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Lewis NM, Zhu Y, Peltan ID, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Bender WS, Taghizadeh L, Brown SM, Hager DN, Gong MN, Mohamed A, Exline MC, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Mohr NM, Mallow C, Lauring AS, Johnson NJ, Gibbs KW, Kwon JH, Columbus C, Gottlieb RL, Raver C, Vaughn IA, Ramesh M, Johnson C, Lamerato L, Safdar B, Casey JD, Rice TW, Halasa N, Chappell JD, Grijalva CG, Talbot HK, Baughman A, Womack KN, Swan SA, Harker E, Price A, DeCuir J, Surie D, Ellington S, Self WH. Vaccine Effectiveness Against Influenza A-Associated Hospitalization, Organ Failure, and Death: United States, 2022-2023. Clin Infect Dis 2024; 78:1056-1064. [PMID: 38051664 DOI: 10.1093/cid/ciad677] [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: 08/09/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Influenza circulation during the 2022-2023 season in the United States largely returned to pre-coronavirus disease 2019 (COVID-19)-pandemic patterns and levels. Influenza A(H3N2) viruses were detected most frequently this season, predominately clade 3C.2a1b.2a, a close antigenic match to the vaccine strain. METHODS To understand effectiveness of the 2022-2023 influenza vaccine against influenza-associated hospitalization, organ failure, and death, a multicenter sentinel surveillance network in the United States prospectively enrolled adults hospitalized with acute respiratory illness between 1 October 2022, and 28 February 2023. Using the test-negative design, vaccine effectiveness (VE) estimates against influenza-associated hospitalization, organ failures, and death were measured by comparing the odds of current-season influenza vaccination in influenza-positive case-patients and influenza-negative, SARS-CoV-2-negative control-patients. RESULTS A total of 3707 patients, including 714 influenza cases (33% vaccinated) and 2993 influenza- and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative controls (49% vaccinated) were analyzed. VE against influenza-associated hospitalization was 37% (95% confidence interval [CI]: 27%-46%) and varied by age (18-64 years: 47% [30%-60%]; ≥65 years: 28% [10%-43%]), and virus (A[H3N2]: 29% [6%-46%], A[H1N1]: 47% [23%-64%]). VE against more severe influenza-associated outcomes included: 41% (29%-50%) against influenza with hypoxemia treated with supplemental oxygen; 65% (56%-72%) against influenza with respiratory, cardiovascular, or renal failure treated with organ support; and 66% (40%-81%) against influenza with respiratory failure treated with invasive mechanical ventilation. CONCLUSIONS During an early 2022-2023 influenza season with a well-matched influenza vaccine, vaccination was associated with reduced risk of influenza-associated hospitalization and organ failure.
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Affiliation(s)
- Nathaniel M Lewis
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah, and University of Utah, Salt Lake City, Utah, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple and Dallas, Texas, and Texas A&M University College of Medicine, Temple, Texas, USA
| | - Tresa McNeal
- Baylor Scott and White Health, and Baylor College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Leyla Taghizadeh
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah, and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St.Louis, Missouri, USA
| | | | - Robert L Gottlieb
- Baylor University Medical Center Dallas, Baylor, Scott & White Heart and Vascular Hospital, Baylor, Scott and White Research Institute, Dallas, Texas, USA
| | | | - Ivana A Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan, USA
| | - Cassandra Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Basmah Safdar
- Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Harker
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ashley Price
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Jennifer DeCuir
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Diya Surie
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sascha Ellington
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt Institute for Clinical and Translational Research, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Lauring AS, Gaglani M, Ghamande S, Peltan ID, Brown SM, Ginde AA, Martinez A, Mohr NM, Gibbs KW, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Bendall EE, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Mosier JM, Safdar B, Casey JD, Talbot HK, Rice TW, Halasa N, Chappell JD, Grijalva CG, Baughman A, Womack KN, Swan SA, Johnson CA, Lwin CT, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults. JAMA Netw Open 2024; 7:e244954. [PMID: 38573635 DOI: 10.1001/jamanetworkopen.2024.4954] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Importance On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making. Objective To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status. Design, Setting, and Participants In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023. Exposures RSV, SARS-CoV-2, or influenza infection. Main Outcomes and Measures Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death. Results Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001). Conclusions and Relevance Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.
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Affiliation(s)
- Diya Surie
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine A Yuengling
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer DeCuir
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Amanda Martinez
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | | | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicholas J Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | | | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Aleda M Leis
- School of Public Health, University of Michigan, Ann Arbor
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Emily E Bendall
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California, Los Angeles
| | - Steven Y Chang
- Department of Medicine, University of California, Los Angeles
| | | | - Jennie H Kwon
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Cristie Columbus
- Baylor Scott &White Health, Dallas, Texas
- Texas A&M University College of Medicine, Dallas
| | - Ivana A Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan
| | - Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona, Tucson
| | - Basmah Safdar
- Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cassandra A Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cara T Lwin
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathaniel M Lewis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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3
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Gigase FAJ, Jessel RH, Kaplowitz E, Boychuk N, Ohrn S, Ibroci E, Castro J, Lynch J, Tubassum R, Balbierz A, Molenaar NM, Graziani M, Missall R, Flores T, Stern T, Carreno JM, Krammer F, Adler A, Brody RI, Lesseur C, Chen J, Ellington S, Galang RR, Snead MC, Howell E, Stone J, Bergink V, Dolan S, Lieb W, Rommel AS, de Witte LD, Janevic T. SARS-CoV-2 infection, inflammation and birth outcomes in a prospective NYC pregnancy cohort. J Reprod Immunol 2024; 163:104243. [PMID: 38522364 DOI: 10.1016/j.jri.2024.104243] [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: 09/12/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
Associations between antenatal SARS-CoV-2 infection and pregnancy outcomes have been conflicting and the role of the immune system is currently unclear. This prospective cohort study investigated the interaction of antenatal SARS-CoV-2 infection, changes in cytokine and HS-CRP levels, birthweight and gestational age at birth. 2352 pregnant participants from New York City (2020-2022) were included. Plasma levels of interleukin (IL)-1β, IL-6, IL-17A and high-sensitivity C-reactive protein (HS-CRP) were quantified in blood specimens obtained across pregnancy. Quantile and linear regression models were conducted to 1) assess the impact of antenatal SARS-CoV-2 infection, overall and by timing of detection of SARS-CoV-2 positivity (< 20 weeks versus ≥ 20 weeks), on birthweight and gestational age at delivery; 2) examine the relationship between SARS-CoV-2 infection and maternal immune changes during pregnancy. All models were adjusted for maternal demographic and obstetric factors and pandemic timing. Birthweight models were additionally adjusted for gestational age at delivery and fetal sex. Immune marker models were also adjusted for gestational age at specimen collection and multiplex assay batch. 371 (15.8%) participants were infected with SARS-CoV-2 during pregnancy, of which 98 (26.4%) were infected at < 20 weeks gestation. Neither SARS-CoV-2 infection in general nor in early or late pregnancy was associated with lower birthweight nor earlier gestational age at delivery. Further, we did not observe cytokine or HS-CRP changes in response to SARS-CoV-2 infection and thus found no evidence to support a potential association between immune dysregulation and the diversity in pregnancy outcomes following infection.
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Affiliation(s)
- Frederieke A J Gigase
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Rebecca H Jessel
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Elianna Kaplowitz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Natalie Boychuk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sophie Ohrn
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Erona Ibroci
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Juliana Castro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jezelle Lynch
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rushna Tubassum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Amy Balbierz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Nina M Molenaar
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mara Graziani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Roy Missall
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Tammy Flores
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Toni Stern
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Juan Manuel Carreno
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Florian Krammer
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Adler
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rachel I Brody
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Corina Lesseur
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jia Chen
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sascha Ellington
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Romeo R Galang
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret C Snead
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Howell
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Siobhan Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lotje D de Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Teresa Janevic
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Kortsmit K, Salvesen von Essen B, Anstey E, Ellington S, Hernández Virella WI, D'Angelo DV, Strid P, Magly Olmos I, Vargas Bernal M, Warner L. Changes in Breastfeeding and Related Maternity Care Practices After Hurricanes Irma and Maria in Puerto Rico. Breastfeed Med 2024; 19:177-186. [PMID: 38489529 DOI: 10.1089/bfm.2023.0261] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background: Breastfeeding is recommended globally for most infants, especially during and after natural disasters when risk of adverse outcomes increases because of unsanitary conditions and lack of potable water. Materials and Methods: Using 2017-2019 data from Puerto Rico's Pregnancy Risk Assessment Monitoring System for 2,448 respondents with a recent live birth, we classified respondents into 4 hurricane exposure time periods based on infant birth month and year relative to when Hurricanes Irma and Maria occurred: (1) prehurricane; (2) acute hurricane; (3) posthurricane, early recovery; and (4) posthurricane, long-term recovery. We examined the association between maternity care practices during delivery hospitalization and exclusive breastfeeding at 3 months overall and stratified by time period. We also examined the associations between each maternity care practice and exclusive breastfeeding separately by time period. Results: Exclusive breastfeeding at 3 months was higher during the acute hurricane time period (adjusted prevalence ratio [aPR]: 1.43, 95% confidence interval: 1.09-1.87) than the prehurricane time period. Supportive maternity care practices were positively associated with exclusively breastfeeding, and practices that are risk factors for discontinuing breastfeeding were negatively associated with exclusive breastfeeding. Breastfeeding in the first hour (aPR range: 1.51-1.92) and rooming-in (aPR range: 1.50-2.58) were positively associated with exclusive breastfeeding across all time periods, except the prehurricane time period. Receipt of a gift pack with formula was negatively associated with exclusive breastfeeding (aPR range: 0.22-0.54) across all time periods. Conclusions: Maternity care practices during delivery hospitalization may influence breastfeeding behaviors and can improve breastfeeding during and after natural disasters. Strategies to maintain and improve these practices can be further supported during and after natural disasters.
