie D. Effectiveness of COVID-19 mRNA Vaccines Against COVID-19-Associated Hospitalization - Five Veterans Affairs Medical Centers, United States, February 1-August 6, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1294-1299. [PMID: 34529636 PMCID: PMC8445376 DOI: 10.15585/mmwr.mm7037e3] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) have been shown to be highly protective against COVID-19-associated hospitalizations (1-3). Data are limited on the level of protection against hospitalization among disproportionately affected populations in the United States, particularly during periods in which the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, predominates (2). U.S. veterans are older, more racially diverse, and have higher prevalences of underlying medical conditions than persons in the general U.S. population (2,4). CDC assessed the effectiveness of mRNA vaccines against COVID-19-associated hospitalization among 1,175 U.S. veterans aged ≥18 years hospitalized at five Veterans Affairs Medical Centers (VAMCs) during February 1-August 6, 2021. Among these hospitalized persons, 1,093 (93.0%) were men, the median age was 68 years, 574 (48.9%) were non-Hispanic Black (Black), 475 were non-Hispanic White (White), and 522 (44.4%) had a Charlson comorbidity index score of ≥3 (5). Overall adjusted vaccine effectiveness against COVID-19-associated hospitalization was 86.8% (95% confidence interval [CI] = 80.4%-91.1%) and was similar before (February 1-June 30) and during (July 1-August 6) SARS-CoV-2 Delta variant predominance (84.1% versus 89.3%, respectively). Vaccine effectiveness was 79.8% (95% CI = 67.7%-87.4%) among adults aged ≥65 years and 95.1% (95% CI = 89.1%-97.8%) among those aged 18-64 years. COVID-19 mRNA vaccines are highly effective in preventing COVID-19-associated hospitalization in this older, racially diverse population of predominately male U.S. veterans. Additional evaluations of vaccine effectiveness among various age groups are warranted. To prevent COVID-19-related hospitalizations, all eligible persons should receive COVID-19 vaccination.
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7
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Burke RM, Mattison C, Pindyck T, Dahl RM, Rudd J, Bi D, Curns AT, Parashar U, Hall AJ. Burden of Norovirus in the United States, as Estimated Based on Administrative Data: Updates for Medically Attended Illness and Mortality, 2001-2015. Clin Infect Dis 2021; 73:e1-e8. [PMID: 32291450 PMCID: PMC8112883 DOI: 10.1093/cid/ciaa438] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Up-to-date estimates of the burden of norovirus, a leading cause of acute gastroenteritis (AGE) in the United States, are needed to assess the potential value of norovirus vaccines in development. We aimed to estimate the rates, annual counts, and healthcare charges of norovirus-associated ambulatory clinic encounters, emergency department (ED) visits, hospitalizations, and deaths in the United States. METHODS We analyzed administrative data on AGE outcomes from 1 July 2001 through 30 June 2015. Data were sourced from IBM MarketScan Commercial and Medicare Supplemental Databases (ambulatory clinic and ED visits), the Healthcare Utilization Project National Inpatient Sample (hospitalizations), and the National Center for Health Statistics multiple-cause-of-mortality data (deaths). Outcome data (ambulatory clinic and ED visits, hospitalizations, or deaths) were summarized by month, age group, and setting. Healthcare charges were estimated based on insurance claims. Monthly counts of cause-unspecified gastroenteritis-associated outcomes were modeled as functions of cause-specified outcomes, and model residuals were analyzed to estimate norovirus-associated outcomes. Healthcare charges were estimated by applying average charges per cause-unspecified gastroenteritis encounter to the estimated number of norovirus encounters. RESULTS We estimate 900 deaths (95% confidence interval [CI], 650-1100), 109 000 hospitalizations (95% CI, 80 000-145 000), 465 000 ED visits (95% CI, 348 000-610 000), and 2.3 million ambulatory clinic encounters (95% CI, 1.7-2.9 million) annually due to norovirus, with an associated $430-$740 million in healthcare charges. CONCLUSIONS Norovirus causes a substantial health burden in the United States each year, and an effective vaccine could have important public health impact.