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Affiliation(s)
- Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Beatriz Salvesen von Essen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erica Anstey
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanda I Hernández Virella
- Division of Maternal, Child, and Adolescent Health in the Puerto Rico Department of Health, San Juan, Puerto Rico, USA
| | - Denise V D'Angelo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Penelope Strid
- Division of Health Care Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Idennys Magly Olmos
- Division of Maternal, Child, and Adolescent Health in the Puerto Rico Department of Health, San Juan, Puerto Rico, USA
| | - Manuel Vargas Bernal
- Division of Maternal, Child, and Adolescent Health in the Puerto Rico Department of Health, San Juan, Puerto Rico, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Kortsmit K, Oduyebo T, Simeone RM, Kahn KE, Razzaghi H, Galang RR, Ellington S, Ruffo N, Barfield WD, Warner L, Cox S. Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2020. Public Health Rep 2024; 139:218-229. [PMID: 37386826 PMCID: PMC10851903 DOI: 10.1177/00333549231179252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVES Estimates of vaccination coverage during pregnancy and identification of disparities in vaccination coverage can inform vaccination campaigns and programs. We reported the prevalence of being offered or told to get the influenza vaccine by a health care provider (hereinafter, provider); influenza vaccination coverage during the 12 months before delivery; and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination coverage during pregnancy among women with a recent live birth in the United States. METHODS We analyzed 2020 data from the Pregnancy Risk Assessment Monitoring System from 42 US jurisdictions (n = 41 673). We estimated the overall prevalence of being offered or told to get the influenza vaccine by a provider and influenza vaccination coverage during the 12 months before delivery. We estimated Tdap vaccination coverage during pregnancy from 21 jurisdictions with available data (n = 22 020) by jurisdiction and select characteristics. RESULTS In 2020, 84.9% of women reported being offered or told to get the influenza vaccine, and 60.9% received it, ranging from 35.0% in Puerto Rico to 79.7% in Massachusetts. Influenza vaccination coverage was lower among women who were not offered or told to get the influenza vaccine (21.4%) than among women who were offered or told to get the vaccine (68.1%). Overall, 72.7% of women received the Tdap vaccine, ranging from 52.8% in Mississippi to 86.7% in New Hampshire. Influenza and Tdap vaccination coverage varied by all characteristics examined. CONCLUSIONS These results can inform vaccination programs and strategies to address disparities in vaccination coverage during pregnancy and may inform vaccination efforts for other infectious diseases among pregnant women.
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Affiliation(s)
- Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Titilope Oduyebo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Regina M. Simeone
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine E. Kahn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Leidos, Atlanta, GA, USA
| | - Hilda Razzaghi
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Romeo R. Galang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nan Ruffo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Full Circle Computing, Inc, Exton, PA, USA
| | - Wanda D. Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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6
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Frutos AM, Price AM, Harker E, Reeves EL, Ahmad HM, Murugan V, Martin ET, House S, Saade EA, Zimmerman RK, Gaglani M, Wernli KJ, Walter EB, Michaels MG, Staat MA, Weinberg GA, Selvarangan R, Boom JA, Klein EJ, Halasa NB, Ginde AA, Gibbs KW, Zhu Y, Self WH, Tartof SY, Klein NP, Dascomb K, DeSilva MB, Weber ZA, Yang DH, Ball SW, Surie D, DeCuir J, Dawood FS, Moline HL, Toepfer AP, Clopper BR, Link-Gelles R, Payne AB, Chung JR, Flannery B, Lewis NM, Olson SM, Adams K, Tenforde MW, Garg S, Grohskopf LA, Reed C, Ellington S. Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States. MMWR Morb Mortal Wkly Rep 2024; 73:168-174. [PMID: 38421935 PMCID: PMC10907036 DOI: 10.15585/mmwr.mm7308a3] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In the United States, annual influenza vaccination is recommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023-24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory illness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - CDC Influenza Vaccine Effectiveness Collaborators
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; Epidemic Intelligence Service, CDC; Biodesign Center for Personalized Diagnostics, Arizona State University, Tempe, Arizona; University of Michigan School of Public Health, Ann Arbor, Michigan; Washington University School of Medicine in St. Louis, St. Louis, Missouri; University Hospitals of Cleveland, Cleveland, Ohio; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Baylor Scott & White Health, Temple, Texas; Baylor College of Medicine, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina; UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; University of Rochester School of Medicine and Dentistry, Rochester, New York; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Children’s Mercy Hospital, Kansas City, Missouri; Baylor College of Medicine, Houston, Texas; Texas Children’s Hospital, Houston, Texas; Seattle Children’s Research Institute, Seattle, Washington; Vanderbilt University Medical Center, Nashville, Tennessee; University of Colorado School of Medicine, Aurora, Colorado; Wake Forest University School of Medicine, Winston-Salem, North Carolina; Kaiser Permanente Department of Research & Evaluation, Pasadena, California; Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California; Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Salt Lake City, Utah; HealthPartners Institute, Minneapolis, Minnesota; Westat, Rockville, Maryland; Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
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7
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DeCuir J, Payne AB, Self WH, Rowley EA, Dascomb K, DeSilva MB, Irving SA, Grannis SJ, Ong TC, Klein NP, Weber ZA, Reese SE, Ball SW, Barron MA, Naleway AL, Dixon BE, Essien I, Bride D, Natarajan K, Fireman B, Shah AB, Okwuazi E, Wiegand R, Zhu Y, Lauring AS, Martin ET, Gaglani M, Peltan ID, Brown SM, Ginde AA, Mohr NM, Gibbs KW, Hager DN, Prekker M, Mohamed A, Srinivasan V, Steingrub JS, Khan A, Busse LW, Duggal A, Wilson JG, Chang SY, Mallow C, Kwon JH, Exline MC, Columbus C, Vaughn IA, Safdar B, Mosier JM, Harris ES, Casey JD, Chappell JD, Grijalva CG, Swan SA, Johnson C, Lewis NM, Ellington S, Adams K, Tenforde MW, Paden CR, Dawood FS, Fleming-Dutra KE, Surie D, Link-Gelles R. Interim Effectiveness of Updated 2023-2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years - VISION and IVY Networks, September 2023-January 2024. MMWR Morb Mortal Wkly Rep 2024; 73:180-188. [PMID: 38421945 PMCID: PMC10907041 DOI: 10.15585/mmwr.mm7308a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In September 2023, CDC's Advisory Committee on Immunization Practices recommended updated 2023-2024 (monovalent XBB.1.5) COVID-19 vaccination for all persons aged ≥6 months to prevent COVID-19, including severe disease. However, few estimates of updated vaccine effectiveness (VE) against medically attended illness are available. This analysis evaluated VE of an updated COVID-19 vaccine dose against COVID-19-associated emergency department (ED) or urgent care (UC) encounters and hospitalization among immunocompetent adults aged ≥18 years during September 2023-January 2024 using a test-negative, case-control design with data from two CDC VE networks. VE against COVID-19-associated ED/UC encounters was 51% (95% CI = 47%-54%) during the first 7-59 days after an updated dose and 39% (95% CI = 33%-45%) during the 60-119 days after an updated dose. VE estimates against COVID-19-associated hospitalization from two CDC VE networks were 52% (95% CI = 47%-57%) and 43% (95% CI = 27%-56%), with a median interval from updated dose of 42 and 47 days, respectively. Updated COVID-19 vaccine provided increased protection against COVID-19-associated ED/UC encounters and hospitalization among immunocompetent adults. These results support CDC recommendations for updated 2023-2024 COVID-19 vaccination. All persons aged ≥6 months should receive updated 2023-2024 COVID-19 vaccine.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - CDC COVID-19 Vaccine Effectiveness Collaborators
- Coronavirus and Other
Respiratory Viruses Division, National Center for Immunization and Respiratory
Diseases, CDC; Vanderbilt University Medical Center, Nashville,
Tennessee; Westat,
Rockville, Maryland; Division of Infectious Diseases and Clinical Epidemiology,
Intermountain Healthcare, Salt Lake City, Utah; HealthPartners Institute,
Minneapolis, Minnesota; Kaiser Permanente Center for Health Research,
Portland, Oregon; Indiana University School of Medicine, Indianapolis,
Indiana; Regenstrief
Institute Center for Biomedical Informatics, Indianapolis, Indiana; University of Colorado
School of Medicine, Aurora, Colorado; Kaiser Permanente Vaccine Study Center, Kaiser
Permanente Northern California Division of Research, Oakland, California;
Department of
Biomedical Informatics, Columbia University Irving Medical Center, New York, New
York; New
York-Presbyterian Hospital, New York, New York; General Dynamics Information
Technology, Falls Church, Virginia; University of Michigan, Ann Arbor, Michigan;
Baylor Scott
& White Health, Texas; Baylor College of Medicine, Temple, Texas; Intermountain Medical
Center, Murray, Utah; University of Utah, Salt Lake City, Utah; University of Iowa, Iowa
City, Iowa; Wake
Forest School of Medicine, Winston-Salem, North Carolina; Johns Hopkins University School of
Medicine, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis,
Minnesota; Montefiore
Medical Center, Albert Einstein College of Medicine, New York, New York; University of Washington,
Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts;
Oregon Health
& Science University, Portland, Oregon; Emory University, Atlanta, Georgia; Cleveland Clinic,
Cleveland, Ohio; Stanford University School of Medicine, Stanford,
California; Ronald
Reagan UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida;
Washington
University in St. Louis, St. Louis, Missouri; The Ohio State University, Columbus,
Ohio; Texas A&M
University College of Medicine, Dallas, Texas; Henry Ford Health, Detroit,
Michigan; Yale
University School of Medicine, New Haven, Connecticut; University of Arizona, Tucson,
Arizona; Influenza
Division, National Center for Immunization and Respiratory Diseases, CDC
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8
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Meaney-Delman D, Carroll S, Polen K, Jatlaoui TC, Meyer S, Oliver S, Gee J, Shimabukuro T, Razzaghi H, Riley L, Galang RR, Tong V, Gilboa S, Ellington S, Cohn A. Planning for the future of maternal immunization: Building on lessons learned from the COVID-19 pandemic. Vaccine 2024:S0264-410X(24)00081-1. [PMID: 38423818 DOI: 10.1016/j.vaccine.2024.01.069] [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: 09/30/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
As the worldwide COVID-19 pandemic unfolded, the clinical and public health community raced to understand SARS-CoV-2 infection and develop life-saving vaccines. Pregnant persons were disproportionately impacted, experiencing more severe illness and adverse pregnancy outcomes. And yet, when COVID-19 vaccines became available in late 2020, safety and efficacy data were not available to inform their use during pregnancy because pregnant persons were excluded from pre-authorization clinical trials. Concerns about vaccine safety during pregnancy and misinformation linking vaccination and infertility circulated widely, creating a lack of vaccine confidence. Many pregnant people initially chose not to get vaccinated, and while vaccination rates rose after safety and effectiveness data became available, COVID-19 vaccine acceptance was suboptimal and varied across racial and ethnic distribution of the pregnant population. The COVID-19 pandemic experience provided valuable insights that can inform current and future approaches to maternal vaccination against.
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Affiliation(s)
- Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Sarah Carroll
- American College of Obstetricians and Gynecologists, Washington, D.C, United States
| | - Kara Polen
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tara C Jatlaoui
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Meyer
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sara Oliver
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julianne Gee
- Immunization Safety Office, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tom Shimabukuro
- Immunization Safety Office, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hilda Razzaghi
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laura Riley
- Department of Obstetrics and Gynecology, Weill Cornell School of Medicine, New York, NY, United States
| | - Romeo R Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Van Tong
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Suzanne Gilboa
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sascha Ellington
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amanda Cohn
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
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9
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Reeves EL, Neelam V, Carlson JM, Olsen EO, Fox CJ, Woodworth KR, Nestoridi E, Mobley E, Montero Castro S, Dzimira P, Sokale A, Sizemore L, Hall AJ, Ellington S, Cohn A, Gilboa SM, Tong VT. Pregnancy and infant outcomes following SARS-CoV-2 infection in pregnancy during delta variant predominance - Surveillance for Emerging Threats to Pregnant People and Infants. Am J Obstet Gynecol MFM 2024; 6:101265. [PMID: 38135220 DOI: 10.1016/j.ajogmf.2023.101265] [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: 09/29/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse birth outcomes such as preterm birth, stillbirth, and maternal and infant complications. Previous research suggests an increased risk of severe COVID-19 illness and stillbirth in pregnant people during delta variant predominance in 2021; however, those studies did not assess timing of infection during pregnancy, and few of them described COVID-19 vaccination status. OBJECTIVE Using a large population-based cohort, this study compared pregnancy and infant outcomes and described demographic and clinical characteristics of pregnant people with SARS-CoV-2 infection prior to and during the delta variant period. STUDY DESIGN This retrospective cohort analysis included persons with confirmed SARS-CoV-2 infection in pregnancy from 6 US jurisdictions reporting to the Surveillance for Emerging Threats to Pregnant People and Infants Network. Data were collected through case reports of polymerase chain reaction-positive pregnant persons and linkages to birth certificates, fetal death records, and immunization records. We described clinical characteristics and compared frequency of spontaneous abortion (<20 weeks of gestation), stillbirth (≥20 weeks), preterm birth (<37 weeks), small for gestational age, and term infant neonatal intensive care unit admission between the time periods of pre-delta and delta variant predominance. Study time periods were determined by when variants constituted more than 50% of sequences isolated according to regional SARS-CoV-2 genomic surveillance data, with time periods defined for pre-delta (March 3, 2020-June 25, 2021) and Delta (June 26, 2021-December 25, 2021). Adjusted prevalence ratios were estimated for each outcome measure using Poisson regression and were adjusted for continuous maternal age, race and ethnicity, and insurance status at delivery. RESULTS Among 57,563 pregnancy outcomes, 57,188 (99.3%) were liveborn infants, 65 (0.1%) were spontaneous abortions, and 310 (0.5%) were stillbirths. Most pregnant persons were unvaccinated at the time of SARS-CoV-2 infection, with a higher proportion in pre-delta (99.4%) than in the delta period (78.4%). Of those with infections during delta and who were previously vaccinated, the timing from last vaccination to infection was a median of 183 days. Compared to pre-delta, infections during delta were associated with a higher frequency of stillbirths (0.7% vs 0.4%; adjusted prevalence ratio, 1.55; 95% confidence interval, 1.14-2.09) and preterm births (12.8% vs 11.9%; adjusted prevalence ratio, 1.14; 95% confidence interval, 1.07-1.20). The delta period was associated with a lower frequency of neonatal intensive care unit admission (adjusted prevalence ratio, 0.74; 95% confidence interval, 0.67-0.82) than in the pre-delta period. During the delta period, infection during the third trimester was associated with a higher frequency of preterm birth (adjusted prevalence ratio, 1.41; 95% confidence interval, 1.28-1.56) and neonatal intensive care unit admission (adjusted prevalence ratio, 1.21; 95% confidence interval, 1.01-1.45) compared to the first and second trimester combined. CONCLUSION In this US-based cohort of persons with SARS-CoV-2 infection in pregnancy, the majority were unvaccinated, and frequencies of stillbirth and preterm birth were higher during the delta variant predominance period than in the pre-delta period. During the delta period, frequency of preterm birth and neonatal intensive care unit admission was higher among infections occurring in the third trimester vs those earlier in pregnancy. These findings demonstrate population-level increases of adverse fetal and infant outcomes, specifically in the presence of a COVID-19 variant with more severe presentation.
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Affiliation(s)
- Emily L Reeves
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox).
| | - Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Jeffrey M Carlson
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox)
| | - Emily O Olsen
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Charise J Fox
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox)
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Eirini Nestoridi
- Massachusetts Department of Public Health, Boston, MA (Dr Nestoridi)
| | - Evan Mobley
- Missouri Department of Health and Senior Services, Jefferson City, MO (Mr Mobley)
| | | | - Paula Dzimira
- Pennsylvania Department of Health, Pittsburgh, PA (Ms Dzimira)
| | - Ayomide Sokale
- Philadelphia Department of Public Health, Philadelphia, PA (Ms Sokale)
| | | | - Aron J Hall
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Dr Hall)
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Dr Ellington)
| | - Amanda Cohn
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
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10
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Carlson J, Simeone RM, Ellington S, Galang R, DeSisto CL, Fleming-Dutra K, Riley L, Meaney-Delman D, Tong VT. Pre-Delta, Delta, and Omicron Periods of the Coronavirus Disease 2019 (COVID-19) Pandemic and Health Outcomes During Delivery Hospitalization. Obstet Gynecol 2024; 143:131-138. [PMID: 37917932 PMCID: PMC10949122 DOI: 10.1097/aog.0000000000005449] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To examine the relationship between coronavirus disease 2019 (COVID-19) diagnosis at delivery and adverse maternal health and pregnancy outcomes during pre-Delta, Delta, and Omicron variant predominance, with a focus on the time period of Omicron variant predominance. METHODS We conducted a cross-sectional observational study with data from delivery hospitalizations in the Premier Healthcare Database from February 2020 to August 2023. The pre-Delta (February 2020-June 2021), Delta (July 2021-December 2021), and Omicron (January 2022-August 2023) periods of variant predominance were examined. Exposure to COVID-19 was identified by having a diagnostic code for COVID-19 during the delivery hospitalization. Adjusted prevalence ratios (aPRs) were calculated to compare the risks of adverse maternal and pregnancy outcomes for women with and without COVID-19 diagnoses at the time of delivery for each variant period. RESULTS Among 2,990,973 women with delivery hospitalizations, 1.9% (n=56,618) had COVID-19 diagnoses noted at delivery admission discharge, including 26,053 during the Omicron period. Across all variant time periods, the prevalence of many adverse maternal and pregnancy outcomes during the delivery hospitalization was significantly higher for pregnant women with COVID-19 compared with pregnant women without COVID-19. In adjusted models, COVID-19 during the Omicron period was associated with significant increased risks for maternal sepsis (COVID-19: 0.4% vs no COVID-19: 0.1%; aPR 3.32, 95% CI, 2.70-4.08), acute respiratory distress syndrome (0.6% vs 0.1%; aPR 6.19, 95% CI, 5.26-7.29), shock (0.2% vs 0.1%; aPR 2.14, 95% CI, 1.62-2.84), renal failure (0.5% vs 0.2%; aPR 2.08, 95% CI, 1.73-2.49), intensive care unit admission (2.7% vs 1.7%; aPR 1.64, 95% CI, 1.52-1.77), mechanical ventilation (0.3% vs 0.1%; aPR 3.15, 95% CI, 2.52-3.93), in-hospital death (0.03% vs 0.01%; aPR 5.00, 95% CI, 2.30-10.90), stillbirth (0.7% vs 0.6%; aPR 1.17, 95% CI, 1.01-1.36), and preterm delivery (12.3% vs 9.6%; aPR 1.28, 95% CI, 1.24-1.33). CONCLUSION Despite the possibility of some level of immunity due to previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, vaccination, or testing differences, risks of adverse outcomes associated with COVID-19 diagnosis at delivery remained elevated during the Omicron variant time period.