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Affiliation(s)
- Rachel M. Burke
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claire Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Talia Pindyck
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca M. Dahl
- Maximus Federal, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Rudd
- Maximus Federal, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daoling Bi
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron T Curns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aron J. Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Cates J, Lucero-Obusan C, Dahl RM, Schirmer P, Garg S, Oda G, Hall AJ, Langley G, Havers FP, Holodniy M, Cardemil CV. Risk for In-Hospital Complications Associated with COVID-19 and Influenza - Veterans Health Administration, United States, October 1, 2018-May 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1528-1534. [PMID: 33090987 PMCID: PMC7583498 DOI: 10.15585/mmwr.mm6942e3] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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9
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Gargano JW, Park IU, Griffin MR, Niccolai LM, Powell M, Bennett NM, Johnson Jones ML, Whitney E, Pemmaraju M, Brackney M, Abdullah N, Scahill M, Dahl RM, Cleveland AA, Unger ER, Markowitz LE. Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008-2015. Clin Infect Dis 2020; 68:1282-1291. [PMID: 30137283 DOI: 10.1093/cid/ciy707] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/21/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We describe changes in rates of cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) during a period of human papillomavirus (HPV) vaccine uptake and changing cervical cancer screening recommendations. METHODS We conducted population-based laboratory surveillance for CIN2+ in catchment areas in 5 states, 2008-2015. We calculated age-specific CIN2+ rates per 100000 women by age groups. We estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and among screened women to evaluate changes over time. RESULTS A total of 16572 CIN2+ cases were reported. Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites, whereas in women aged 25-29, 30-34, and 35-39 years, trends differed across sites. The percent of women screened annually declined in all sites and age groups. Compared to 2008-2009, rates among screened women were significantly lower for all 3 periods in women aged 18-20 years (2010-2011: IRR 0.82, 95% confidence interval [CI] 0.67-0.99; 2012-2013: IRR 0.63, 95% CI 0.47-0.85; 2014-2015: IRR 0.44, 95% CI 0.28-0.68) and lower for the latter 2 time periods in women aged 21-24 years (2012-2013: IRR 0.86, 95% CI 0.79-0.94; 2014-2015: IRR 0.61, 95% CI 0.55-0.67). CONCLUSIONS From 2008-2015, both CIN2+ rates and cervical cancer screening declined in women aged 18-24 years. The significant decreases in CIN2+ rates among screened women aged 18-24 years are consistent with a population-level impact of HPV vaccination.
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Affiliation(s)
- Julia Warner Gargano
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Ina U Park
- Department of Family and Community Medicine, School of Medicine, University of California at San Francisco
| | | | | | - Melissa Powell
- Oregon Health Authority Public Health Division, Portland
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, New York
| | - Michelle L Johnson Jones
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Erin Whitney
- California Emerging Infections Program, Richmond
| | | | | | | | - Mary Scahill
- University of Rochester School of Medicine and Dentistry, New York
| | - Rebecca M Dahl
- MAXIMUS Federal, contracting agency to National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Angela A Cleveland
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Elizabeth R Unger
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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10
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Cardemil CV, Balachandran N, Kambhampati A, Grytdal S, Dahl RM, Rodriguez-Barradas MC, Vargas B, Beenhouwer DO, Evangelista KV, Marconi VC, Meagley KL, Brown ST, Perea A, Lucero-Obusan C, Holodniy M, Browne H, Gautam R, Bowen MD, Vinjé J, Parashar UD, Hall AJ. Incidence, etiology, and severity of acute gastroenteritis among prospectively enrolled patients in 4 Veterans Affairs hospitals and outpatient centers, 2016-18. Clin Infect Dis 2020; 73:e2729-e2738. [PMID: 32584956 DOI: 10.1093/cid/ciaa806] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute gastroenteritis (AGE) burden, etiology, and severity in adults is not well-characterized. We implemented a multisite AGE surveillance platform in 4 Veterans Affairs Medical Centers (Atlanta, Bronx, Houston and Los Angeles), collectively serving >320,000 patients annually. METHODS From July 1, 2016-June 30, 2018, we actively identified AGE inpatient cases and non-AGE inpatient controls through prospective screening of admitted patients and passively identified outpatient cases through stool samples submitted for clinical diagnostics. We abstracted medical charts and tested stool samples for 22 pathogens via multiplex gastrointestinal PCR panel followed by genotyping of norovirus- and rotavirus-positive samples. We determined pathogen-specific prevalence, incidence, and modified Vesikari severity scores. RESULTS We enrolled 724 inpatient cases, 394 controls, and 506 outpatient cases. Clostridioides difficile and norovirus were most frequently detected among inpatients (cases vs controls: C. difficile, 18.8% vs 8.4%; norovirus, 5.1% vs 1.5%; p<0.01 for both) and outpatients (norovirus: 10.7%; C. difficile: 10.5%). Incidence per 100,000 population was highest among outpatients (AGE: 2715; C. difficile: 285; norovirus: 291) and inpatients ≥65 years old (AGE: 459; C. difficile: 91; norovirus: 26). Clinical severity scores were highest for inpatient norovirus, rotavirus, and Shigella/EIEC cases. Overall, 12% of AGE inpatient cases had ICU stays and 2% died; 3 deaths were associated with C. difficile and 1 with norovirus. C. difficile and norovirus were detected year-round with a fall/winter predominance. CONCLUSIONS C. difficile and norovirus were leading AGE pathogens in outpatient and hospitalized US Veterans, resulting in severe disease. Clinicians should remain vigilant for bacterial and viral causes of AGE year-round.