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Affiliation(s)
- Jeffrey Carlson
- Eagle Global Scientific, LLC, and the Division of Birth Defects and Infant Disorders, the Coronavirus and Other Respiratory Viruses Division, the Influenza Division, the Division of Reproductive Health, and the Division of Viral Disease, Centers for Disease Control and Prevention, Atlanta, Georgia; and Weill Cornell Medicine, New York, New York
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11
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Meeker JR, Strid P, Simeone R, D'Angelo DV, Dieke A, von Essen BS, Galang RR, Zapata LB, Ellington S. Pandemic-related stressors and mental health among women with a live birth in 2020. Arch Womens Ment Health 2023; 26:767-776. [PMID: 37608095 PMCID: PMC11025528 DOI: 10.1007/s00737-023-01364-7] [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] [Received: 02/16/2023] [Accepted: 08/12/2023] [Indexed: 08/24/2023]
Abstract
The objective of this analysis was to assess the associations between pandemic-related stressors and feeling more anxious/depressed, among women with a live birth. We analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS) COVID-19 maternal experiences supplement, implemented in 29 U.S. jurisdictions from October 2020-June 2021, among women with a live birth during April-December 2020. We examined stressors by type (economic, housing, childcare, food insecurity, partner, COVID-19 illness) and score (number of stressor types experienced [none, 1-2, 3-4, or 5-6]). Outcomes were feeling 1) more anxious and 2) more depressed than usual due to the pandemic. We calculated adjusted prevalence ratios estimating associations between stressors and outcomes. Among 12,525 respondents, half reported feeling more anxious and 28% more depressed than usual. The prevalence of stressor types was 50% economic, 41% childcare, 18% partner, 17% food insecurity, 12% housing, and 10% COVID-19 illness. Respondents who experienced partner stressors (anxious aPR: 1.81, 95% CI: 1.73-1.90; depressed aPR: 3.01, 95% CI: 2.78-3.25) and food insecurity (anxious aPR: 1.79, 95% CI: 1.71-1.88; depressed aPR: 2.32, 95% CI: 2.13-2.53) had the largest associations with feeling more anxious and depressed than usual. As stressor scores increased, so did the aPRs for feeling more anxious and more depressed due to the pandemic. COVID-19 stressors, not COVID-19 illness, were found to be significantly associated with feeling more anxious and depressed. Pregnant and postpartum women might benefit from access to supports and services to address pandemic-related stressors/social-determinants and feelings of anxiety and depression.
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Affiliation(s)
- Jessica R Meeker
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA.
| | - Penelope Strid
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Regina Simeone
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Denise V D'Angelo
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Ada Dieke
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | | | - Romeo R Galang
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Lauren B Zapata
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Sascha Ellington
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Gaglani M, Ginde AA, Talbot HK, Casey JD, Mohr NM, Ghamande S, Gibbs KW, Files DC, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Safdar B, Halasa N, Chappell JD, Grijalva CG, Baughman A, Rice TW, Womack KN, Han JH, Swan SA, Mukherjee I, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Disease Severity of Respiratory Syncytial Virus Compared with COVID-19 and Influenza Among Hospitalized Adults Aged ≥60 Years - IVY Network, 20 U.S. States, February 2022-May 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1083-1088. [PMID: 37796753 PMCID: PMC10564326 DOI: 10.15585/mmwr.mm7240a2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
On June 21, 2023, CDC's Advisory Committee on Immunization Practices recommended respiratory syncytial virus (RSV) vaccination for adults aged ≥60 years, offered to individual adults using shared clinical decision-making. Informed use of these vaccines requires an understanding of RSV disease severity. To characterize RSV-associated severity, 5,784 adults aged ≥60 years hospitalized with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 U.S. states during February 1, 2022-May 31, 2023. Multivariable logistic regression was used to compare RSV disease severity with COVID-19 and influenza severity on the basis of the following outcomes: 1) standard flow (<30 L/minute) oxygen therapy, 2) high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV), 3) intensive care unit (ICU) admission, and 4) invasive mechanical ventilation (IMV) or death. Overall, 304 (5.3%) enrolled adults were hospitalized with RSV, 4,734 (81.8%) with COVID-19 and 746 (12.9%) with influenza. Patients hospitalized with RSV were more likely to receive standard flow oxygen, HFNC or NIV, and ICU admission than were those hospitalized with COVID-19 or influenza. Patients hospitalized with RSV were more likely to receive IMV or die compared with patients hospitalized with influenza (adjusted odds ratio = 2.08; 95% CI = 1.33-3.26). Among hospitalized older adults, RSV was less common, but was associated with more severe disease than COVID-19 or influenza. High disease severity in older adults hospitalized with RSV is important to consider in shared clinical decision-making regarding RSV vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Vanderbilt University Medical Center, Nashville, Tennessee; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Baylor, Scott & White Health, Dallas, Texas; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, New York, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Stanford, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; The Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Henry Ford Health, Detroit, Michigan; Yale University School of Medicine, New Haven, Connecticut; Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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13
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Meghani M, Salvesen Von Essen B, Zapata LB, Polen K, Galang RR, Razzaghi H, Meaney-Delman D, Waits G, Ellington S. COVID-19 Vaccination Recommendations and Practices for Women of Reproductive Age by Health Care Providers - Fall DocStyles Survey, United States, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:1045-1051. [PMID: 37768870 PMCID: PMC10545435 DOI: 10.15585/mmwr.mm7239a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Pregnant and postpartum women are at increased risk for severe illness from COVID-19 compared with nonpregnant women of reproductive age. COVID-19 vaccination is recommended for all persons ≥6 months of age. Health care providers (HCPs) have a unique opportunity to counsel women of reproductive age, including pregnant and postpartum patients, about the importance of receiving COVID-19, influenza, and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. Data from the Fall 2022 DocStyles survey were analyzed to examine the prevalence of COVID-19 vaccination attitudes and practices among HCPs caring for women of reproductive age, and to determine whether providers recommended and offered or administered COVID-19 vaccines to women of reproductive age, including their pregnant patients. Overall, 82.9% of providers reported recommending COVID-19 vaccination to women of reproductive age, and 54.7% offered or administered the vaccine in their practice. Among HCPs who cared for pregnant patients, obstetrician-gynecologists were more likely to recommend COVID-19 vaccination to pregnant patients (94.2%) than were family practitioners or internists (82.1%) (adjusted prevalence ratio [aPR] = 1.1). HCPs were more likely to offer or administer COVID-19 vaccination on-site to pregnant patients if they also offered or administered influenza (aPR = 5.5) and Tdap vaccines (aPR = 2.3). Encouraging HCPs to recommend, offer, and administer the COVID-19 vaccines along with influenza or Tdap vaccines might help reinforce vaccine confidence and increase coverage among women of reproductive age, including pregnant women.
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14
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Sharpe JD, Charniga K, Byrd KM, Stefanos R, Lewis L, Watson J, Feldpausch A, Pavlick J, Hand J, Sokol T, Ortega E, Pathela P, Hennessy RR, Dulcey M, McHugh L, Pietrowski M, Perella D, Shah S, Maroufi A, Taylor M, Cope A, Belay ED, Ellington S, McCollum AM, Zilversmit Pao L, Guagliardo SAJ, Dawson P. Possible Exposures Among Mpox Patients Without Reported Male-to-Male Sexual Contact - Six U.S. Jurisdictions, November 1-December 14, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:944-948. [PMID: 37651279 DOI: 10.15585/mmwr.mm7235a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The extent to which the 2022 mpox outbreak has affected persons without a recent history of male-to-male sexual contact (MMSC) is not well understood. During November 1-December 14, 2022, CDC partnered with six jurisdictional health departments to characterize possible exposures among mpox patients aged ≥18 years who did not report MMSC during the 3 weeks preceding symptom onset. Among 52 patients included in the analysis, 14 (27%) had a known exposure to a person with mpox, including sexual activity and other close intimate contact (eight) and household contact (six). Among 38 (73%) patients with no known exposure to a person with mpox, self-reported activities before illness onset included sexual activity and other close intimate contact (17; 45%), close face-to-face contact (14; 37%), attending large social gatherings (11; 29%), and being in occupational settings involving close skin-to-skin contact (10; 26%). These findings suggest that sexual activity remains an important route of mpox exposure among patients who do not report MMSC.
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Kota KK, Chesson H, Hong J, Zelaya C, Spicknall IH, Riser AP, Hurley E, Currie DW, Lash RR, Carnes N, Concepción-Acevedo J, Ellington S, Belay ED, Mermin J. Progress Toward Equitable Mpox Vaccination Coverage: A Shortfall Analysis - United States, May 2022-April 2023. MMWR Morb Mortal Wkly Rep 2023; 72:627-632. [PMID: 37289660 DOI: 10.15585/mmwr.mm7223a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
More than 30,000 monkeypox (mpox) cases were reported in the United States during the 2022 multinational outbreak; cases disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Substantial racial and ethnic disparities in incidence were also reported (1). The national mpox vaccination strategy* emphasizes that efforts to administer the JYNNEOS mpox vaccine should be focused among the populations at elevated risk for exposure to mpox (2). During May 2022-April 2023, a total of 748,329 first JYNNEOS vaccine doses (of the two recommended) were administered in the United States.† During the initial months of the outbreak, lower vaccination coverage rates among racial and ethnic minority groups were reported (1,3); however, after implementation of initiatives developed to expand access to mpox vaccination,§ coverage among racial and ethnic minority groups increased (1,4). A shortfall analysis was conducted to examine whether the increase in mpox vaccination coverage was equitable across all racial and ethnic groups (5). Shortfall was defined as the percentage of the vaccine-eligible population that did not receive the vaccine (i.e., 100% minus the percentage of the eligible population that did receive a first dose). Monthly mpox vaccination shortfalls were calculated and were stratified by race and ethnicity; monthly percent reductions in shortfall were also calculated compared with the preceding month's shortfall (6). The mpox vaccination shortfall decreased among all racial and ethnic groups during May 2022-April 2023; however, based on analysis of vaccine administration data with race and ethnicity reported, 66.0% of vaccine-eligible persons remained unvaccinated at the end of this period. The shortfall was largest among non-Hispanic Black or African American (Black) (77.9%) and non-Hispanic American Indian or Alaska Native (AI/AN) (74.5%) persons, followed by non-Hispanic White (White) (66.6%) and Hispanic or Latino (Hispanic) (63.0%) persons, and was lowest among non-Hispanic Asian (Asian) (38.5%) and non-Hispanic Native Hawaiian and other Pacific Islander (NH/OPI) (43.7%) persons. The largest percentage decreases in the shortfall were achieved during August (17.7%) and September (8.5%). However, during these months, smaller percentage decreases were achieved among Black persons (12.2% and 4.9%, respectively), highlighting the need for a focus on equity for the entirety of a public health response. Achieving equitable progress in JYNNEOS vaccination coverage will require substantial decreases in shortfalls among Black and AI/AN persons.