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Affiliation(s)
- Cristina V Cardemil
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Neha Balachandran
- Cherokee Nation Assurance, Arlington, VA, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, GA
| | - Anita Kambhampati
- Cherokee Nation Assurance, Arlington, VA, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, GA
| | - Scott Grytdal
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rebecca M Dahl
- Maximus Federal, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, GA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Blanca Vargas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - David O Beenhouwer
- VA Greater Los Angeles Healthcare System, Los Angeles, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Karen V Evangelista
- VA Greater Los Angeles Healthcare System, Los Angeles, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vincent C Marconi
- Atlanta VA Medical Center, Atlanta, GA.,Emory University School of Medicine, Atlanta, GA
| | | | - Sheldon T Brown
- James J. Peters VA Medical Center, Bronx, NY.,Icahn School of Medicine at Mt. Sinai, NY, NY
| | | | - Cynthia Lucero-Obusan
- Public Health Surveillance and Research, Department of Veterans Affairs, Washington, DC.,VA Palo Alto Health Care System, Palo Alto, CA
| | - Mark Holodniy
- Public Health Surveillance and Research, Department of Veterans Affairs, Washington, DC.,VA Palo Alto Health Care System, Palo Alto, CA.,Stanford University, Stanford, CA
| | - Hannah Browne
- Cherokee Nation Assurance, Arlington, VA, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, GA
| | - Rashi Gautam
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael D Bowen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Aron J Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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11
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Burke RM, Tate JE, Dahl RM, Aliabadi N, Parashar UD. Does Rotavirus Vaccination Affect Longer-Term Intussusception Risk in US Infants? J Pediatric Infect Dis Soc 2020; 9:257-260. [PMID: 31197368 PMCID: PMC8112885 DOI: 10.1093/jpids/piz035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/03/2019] [Indexed: 11/14/2022]
Abstract
Rotavirus vaccination has been associated with a short-term increased risk of intussusception. Our analysis of insurance claims for 1 858 827 US children with 544 recorded cases of intussusception found a nonsignificant decrease in intussusception (hazard ratio, 0.79 [95% confidence interval, 0.57-1.09]) in fully rotavirus-vaccinated children followed up to the age of 2 years.
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Affiliation(s)
- Rachel M. Burke
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA;,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E. Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca M. Dahl
- Maximus Federal, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Negar Aliabadi
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D. Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Burke RM, Tate JE, Dahl RM, Saydah S, Imperatore G, Gregg EW, Parashar UD. Rotavirus Vaccination and Type 1 Diabetes Risk Among US Children With Commercial Insurance. JAMA Pediatr 2020; 174:383-385. [PMID: 31961393 PMCID: PMC6990735 DOI: 10.1001/jamapediatrics.2019.5513] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study uses commercial insurance data to examine the association between rotavirus vaccination and type 1 diabetes incidence.