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Wallace B, Chang D, O'Malley Olsen E, Flannery DD, Tong VT, Ellington S, Woodworth KR. Critical care among newborns with and without a COVID-19 diagnosis, May 2020-February 2022. J Perinatol 2023; 43:766-774. [PMID: 37117394 PMCID: PMC10141806 DOI: 10.1038/s41372-023-01663-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 03/22/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To assess COVID-19 association with newborn critical care outcomes, including nursery level of care and ventilation, during three time periods: Pre-delta (May 2020-June 2021), Delta (July-November 2021), and Omicron (December 2021-February 2022). STUDY DESIGN In a retrospective cohort of newborns born May 2020-February 2022 using the Premier Healthcare Database, we classified COVID-19 status and critical care using International Classification of Diseases 10th Revision and Current Procedural Terminology codes, laboratory data, and billing records and assessed for variation during three time periods. RESULTS Of 1,388,712 newborns, 0.06% had COVID-19 during the birth hospitalization (Pre-delta period: 0.03%; Delta: 0.07%; Omicron: 0.21%). Among newborns with COVID-19, the risks for admission to a higher-level nursery and for invasive or non-invasive ventilation were lower in the Omicron period compared to Pre-delta and Delta periods. CONCLUSION From May 2020-February 2022, COVID-19 in newborns was rare and cases were less severe during the period of Omicron predominance.
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Affiliation(s)
- Bailey Wallace
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Daniel Chang
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Eagle Global Scientific, LLC, Atlanta, GA, USA
| | - Emily O'Malley Olsen
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dustin D Flannery
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sascha Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zelaya CE, Smith BP, Riser AP, Hong J, Distler S, O'Connor S, Belay E, Shoeb M, Waltenburg MA, Negron ME, Ellington S. Urban and Rural Mpox Incidence Among Persons Aged 15-64 Years - United States, May 10-December 31, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:574-578. [PMID: 37227985 DOI: 10.15585/mmwr.mm7221a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
During May 10-December 31, 2022, a total of 29,980 confirmed and probable† U.S. monkeypox (mpox) cases were reported to CDC, predominantly in cisgender adult men reporting recent same-gender sexual partners (1). Urban-rural differences in health (2) and diagnosis of HIV (3,4) and other sexually transmitted infections (5) are well documented nationally. This report describes urban-rural differences in mpox incidence (cases per 100,000 population) among persons aged 15-64 years, by gender and race and ethnicity. Urbanicity was assessed using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties (2). Substantial differences in incidence by urbanicity, gender, and race and ethnicity were observed; most (71.0%) cases occurred in persons residing in large central urban areas. Among the cases in large central urban areas, most (95.7%) were in cisgender men. The overall incidence of mpox in the United States was 13.5 per 100,000 persons aged 15-64 years and peaked in August in both urban and rural areas. Among cisgender men, incidence in rural areas was approximately 4% that in large central urban areas (risk ratio [RR] = 0.04). Among cisgender women, incidence in rural areas was approximately 11% that in large central urban areas (RR = 0.11). In both urban and rural areas, incidence among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) persons was consistently higher than that among non-Hispanic White (White) persons; RRs between Black and White persons were highest in rural areas. Support and maintenance of mpox surveillance and prevention efforts including vaccinations should focus on urban areas with the highest incidence of mpox during the 2022 outbreak; however, surveillance and prevention efforts should include all genders, persons of color, and persons residing in both urban and rural areas who are at increased risk for mpox.
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McQuiston JH, Braden CR, Bowen MD, McCollum AM, McDonald R, Carnes N, Carter RJ, Christie A, Doty JB, Ellington S, Fehrenbach SN, Gundlapalli AV, Hutson CL, Kachur RE, Maitland A, Pearson CM, Prejean J, Quilter LAS, Rao AK, Yu Y, Mermin J. The CDC Domestic Mpox Response - United States, 2022-2023. MMWR Morb Mortal Wkly Rep 2023; 72:547-552. [PMID: 37200231 DOI: 10.15585/mmwr.mm7220a2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.S. Public Health Emergency on August 4, 2022, by the U.S. Department of Health and Human Services.† A U.S. government response was initiated, and CDC coordinated activities with the White House, the U.S. Department of Health and Human Services, and many other federal, state, and local partners. CDC quickly adapted surveillance systems, diagnostic tests, vaccines, therapeutics, grants, and communication systems originally developed for U.S. smallpox preparedness and other infectious diseases to fit the unique needs of the outbreak. In 1 year, more than 30,000 U.S. mpox cases were reported, more than 140,000 specimens were tested, >1.2 million doses of vaccine were administered, and more than 6,900 patients were treated with tecovirimat, an antiviral medication with activity against orthopoxviruses such as Variola virus and Monkeypox virus. Non-Hispanic Black (Black) and Hispanic or Latino (Hispanic) persons represented 33% and 31% of mpox cases, respectively; 87% of 42 fatal cases occurred in Black persons. Sexual contact among gay, bisexual, and other men who have sex with men (MSM) was rapidly identified as the primary risk for infection, resulting in profound changes in our scientific understanding of mpox clinical presentation, pathogenesis, and transmission dynamics. This report provides an overview of the first year of the response to the U.S. mpox outbreak by CDC, reviews lessons learned to improve response and future readiness, and previews continued mpox response and prevention activities as local viral transmission continues in multiple U.S. jurisdictions (Figure).
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Dawood FS, Tita A, Stockwell MS, Newes-Adeyi G, Wielgosz K, Gyamfi-Bannerman C, Battarbee A, Reichle L, Thornburg N, Ellington S, Galang RR, Vorwaller K, Vargas CY, Morrill T, Parks M, Powers E, Gibson M, Varner M. Neutralizing Antibody Responses to Messenger RNA Coronavirus Disease 2019 Vaccines Versus Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Pregnant Women and Vaccine-Induced Antibody Transfer to Infants. Open Forum Infect Dis 2023; 10:ofad204. [PMID: 37187508 PMCID: PMC10167992 DOI: 10.1093/ofid/ofad204] [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: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Background Early coronavirus disease 2019 (COVID-19) vaccine trials excluded pregnant women, resulting in limited data about immunogenicity and maternal-fetal antibody transfer, particularly by gestational timing of vaccination. Methods In this multicenter observational immunogenicity study, pregnant and nonpregnant women receiving COVID-19 vaccines were prospectively enrolled. Participants had sera collected before vaccination, at 14-28 days after each vaccine dose, at delivery (umbilical cord and peripheral), and from their infants at 3 and 6 months. Geometric mean titers (GMTs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ID50 neutralizing antibody (nAb) against D614G-like viruses were compared by participant characteristics. Results Overall, 23 nonpregnant and 85 pregnant participants (trimester of first vaccine dose: 10 first, 47 second, 28 third) were enrolled. Ninety-three percent (76/82 with blood samples) of pregnant participants had detectable SARS-CoV-2 nAb after 2 vaccine doses, but GMTs (95% confidence intervals) were lower in pregnant participants than nonpregnant participants (1722 [1136-2612] vs 4419 [2012-9703]; P = .04). By 3 and 6 months, 28% and 74% of infants, respectively, of vaccinated participants had no detectable nAb to D614G-like viruses. Among the 71 pregnant participants without detectable nAb before vaccination, cord blood GMTs at delivery were 5-fold higher among participants vaccinated during the third versus first trimester, and cord blood nAb titers appeared inversely correlated with weeks since first vaccine dose (R2 = 0.06, P = .06). Conclusions Though most pregnant women develop nAb after 2 doses of mRNA COVID-19 vaccines, this analysis suggests that infant protection from maternal vaccination varies by gestational timing of vaccination and wanes. Additional prevention strategies such as caregiver vaccination may warrant consideration to optimize infant protection.
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Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alan Tita
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa S Stockwell
- New York–Presbyterian Hospital, New York, New York, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Kristina Wielgosz
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia Gyamfi-Bannerman
- New York–Presbyterian Hospital, New York, New York, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
| | - Ashley Battarbee
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Natalie Thornburg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha Ellington
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Romeo R Galang
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | | | - Mickey Parks
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily Powers
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie Gibson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Kota KK, Hong J, Zelaya C, Riser AP, Rodriguez A, Weller DL, Spicknall IH, Kriss JL, Lee F, Boersma P, Hurley E, Hicks P, Wilkins C, Chesson H, Concepción-Acevedo J, Ellington S, Belay E, Mermin J. Racial and Ethnic Disparities in Mpox Cases and Vaccination Among Adult Males - United States, May-December 2022. MMWR Morb Mortal Wkly Rep 2023; 72:398-403. [PMID: 37053122 PMCID: PMC10121252 DOI: 10.15585/mmwr.mm7215a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
As of December 31, 2022, a total of 29,939 monkeypox (mpox) cases* had been reported in the United States, 93.3% of which occurred in adult males. During May 10-December 31, 2022, 723,112 persons in the United States received the first dose in a 2-dose mpox (JYNNEOS)† vaccination series; 89.7% of these doses were administered to males (1). The current mpox outbreak has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and racial and ethnic minority groups (1,2). To examine racial and ethnic disparities in mpox incidence and vaccination rates, rate ratios (RRs) for incidence and vaccination rates and vaccination-to-case ratios were calculated, and trends in these measures were assessed among males aged ≥18 years (males) (3). Incidence in males in all racial and ethnic minority groups except non-Hispanic Asian (Asian) males was higher than that among non-Hispanic White (White) males. At the peak of the outbreak in August 2022, incidences among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) males were higher than incidence among White males (RR = 6.9 and 4.1, respectively). Overall, vaccination rates were higher among males in racial and ethnic minority groups than among White males. However, the vaccination-to-case ratio was lower among Black (8.8) and Hispanic (16.2) males than among White males (42.5) during the full analytic period, indicating that vaccination rates among Black and Hispanic males were not proportionate to the elevated incidence rates (i.e., these groups had a higher unmet vaccination need). Efforts to increase vaccination among Black and Hispanic males might have resulted in the observed relative increased rates of vaccination; however, these increases were only partially successful in reducing overall incidence disparities. Continued implementation of equity-based vaccination strategies is needed to further increase vaccination rates and reduce the incidence of mpox among all racial and ethnic groups. Recent modeling data (4) showing that, based on current vaccination coverage levels, many U.S. jurisdictions are vulnerable to resurgent mpox outbreaks, underscore the need for continued vaccination efforts, particularly among racial and ethnic minority groups.