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Affiliation(s)
- Rachel M. Burke
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline E. Tate
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca M. Dahl
- Maximus Federal, Contracting Agency to the Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon Saydah
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edward W. Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umesh D. Parashar
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Al-Abdely HM, Midgley CM, Alkhamis AM, Abedi GR, Lu X, Binder AM, Alanazi KH, Tamin A, Banjar WM, Lester S, Abdalla O, Dahl RM, Mohammed M, Trivedi S, Algarni HS, Sakthivel SK, Algwizani A, Bafaqeeh F, Alzahrani A, Alsharef AA, Alhakeem RF, Jokhdar HAA, Ghazal SS, Thornburg NJ, Erdman DD, Assiri AM, Watson JT, Gerber SI. Middle East Respiratory Syndrome Coronavirus Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia. Emerg Infect Dis 2019; 25:753-766. [PMID: 30882305 PMCID: PMC6433025 DOI: 10.3201/eid2504.181595] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, particularly in relation to underlying medical conditions, clinical manifestations, and mortality. We enrolled MERS-CoV–positive patients at a hospital in Saudi Arabia and periodically collected specimens from multiple sites for real-time reverse transcription PCR and serologic testing. We conducted interviews and chart abstractions to collect clinical, epidemiologic, and laboratory information. We found that diabetes mellitus among survivors was associated with prolonged MERS-CoV RNA detection in the respiratory tract. Among case-patients who died, development of robust neutralizing serum antibody responses during the second and third week of illness was not sufficient for patient recovery or virus clearance. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics.
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14
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Rha B, Dahl RM, Moyes J, Binder AM, Tempia S, Walaza S, Bi D, Groome MJ, Variava E, Naby F, Kahn K, Treurnicht F, Cohen AL, Gerber SI, Madhi SA, Cohen C. Performance of Surveillance Case Definitions in Detecting Respiratory Syncytial Virus Infection Among Young Children Hospitalized With Severe Respiratory Illness-South Africa, 2009-2014. J Pediatric Infect Dis Soc 2019; 8:325-333. [PMID: 29931284 DOI: 10.1093/jpids/piy055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/05/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection (ALRTI) in young children, but data on surveillance case definition performance in estimating burdens have been limited. METHODS We enrolled children aged <5 years hospitalized for ALRTI (or neonatal sepsis in young infants) through active prospective surveillance at 5 sentinel hospitals in South Africa and collected nasopharyngeal aspirates from them for RSV molecular diagnostic testing between 2009 and 2014. Clinical data were used to characterize RSV disease and retrospectively evaluate the performance of respiratory illness case definitions (including the World Health Organization definition for severe acute respiratory infection [SARI]) in identifying hospitalized children with laboratory-confirmed RSV according to age group (<3, 3-5, 6-11, 12-23, and 24-59 months). RESULTS Of 9969 hospitalized children, 2723 (27%) tested positive for RSV. Signs and symptoms in RSV-positive children varied according to age; fever was less likely to occur in children aged <3 months (57%; odds ratio [OR], 0.8 [95% CI, 0.7-0.9]) but more likely in those aged ≥12 months (82%; OR, 1.7-1.9) than RSV-negative children. The sensitivity (range, 55%-81%) and specificity (range, 27%-54%) of the SARI case definition to identify hospitalized RSV-positive children varied according to age; the lowest sensitivity was for infants aged <6 months. Using SARI as the case definition would have missed 36% of RSV-positive children aged <5 years and 49% of those aged <3 months; removing the fever requirement from the definition recovered most missed cases. CONCLUSION Including fever in the SARI case definition lowers the sensitivity for RSV case detection among young children hospitalized with an ALRTI and likely underestimates its burden.
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Affiliation(s)
- Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Rebecca M Dahl
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia.,Maximus Federal, Atlanta, Georgia
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Alison M Binder
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Daoling Bi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Michelle J Groome
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Faculty of Health Sciences, Johannesburg, South Africa.,Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborative Centre for HIV/AIDS and TB, Johannesburg, South Africa.,Department of Medicine, Klerksdorp Tshepong Hospital, South Africa
| | - Fathima Naby
- Department of Paediatrics, Pietermaritzburg Metropolitan Hospitals, University of KwaZulu-Natal, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Sweden.,INDEPTH Network, Accra, Ghana
| | - Florette Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Department of Immunizations, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
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15
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Baker JM, Dahl RM, Cubilo J, Parashar UD, Lopman BA. Effects of the rotavirus vaccine program across age groups in the United States: analysis of national claims data, 2001-2016. BMC Infect Dis 2019; 19:186. [PMID: 30795739 PMCID: PMC6387516 DOI: 10.1186/s12879-019-3816-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 11/02/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The direct effectiveness of infant rotavirus vaccination implemented in 2006 in the United States has been evaluated extensively, however, understanding of population-level vaccine effectiveness (VE) is still incomplete. METHODS We analyzed time series data on rotavirus gastroenteritis (RVGE) and all-cause acute gastroenteritis (AGE) hospitalization rates in the United States from the MarketScan® Research Databases for July 2001-June 2016. Individuals were grouped into ages 0-4, 5-9, 10-14, 15-24, 25-44, and 45-64 years. Negative binomial regression models were fitted to monthly RVGE and AGE data to estimate the direct, indirect, overall, and total VE. RESULTS A total of 9211 RVGE and 726,528 AGE hospitalizations were analyzed. Children 0-4 years of age had the largest declines in RVGE hospitalizations with direct VE of 87% (95% CI: 83, 90%). Substantial indirect effects were observed across age groups and generally declined in each older group. Overall VE against RVGE hospitalizations for all ages combined was 69% (95% CI: 62, 76%). Total VE was highest among young children; a vaccinated child in the post-vaccine era has a 95% reduced risk of RVGE hospitalization compared to a child in the pre-vaccine era. We observed higher direct VE in odd post-vaccine years and an opposite pattern for indirect VE. CONCLUSIONS Vaccine benefits extended to unvaccinated individuals in all age groups, suggesting infants are important drivers of disease transmission across the population. Imperfect disease classification and changing disease incidence may lead to bias in observed direct VE. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Julia M Baker
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA. .,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30333, USA.
| | - Rebecca M Dahl
- MAXIMUS Federal, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Justin Cubilo
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30333, USA
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16
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Abstract
BACKGROUND The effectiveness of rotavirus vaccines in low and very low birth weight infants (LBW and VLBW) weighing <2500 and <1500 g at birth, respectively, a high-risk population for severe rotavirus gastroenteritis, has not been well examined. METHODS We analyzed inpatient commercial claims data for US children <5 years of age from July 2001 to June 2015. Claims for acute gastroenteritis (AGE) and rotavirus-coded hospitalizations and LBW, VLBW and normal birth weight (NBW) infants were identified. Receipt of rotavirus vaccine was defined using Current Procedural Terminology. Rate reductions were calculated using prevaccine (2001-2006) and postvaccine (2007-2015) annual AGE and rotavirus hospitalization rates. RESULTS As of December 2014, rotavirus vaccine coverage was 87%, 82% and 64%, for NBW, LBW and VLBW infants, respectively. For 2014-2015, among NBW, LBW and VLBW children <5 years of age, AGE hospitalization rate reductions relative to the prevaccine introduction period were 60% [95% confidence interval (CI): 58%-61%], 64% (95% CI: 57%-70%) and 55% (95% CI: 39%-67%), respectively. Rotavirus hospitalization rate reductions were 91% (95% CI: 90%-92%), 98% (95% CI: 93%-100%) and 93% (95% CI: 70%-98%). Rotavirus vaccines resulted in a 62% (95% CI: 51%-71%), 72% (95% CI: 44%-86%) and 71% (95% CI: 7%-91%) reduction in AGE hospitalization rates comparing vaccinated versus unvaccinated NBW, LBW and VLBW children 3-23 months of age, respectively. CONCLUSIONS Rotavirus vaccines have substantially reduced AGE hospitalizations and are highly effective in LBW and VLBW infants, similar to NBW infants. Efforts to improve vaccination coverage, particularly in LBW and VLBW infants, should continue.
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Affiliation(s)
- Rebecca M. Dahl
- MAXIMUS Federal, Contracting Agency to the Division of Viral Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Aaron T. Curns
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Jacqueline E. Tate
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Umesh D. Parashar
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
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17
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Harpaz R, Dahl RM. Administrative Data to Explore the Role of Family History as a Risk Factor for Herpes Zoster. Mayo Clin Proc 2018; 93:747-751. [PMID: 29731177 DOI: 10.1016/j.mayocp.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/03/2018] [Accepted: 02/14/2018] [Indexed: 01/07/2023]
Abstract
We used administrative data to study the impact of family history on the risk of herpes zoster (HZ). Our HZ cases and our HZ family history were both ascertained on the basis of medically attended diagnoses, without reliance on self-report or recall bias. Family history was associated with HZ risk among both siblings and parents. The strength of the association differed when the index child was latently infected with vaccine-strain vs wild-type varicella zoster virus.