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21
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Riser AP, Hanley A, Cima M, Lewis L, Saadeh K, Alarcón J, Finn L, Kim M, Adams J, Holt D, Feldpausch A, Pavlick J, English A, Smith M, Rehman T, Lubelchek R, Black S, Collins M, Mounsey L, Blythe D, Avalos MH, Lee EH, Samson O, Wong M, Stokich BD, Salehi E, Denny L, Waller K, Talley P, Schuman J, Fischer M, White S, Davis K, Caeser Cuyler A, Sabzwari R, Anderson RN, Byrd K, Gold JAW, Kindilien S, Lee JT, O’Connor S, O’Shea J, Salmon-Trejo LAT, Velazquez-Kronen R, Zelaya C, Bower W, Ellington S, Gundlapalli AV, McCollum AM, Zilversmit Pao L, Rao AK, Wong KK, Guagliardo SAJ. Epidemiologic and Clinical Features of Mpox-Associated Deaths - United States, May 10, 2022-March 7, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:404-410. [PMID: 37053126 PMCID: PMC10121256 DOI: 10.15585/mmwr.mm7215a5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
As of March 7, 2023, a total of 30,235 confirmed and probable monkeypox (mpox) cases were reported in the United States,† predominantly among cisgender men§ who reported recent sexual contact with another man (1). Although most mpox cases during the current outbreak have been self-limited, cases of severe illness and death have been reported (2-4). During May 10, 2022-March 7, 2023, 38 deaths among persons with probable or confirmed mpox¶ (1.3 per 1,000 mpox cases) were reported to CDC and classified as mpox-associated (i.e., mpox was listed as a contributing or causal factor). Among the 38 mpox-associated deaths, 94.7% occurred in cisgender men (median age = 34 years); 86.8% occurred in non-Hispanic Black or African American (Black) persons. The median interval from symptom onset to death was 68 days (IQR = 50-86 days). Among 33 decedents with available information, 93.9% were immunocompromised because of HIV. Public health actions to prevent mpox deaths include integrated testing, diagnosis, and early treatment for mpox and HIV, and ensuring equitable access to both mpox and HIV prevention and treatment, such as antiretroviral therapy (ART) (5).
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22
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Meghani M, Zapata LB, Polen K, Galang RR, Razzaghi H, Meaney-Delman D, Ellington S. COVID-19 vaccination recommendations and practices for women of reproductive age, U.S. Physicians, Fall 2021. Prev Med Rep 2023; 32:102141. [PMID: 36816768 PMCID: PMC9922671 DOI: 10.1016/j.pmedr.2023.102141] [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: 09/29/2022] [Revised: 12/09/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Pregnant people with COVID-19 are at increased risk for severe illness and adverse pregnancy outcomes. COVID-19 vaccinations are safe and effective, including for pregnant and recently pregnant people. The objective of this analysis was to describe the extent to which primary care physicians across the United States report confidence in talking with female patients of reproductive age about COVID-19 vaccination, recommending COVID-19 vaccinations to pregnant patients, and offering COVID-19 vaccinations at their practices in fall 2021. We analyzed cross-sectional data from the Fall 2021 DocStyles survey, a web-based panel survey of U.S. primary healthcare providers (64% response rate). Family practitioners/internists, obstetrician-gynecologists, and pediatricians were asked about confidence in talking with female patients of reproductive age about COVID-19 vaccination, vaccination practices regarding pregnant patients, and offering COVID-19 vaccinations. We describe results overall and by select physician characteristics. Among 1501 respondents, most were family practitioners/internists (67%), 17% were obstetrician-gynecologists, and 17% were pediatricians. Overall, 63% were very confident talking with female patients of reproductive age about COVID-19 vaccination, 80% recommended pregnant patients get vaccinated as soon as possible, and 50% offered COVID-19 vaccinations at their current practice. Obstetrician-gynecologists were most confident in talking with female patients, but only one-third offered the vaccine at their practices. This analysis found that most physicians felt confident talking about COVID-19 vaccinations and recommended pregnant patients get vaccinated as soon as possible. Provider recommendation for vaccination remains a key strategy for achieving high vaccination coverage, and consistent recommendations may improve vaccine acceptance among pregnant and postpartum people.
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Affiliation(s)
- Mehreen Meghani
- Centers for Disease Control and Prevention Foundation, Atlanta, GA, United States,Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States,Corresponding author at: Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
| | - Lauren B. Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kara Polen
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Romeo R. Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hilda Razzaghi
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sascha Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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23
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Meghani M, Razzaghi H, Kahn KE, Hung MC, Srivastav A, Lu PJ, Ellington S, Zhou F, Weintraub E, Black CL, Singleton JA. Surveillance Systems for Monitoring Vaccination Coverage with Vaccines Recommended for Pregnant Women, United States. J Womens Health (Larchmt) 2023; 32:260-270. [PMID: 36884385 DOI: 10.1089/jwh.2022.0445] [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: 03/09/2023] Open
Abstract
Pregnant women* and their infants are at increased risk for serious influenza, pertussis, and COVID-19-related complications, including preterm birth, low-birth weight, and maternal and fetal death. The advisory committee on immunization practices recommends pregnant women receive tetanus-toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy, and influenza and COVID-19 vaccines before or during pregnancy. Vaccination coverage estimates and factors associated with maternal vaccination are measured by various surveillance systems. The objective of this report is to provide a detailed overview of the following surveillance systems that can be used to assess coverage of vaccines recommended for pregnant women: Internet panel survey, National Health Interview Survey, National Immunization Survey-Adult COVID Module, Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Vaccine Safety Datalink, and MarketScan. Influenza, Tdap, and COVID-19 vaccination coverage estimates vary by data source, and select estimates are presented. Each surveillance system differs in the population of pregnant women, time period, geographic area for which estimates can be obtained, how vaccination status is determined, and data collected regarding vaccine-related knowledge, attitudes, behaviors, and barriers. Thus, multiple systems are useful for a more complete understanding of maternal vaccination. Ongoing surveillance from the various systems to obtain vaccination coverage and information regarding disparities and barriers related to vaccination are needed to guide program and policy improvements.
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Affiliation(s)
- Mehreen Meghani
- CDC Foundation, Atlanta, Georgia, USA.,Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Hilda Razzaghi
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Katherine E Kahn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA.,Leidos, Inc., Atlanta, Georgia, USA
| | - Mei-Chuan Hung
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA.,Leidos, Inc., Atlanta, Georgia, USA
| | - Anup Srivastav
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA.,Leidos, Inc., Atlanta, Georgia, USA
| | - Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Fangjun Zhou
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Eric Weintraub
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections, CDC, Atlanta, Georgia, USA
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
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24
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Affiliation(s)
- Sascha Ellington
- Division of Reproductive Health, Centers for Disease Control (CDC) and Prevention, Atlanta, GA 30329, USA.
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25
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Ibroci E, Liu X, Lieb W, Jessel R, Gigase FAJ, Chung K, Graziani M, Lieber M, Ohrn S, Lynch J, Castro J, Marshall C, Tubassum R, Mutawakil F, Kaplowitz ET, Ellington S, Molenaar N, Sperling RS, Howell EA, Janevic T, Dolan SM, Stone J, De Witte LD, Bergink V, Rommel AS. Impact of prenatal COVID-19 vaccination on delivery and neonatal outcomes: Results from a New York City cohort. Vaccine 2023; 41:649-656. [PMID: 36526507 PMCID: PMC9749885 DOI: 10.1016/j.vaccine.2022.09.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022]
Abstract
Research suggest prenatal vaccination against coronavirus disease-19 (COVID-19) is safe. However, previous studies utilized retrospectively collected data or examined late pregnancy vaccinations. We investigated the associations of COVID-19 vaccination throughout pregnancy with delivery and neonatal outcomes. We included 1,794 mother-neonate dyads enrolled in the Generation C Study with known prenatal COVID-19 vaccination status and complete covariate and outcome data. We used multivariable quantile regressions to estimate the effect of prenatal COVID-19 vaccination on birthweight, delivery gestational age, and blood loss at delivery; and Poisson generalized linear models for Caesarean delivery (CD) and Neonatal Intensive Care Unit (NICU) admission. Using the above methods, we estimated effects of trimester of vaccine initiation on these outcomes. In our sample, 13.7% (n = 250) received at least one prenatal dose of any COVID-19 vaccine. Vaccination was not associated with birthweight (β = 12.42 g [-90.5, 114.8]), gestational age (β = 0.2 days [-1.1, 1.5]), blood loss (β = -50.6 ml [-107.0, 5.8]), the risks of CD (RR = 0.8; [0.6, 1.1]) or NICU admission (RR = 0.9 [0.5, 1.7]). Trimester of vaccine initiation was also not associated with these outcomes. Our findings suggest that there is no associated risk between prenatal COVID-19 vaccination and adverse delivery and neonatal outcomes in a cohort sample from NYC.
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Affiliation(s)
- Erona Ibroci
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus 8000, Denmark
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York 10029, NY USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Rebecca Jessel
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Frederieke A J Gigase
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Kyle Chung
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Mara Graziani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Molly Lieber
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Sophie Ohrn
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Jezelle Lynch
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Juliana Castro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Christina Marshall
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Rushna Tubassum
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Farida Mutawakil
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Elianna T Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Sascha Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta 30329, GA, USA
| | - Nina Molenaar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Rhoda S Sperling
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA; Department of Medicine, Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 109104, PA, USA
| | - Teresa Janevic
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York 10029, NY USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Siobhan M Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Lotje D De Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA.