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Affiliation(s)
- Rafael Harpaz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Rebecca M Dahl
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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18
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Killerby ME, Biggs HM, Haynes A, Dahl RM, Mustaquim D, Gerber SI, Watson JT. Human coronavirus circulation in the United States 2014-2017. J Clin Virol 2018; 101:52-56. [PMID: 29427907 PMCID: PMC7106380 DOI: 10.1016/j.jcv.2018.01.019] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human coronaviruses (HCoVs) -OC43, -229E, -NL63 and -HKU1 cause upper and lower respiratory tract infections. HCoVs are globally distributed and the predominant species may vary by region or year. Prior studies have shown seasonal patterns of HCoV species and annual variation in species prevalence but national circulation patterns in the US have not yet been described. OBJECTIVES To describe circulation patterns of HCoVs -OC43, -229E, -NL63 and -HKU1 in the US. STUDY DESIGN We reviewed real-time reverse transcription polymerase chain reaction (rRT-PCR) test results for HCoV-OC43, -229E, -NL63 and -HKU1 reported to The National Respiratory and Enteric Virus Surveillance System (NREVSS) by U.S. laboratories from July 2014-June 2017. We calculated the total number of tests and percent positive by week. For a subset of HCoV positive submissions with age and sex of the patient available, we tested for differences in age and sex across the four HCoV species using Chi Square and Kruskal Wallace tests. RESULTS 117 laboratories reported 854,575 HCoV tests; 2.2% were positive for HCoV-OC43, 1.0% for HCoV-NL63, 0.8% for HCoV-229E, and 0.6% for HCoV-HKU1. The percentage of positive tests peaked during December - March each year. No significant differences in sex were seen across species, although a significant difference in age distribution was noted. CONCLUSIONS Common HCoVs may have annual peaks of circulation in winter months in the US, and individual HCoVs may show variable circulation from year to year. Different HCoV species may be detected more frequently in different age groups. Further years of data are needed to better understand patterns of activity for HCoVs.
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Affiliation(s)
- Marie E Killerby
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | - Holly M Biggs
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Amber Haynes
- IHRC, Incorporated, Contracting agency to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Rebecca M Dahl
- MAXIMUS Federal, Contracting agency to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Desiree Mustaquim
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - John T Watson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
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19
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Prill MM, Dahl RM, Midgley CM, Chern SWW, Lu X, Feikin DR, Sakthivel SK, Nix WA, Watson JT, Gerber SI, Oberste MS. Severe Respiratory Illness Associated With Rhinovirus During the Enterovirus D68 Outbreak in the United States, August 2014–November 2014. Clin Infect Dis 2017; 66:1528-1534. [DOI: 10.1093/cid/cix1034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Mila M Prill
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - Rebecca M Dahl
- MAXIMUS Federal, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - Claire M Midgley
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - Shur-Wern Wang Chern
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - Xiaoyan Lu
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - Daniel R Feikin
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | | | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - John T Watson
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - Susan I Gerber
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention Atlanta, Georgia
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20
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Abstract
Background Human coronaviruses (HCoV) OC43, 229E, NL63 and HKU1 commonly cause upper respiratory tract infections, but can also cause severe lower respiratory tract disease. Increased use of diagnostic assays for respiratory viruses has facilitated detection and, since 2014, voluntary reporting of HCoV to the National Respiratory and Enteric Virus Surveillance System (NREVSS). Methods We reviewed weekly aggregate test results for HCoV OC43, 229E, NL63 and HKU1 voluntarily reported to NREVSS by U.S. hospital and clinical laboratories from July 1, 2014‒April 30, 2017. Laboratories reporting any HCoV result using PCR were included, and the weekly percentage of positive HCoV tests by type was calculated. For a subset of HCoV detections reported to NREVSS via the Public Health laboratory Interoperability Project (PHLIP), which collects individual-level demographic data, we described age distribution and sex. Age distribution by HCoV type was compared using the Kruskal–Wallis test. Results 154 laboratories, across all 9 U.S. census divisions, reported 834,742 tests for HCoV; 18,514 (2.2%) were positive for HCoV-OC43, 8,363 (1.0%) for HCoV-NL63, 6,828 (0.8%) for HCoV-229E, and 5,170 (0.6%) for HCoV-HKU1. The percentage of tests positive for HCoV