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Oakley LP, Hufstetler K, O’Shea J, Sharpe JD, McArdle C, Neelam V, Roth NM, Olsen EO, Wolf M, Pao LZ, Gold JAW, Davis KM, Perella D, Epstein S, Lash MK, Samson O, Pavlick J, Feldpausch A, Wallace J, Nambiar A, Ngo V, Halai UA, Richardson CW, Fowler T, Taylor BP, Chou J, Brandon L, Devasia R, Ricketts EK, Stockdale C, Roskosky M, Ostadkar R, Vang Y, Galang RR, Perkins K, Taylor M, Choi MJ, Weidle PJ, Dawson P, Ellington S. Mpox Cases Among Cisgender Women and Pregnant Persons - United States, May 11-November 7, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:9-14. [PMID: 36602932 PMCID: PMC9815154 DOI: 10.15585/mmwr.mm7201a2] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Monkeypox (mpox) cases in the 2022 outbreak have primarily occurred among adult gay, bisexual, and other men who have sex with men (MSM); however, other populations have also been affected (1). To date, data on mpox in cisgender women and pregnant persons have been limited. Understanding transmission in these populations is critical for mpox prevention. In addition, among pregnant persons, Monkeypox virus can be transmitted to the fetus during pregnancy or to the neonate through close contact during or after birth (2-5). Adverse pregnancy outcomes, including spontaneous abortion and stillbirth, have been reported in previous mpox outbreaks (3). During May 11-November 7, 2022, CDC and U.S. jurisdictional health departments identified mpox in 769 cisgender women aged ≥15 years, representing 2.7% of all reported mpox cases.† Among cases with available data, 44% occurred in cisgender women who were non-Hispanic Black or African American (Black), 25% who were non-Hispanic White (White), and 23% who were Hispanic or Latino (Hispanic). Among cisgender women with available data, 73% reported sexual activity or close intimate contact as the likely route of exposure, with mpox lesions most frequently reported on the legs, arms, and genitals. Twenty-three mpox cases were reported in persons who were pregnant or recently pregnant§; all identified as cisgender women based on the mpox case report form.¶ Four pregnant persons required hospitalization for mpox. Eleven pregnant persons received tecovirimat, and no adverse reactions were reported. Continued studies on mpox transmission risks in populations less commonly affected during the outbreak, including cisgender women and pregnant persons, are important to assess and understand the impact of mpox on sexual, reproductive, and overall health.
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Gosdin L, Wallace B, Lanzieri TM, O’Malley Olsen E, Lewis EL, Chang DJ, Khuwaja S, Chicchelly S, Ojo KD, Lush M, Heitner D, Longcore ND, Delgado-López C, Humphries BK, Sizemore L, Mbotha D, Hall AJ, Ellington S, Gilboa SM, Tong VT, Woodworth K. Six-Month Outcomes of Infants Born to People With SARS-CoV-2 in Pregnancy. Pediatrics 2022; 150:e2022059009. [PMID: 36317478 PMCID: PMC9761394 DOI: 10.1542/peds.2022-059009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess the 6-month incidence of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, postnatal care, hospitalization, and mortality among infants born to people with laboratory-confirmed SARS-CoV-2 infection during pregnancy by timing of maternal infection. METHODS Using a cohort of liveborn infants from pregnancies with SARS-CoV-2 infections in the year 2020 from 10 United States jurisdictions in the Surveillance for Emerging Threats to Mother and Babies Network, we describe weighted estimates of infant outcomes from birth through 6 months of age from electronic health and laboratory records. RESULTS Of 6601 exposed infants with laboratory information through 6 months of age, 1.0% (95% confidence interval: 0.8-1.1) tested positive, 19.1% (17.5-20.6) tested negative, and 80.0% (78.4-81.6) were not known to be tested for SARS-CoV-2. Among those ≤14 days of age, SARS-CoV-2 infection occurred only with maternal infection ≤14 days before delivery. Of 3967 infants with medical record abstraction, breastmilk feeding initiation was lower when maternal infection occurred ≤14 days before delivery compared with >14 days (77.6% [72.5-82.6] versus 88.3% [84.7-92.0]). Six-month all-cause hospitalization was 4.1% (2.0-6.2). All-cause mortality was higher among infants born to people with infection ≤14 days (1.0% [0.4-1.6]) than >14 days (0.3% [0.1-0.5]) before delivery. CONCLUSIONS Results are reassuring, with low incidences of most health outcomes examined. Incidence of infant SARS-CoV-2, breastmilk feeding initiation, and all-cause mortality differed by timing of maternal infection. Strategies to prevent infections and support pregnant people with coronavirus disease 2019 may improve infant outcomes.
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Affiliation(s)
- Lucas Gosdin
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bailey Wallace
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tatiana M. Lanzieri
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily O’Malley Olsen
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth L. Lewis
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel J. Chang
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Oak Ridge, Tennessee
| | | | | | | | - Mamie Lush
- Nebraska Department of Health and Human Services, Lincoln, Nebraska
| | | | | | | | - Brian K. Humphries
- South Carolina Department of Health and Environmental Control Columbia, South Carolina
| | | | - Deborah Mbotha
- Washington State Department of Health, Olympia, Washington
| | - Aron J. Hall
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suzanne M. Gilboa
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Van T. Tong
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kate Woodworth
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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28
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Wielgosz K, Dawood FS, Stockwell MS, Varner M, Newes-Adeyi G, Ellington S, Vargas C, Bruno AM, Powers E, Morrill T, Reichle L, Battarbee AN, Tita AT. Agreement Between Pregnant Individuals' Self-Report of Coronavirus Disease 2019 (COVID-19) Vaccination and Medical Record Documentation. Obstet Gynecol 2022; 140:989-992. [PMID: 36357976 PMCID: PMC10563869 DOI: 10.1097/aog.0000000000004994] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022]
Abstract
For public health research such as vaccine uptake or effectiveness assessments, self-reported coronavirus disease 2019 (COVID-19) vaccination status may be a more efficient measure than verifying vaccination status from medical records if agreement between sources is high. We assessed agreement between self-reported and medical record-documented COVID-19 vaccination status among pregnant individuals followed in a cohort during August 2020-October 2021. At end of pregnancy, participants completed questionnaires about COVID-19 vaccine receipt during pregnancy; staff verified vaccination status using medical records. Agreement was assessed between self-reported and medical record vaccination status using Cohen's kappa. There was high agreement between self-reported and medical record vaccination status (Kappa coefficient=0.94, 95% CI 0.91-0.98), suggesting that self-report may be acceptable for ascertaining COVID-19 vaccination status during pregnancy.
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Affiliation(s)
| | | | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Michael Varner
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Celibell Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ann M. Bruno
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Emily Powers
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Ashley N. Battarbee
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Alan T. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
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29
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D'Angelo D, Smith RA, Salvesen von Essen B, Kortsmit K, Ellington S, Galang R, Hernández-Virella W, Shulman H, Vargas-Bernal M, Warner L. Infant Receipt of Health Care Services during the 2016-2017 Zika Virus Outbreak in Puerto Rico. P R Health Sci J 2022; 41:202-209. [PMID: 36516205 PMCID: PMC10030161] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the receipt of health care services among live-born infants of women with and without evidence of Zika virus (ZIKV) infection while pregnant during the 2016-2017 ZIKV outbreak in Puerto Rico. METHODS We used data from the Pregnancy Risk Assessment Monitoring System-Zika Postpartum Emergency Response study telephone surveys to examine maternal reports of the receipt of health care services by infants born in Puerto Rico from August through December 2016 and November through December 2017. Evidence of ZIKV infection was ascertained from the infant's birth certificate or was self-reported in the survey. RESULTS Fourteen percent of women in 2016 and 9% in 2017 had evidence of ZIKV infection during pregnancy. Most infants of women with evidence of ZIKV received the recommended health care services in 2016 and 2017, respectively, including a hearing test (91% vs. 92%), developmental assessment (90% vs. 92%), and an eye exam (74% vs. 70%); fewer received a head scan (45% vs. 36%) and evaluation for physical therapy (17% vs. 10%). From 2016 to 2017, the proportion of infants having a personal doctor increased for all infants; for infants of women without evidence of ZIKV infection, receiving hearing, developmental, and eye assessments increased. CONCLUSION Most infants of women with evidence of ZIKV infection during pregnancy received the recommended hearing and developmental assessments during the ZIKV outbreak. Experiences with increasing service capacity during the ZIKV outbreak can be evaluated to inform the response to future emergencies that affect maternal and child health.
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Affiliation(s)
- Denise D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruben A Smith
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beatriz Salvesen von Essen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Romeo Galang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanda Hernández-Virella
- Division of Maternal, Child, and Adolescent Health, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Holly Shulman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manuel Vargas-Bernal
- Division of Maternal, Child, and Adolescent Health, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kava CM, Rohraff DM, Wallace B, Mendoza-Alonzo JL, Currie DW, Munsey AE, Roth NM, Bryant-Genevier J, Kennedy JL, Weller DL, Christie A, McQuiston JH, Hicks P, Strid P, Sims E, Negron ME, Iqbal K, Ellington S, Smith DK. Epidemiologic Features of the Monkeypox Outbreak and the Public Health Response - United States, May 17-October 6, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1449-1456. [PMID: 36355615 PMCID: PMC9707350 DOI: 10.15585/mmwr.mm7145a4] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
On May 17, 2022, the Massachusetts Department of Health announced the first suspected case of monkeypox associated with the global outbreak in a U.S. resident. On May 23, 2022, CDC launched an emergency response (1,2). CDC's emergency response focused on surveillance, laboratory testing, medical countermeasures, and education. Medical countermeasures included rollout of a national JYNNEOS vaccination strategy, Food and Drug Administration (FDA) issuance of an emergency use authorization to allow for intradermal administration of JYNNEOS, and use of tecovirimat for patients with, or at risk for, severe monkeypox. During May 17-October 6, 2022, a total of 26,384 probable and confirmed* U.S. monkeypox cases were reported to CDC. Daily case counts peaked during mid-to-late August. Among 25,001 of 25,569 (98%) cases in adults with information on gender identity,† 23,683 (95%) occurred in cisgender men. Among 13,997 cisgender men with information on recent sexual or close intimate contact,§ 10,440 (75%) reported male-to-male sexual contact (MMSC) ≤21 days preceding symptom onset. Among 21,211 (80%) cases in persons with information on race and ethnicity,¶ 6,879 (32%), 6,628 (31%), and 6,330 (30%) occurred in non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic White (White) persons, respectively. Among 5,017 (20%) cases in adults with information on HIV infection status, 2,876 (57%) had HIV infection. Prevention efforts, including vaccination, should be prioritized among persons at highest risk within groups most affected by the monkeypox outbreak, including gay, bisexual, and other men who have sex with men (MSM); transgender, nonbinary, and gender-diverse persons; racial and ethnic minority groups; and persons who are immunocompromised, including persons with advanced HIV infection or newly diagnosed HIV infection.