generally peaked between December and March (Figure 1). HCoV-OC43 showed distinct annual peaks with variation in magnitude by year. HCoV-HKU1 and NL63 had similar patterns, each with notable peaks during winter 2016 compared with 2015 or 2017. HCoV-229E showed a discernable peak in 2017 compared with the previous 2 years. Of 20,533 individuals with HCoV test results reported via PHLIP, 1,589 (7.7%) tested positive for any HCoV; 50% of HCoV-positive individuals were male, and the median age was 22 (range 0–96) years. Age distribution differed between HCoV types (P < 0.01, Figure 2). Conclusion Over approximately 3 seasons, peak positivity for HCoV occurred during winter months, and annual differences in circulation by HCoV type were observed. Continued testing and surveillance for HCoV will allow for further characterization of circulation trends over time and by geographic region, and improved understanding of the contribution of HCoV to the winter respiratory virus season. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Holly M Biggs
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marie E Killerby
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amber K Haynes
- IHRC Inc., contracting agency to Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca M Dahl
- Maximus Federal, contracting agency to Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I Gerber
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John T Watson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Cardemil CV, Dahl RM, James L, Wannemuehler K, Gary HE, Shah M, Marin M, Riley J, Feikin DR, Patel M, Quinlisk P. Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control. N Engl J Med 2017; 377:947-956. [PMID: 28877026 PMCID: PMC6546095 DOI: 10.1056/nejmoa1703309] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The effect of a third dose of the measles-mumps-rubella (MMR) vaccine in stemming a mumps outbreak is unknown. During an outbreak among vaccinated students at the University of Iowa, health officials implemented a widespread MMR vaccine campaign. We evaluated the effectiveness of a third dose for outbreak control and assessed for waning immunity. METHODS Of 20,496 university students who were enrolled during the 2015-2016 academic year, mumps was diagnosed in 259 students. We used Fisher's exact test to compare unadjusted attack rates according to dose status and years since receipt of the second MMR vaccine dose. We used multivariable time-dependent Cox regression models to evaluate vaccine effectiveness, according to dose status (three vs. two doses and two vs. no doses) after adjustment for the number of years since the second dose. RESULTS Before the outbreak, 98.1% of the students had received at least two doses of MMR vaccine. During the outbreak, 4783 received a third dose. The attack rate was lower among the students who had received three doses than among those who had received two doses (6.7 vs. 14.5 cases per 1000 population, P<0.001). Students had more than nine times the risk of mumps if they had received the second MMR dose 13 years or more before the outbreak. At 28 days after vaccination, receipt of the third vaccine dose was associated with a 78.1% lower risk of mumps than receipt of a second dose (adjusted hazard ratio, 0.22; 95% confidence interval, 0.12 to 0.39). The vaccine effectiveness of two doses versus no doses was lower among students with more distant receipt of the second vaccine dose. CONCLUSIONS Students who had received a third dose of MMR vaccine had a lower risk of mumps than did those who had received two doses, after adjustment for the number of years since the second dose. Students who had received a second dose of MMR vaccine 13 years or more before the outbreak had an increased risk of mumps. These findings suggest that the campaign to administer a third dose of MMR vaccine improved mumps outbreak control and that waning immunity probably contributed to propagation of the outbreak. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Cristina V Cardemil
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Rebecca M Dahl
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Lisa James
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Kathleen Wannemuehler
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Howard E Gary
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Minesh Shah
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Mona Marin
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Jacob Riley
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Daniel R Feikin
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Manisha Patel
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
| | - Patricia Quinlisk
- From the Centers for Disease Control and Prevention, Atlanta (C.V.C., K.W., H.E.G., M.S., M.M., D.R.F., M.P.); Maximus Federal, Falls Church, VA (R.M.D.); and the University of Iowa (L.J.) and Johnson County Public Health (J.R.), Iowa City, and the Iowa Department of Public Health, Des Moines (P.Q.)
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Affiliation(s)
- Rafael Harpaz
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca M Dahl
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen L Dooling
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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