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Lewis EL, Smoots AN, Woodworth KR, Olsen EO, Roth NM, Yazdy M, Shephard H, Sizemore L, Wingate H, Dzimira P, Reynolds B, Lush M, Fuchs EL, Ojo K, Siebman S, Hall AJ, Azziz-Baumgartner E, Perrine C, Hsia J, Ellington S, Tong VT, Gilboa SM. Breast Milk Feeding of Infants at Birth Among People With Confirmed SARS-CoV-2 Infection in Pregnancy: SET-NET, 5 States, March 29, 2020-December 31, 2020. Am J Public Health 2022; 112:S787-S796. [PMID: 36288521 PMCID: PMC9612185 DOI: 10.2105/ajph.2022.307023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To describe prevalence of breast milk feeding among people with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and examine associations between breast milk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods. We performed a retrospective cohort study using data from Massachusetts, Minnesota, Nebraska, Pennsylvania, and Tennessee of whether people with confirmed SARS-CoV-2 infection during pregnancy in 2020 initiated breast milk feeding at birth. Results. Among 11 114 (weighted number) people with SARS-CoV-2 infection in pregnancy, 86.5% (95% confidence interval [CI] = 82.4%, 87.6%) initiated breast milk feeding during birth hospitalization. People with infection within 14 days before delivery had significantly lower prevalence of breast milk feeding (adjusted prevalence ratio [APR] = 0.88; 95% CI = 0.83, 0.94) than did those with infection at least 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breast milk feeding remained only among infants who did not room in with their mother (APR = 0.77; 95% CI = 0.68, 0.88). Conclusions. Pregnant and postpartum people with SARS-CoV-2 infection should have access to lactation support and be advised about the importance of breast milk feeding and how to safely feed their infants in the same room. (Am J Public Health. 2022;112(S8):S787-S796. https://doi.org/10.2105/AJPH.2022.307023).
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Affiliation(s)
- Elizabeth L Lewis
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Ashley N Smoots
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kate R Woodworth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Emily O'Malley Olsen
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Nicole M Roth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mahsa Yazdy
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Hanna Shephard
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Lindsey Sizemore
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Heather Wingate
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Paula Dzimira
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Bethany Reynolds
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mamie Lush
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Erika L Fuchs
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kristen Ojo
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sam Siebman
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Aron J Hall
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Eduardo Azziz-Baumgartner
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Cria Perrine
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Jason Hsia
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sascha Ellington
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Van T Tong
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Suzanne M Gilboa
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
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Neelam V, Reeves EL, Woodworth KR, O'Malley Olsen E, Reynolds MR, Rende J, Wingate H, Manning SE, Romitti P, Ojo KD, Silcox K, Barton J, Mobley E, Longcore ND, Sokale A, Lush M, Delgado‐Lopez C, Diedhiou A, Mbotha D, Simon W, Reynolds B, Hamdan TS, Beauregard S, Ellis EM, Seo JY, Bennett A, Ellington S, Hall AJ, Azziz‐Baumgartner E, Tong VT, Gilboa SM. Pregnancy and infant outcomes by trimester of SARS-CoV-2 infection in pregnancy-SET-NET, 22 jurisdictions, January 25, 2020-December 31, 2020. Birth Defects Res 2022; 115:145-159. [PMID: 36065896 PMCID: PMC9537929 DOI: 10.1002/bdr2.2081] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/04/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We describe clinical characteristics, pregnancy, and infant outcomes in pregnant people with laboratory-confirmed SARS-CoV-2 infection by trimester of infection. STUDY DESIGN We analyzed data from the Surveillance for Emerging Threats to Mothers and Babies Network and included people with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection. Pregnancy outcomes included live birth and pregnancy loss (<20 weeks and ≥20 weeks gestation). Infant outcomes included preterm birth (<37 weeks gestation), small for gestational age, birth defects, and neonatal intensive care unit admission. Adjusted prevalence ratios (aPR) were calculated for pregnancy and selected infant outcomes by trimester of infection, controlling for demographics. RESULTS Of 35,200 people included in this analysis, 50.8% of pregnant people had infection in the third trimester, 30.8% in the second, and 18.3% in the first. Third trimester infection was associated with a higher frequency of preterm birth compared to first or second trimester infection combined (17.8% vs. 11.8%; aPR 1.44 95% CI: 1.35-1.54). Prevalence of birth defects was 553.4/10,000 live births, with no difference by trimester of infection. CONCLUSIONS There were no signals for increased birth defects among infants in this population relative to national baseline estimates, regardless of timing of infection. However, the prevalence of preterm birth in people with SARS-CoV-2 infection in pregnancy in our analysis was higher relative to national baseline data (10.0-10.2%), particularly among people with third trimester infection. Consequences of COVID-19 during pregnancy support recommended COVID-19 prevention strategies, including vaccination.
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Affiliation(s)
- Varsha Neelam
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Emily L. Reeves
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA,Eagle Global Scientific, LLCAtlantaGeorgiaUSA
| | - Kate R. Woodworth
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Emily O'Malley Olsen
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Megan R. Reynolds
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Joy Rende
- New Jersey Department of HealthTrentonNew JerseyUSA
| | | | - Susan E. Manning
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA,Massachusetts Department of Public HealthBostonMassachusettsUSA
| | - Paul Romitti
- University of Iowa College of Public HealthIowa CityIowaUSA
| | | | | | | | - Evan Mobley
- Missouri Department of Health and Senior ServicesJefferson CityMissouriUSA
| | | | - Ayomide Sokale
- Philadelphia Department of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Mamie Lush
- Nebraska Department of Health and Human ServicesLincolnNebraskaUSA
| | | | - Abdoulaye Diedhiou
- South Carolina Department of Health and Environmental ControlColumbiaSouth CarolinaUSA
| | - Deborah Mbotha
- Washington State Department of HealthShorelineWashingtonUSA
| | - Wanda Simon
- Arkansas Department of HealthLittle RockArkansasUSA
| | | | | | - Suzann Beauregard
- New Hampshire Department of Health and Human ServicesConcordNew HampshireUSA
| | - Esther M. Ellis
- U.S. Virgin Islands Department of HealthChristianstedVirgin IslandsUSA
| | | | - Amanda Bennett
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA,Illinois Department of Public HealthChicagoIllinoisUSA
| | - Sascha Ellington
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Aron J. Hall
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Eduardo Azziz‐Baumgartner
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Van T. Tong
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Suzanne M. Gilboa
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
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Affiliation(s)
- Sascha Ellington
- Field Support Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Christine K Olson
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hayes D, Board A, Calfee CS, Ellington S, Pollack LA, Kathuria H, Eakin MN, Weissman DN, Callahan SJ, Esper AM, Crotty Alexander LE, Sharma NS, Meyer NJ, Smith LS, Novosad S, Evans ME, Goodman AB, Click ES, Robinson RT, Ewart G, Twentyman E. Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury. Chest 2022; 162:256-264. [DOI: 10.1016/j.chest.2022.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/17/2021] [Accepted: 02/18/2022] [Indexed: 12/15/2022] Open
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Arriola CS, Li DK, Muñoz F, Daugherty M, Doughty-Skierski C, Ellington S, Ferber J, Ferguson N, Greenberg M, Hadden L, Henderson JT, Irving SA, Juergens M, Kancharla V, Naleway AL, Newes-Adeyi G, Nicholson E, Odouli R, Reichle L, Sanyang M, Dawood FS. Factors Associated with Hospitalization with Symptomatic COVID-19 Illness Among Pregnant Individuals: A Multi-Center Retrospective Cohort Study. Open Forum Infect Dis 2022. [PMCID: PMC9278221 DOI: 10.1093/ofid/ofac308] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Pregnant individuals are at increased risk of COVID-19 hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population. Methods Among a cohort of pregnant individuals who received prenatal care at three healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional-hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for SARS-CoV-2 circulation; model covariates included site, age, race, ethnicity, insurance status, pre-pregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction. Results Among 19,456 pregnant individuals with an estimated due date March 1, 2020-February 28, 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (aHR: 2.7; 95% CI: 1.3,5.5), native Hawaiian or Pacific Islander race (aHR: 12; 95% CI: 3.2,45.5), age <25 years (aHR: 3.1; 95% CI: 1.3,7.6), pre-pregnancy obesity (aHR: 2.1; 95% CI: 1.1,3.9), diagnosis of a metabolic disorder (aHR: 2.2; 95% CI: 1.2,3.8), lung disease excluding asthma (aHR: 49; 95% CI: 28,84) and cardiovascular disease (aHR: 2.6; 95% CI: 1.5,4.7). Conclusion Although hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination.
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Affiliation(s)
| | - De Kun Li
- Kaiser Permanente Northern California , Oakland, California , USA
| | - Flor Muñoz
- Baylor College of Medicine , Houston, Texas , USA
| | | | | | - Sascha Ellington
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Jeannette Ferber
- Kaiser Permanente Northern California , Oakland, California , USA
| | | | - Mara Greenberg
- Kaiser Permanente Northern California , Oakland, California , USA
| | | | - Jillian T Henderson
- Center for Health Research , Kaiser Permanente Northwest, Portland, Oregon , USA
| | - Stephanie A Irving
- Center for Health Research , Kaiser Permanente Northwest, Portland, Oregon , USA
| | | | | | - Allison L Naleway
- Center for Health Research , Kaiser Permanente Northwest, Portland, Oregon , USA
| | | | | | - Roxana Odouli
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | | | - Mo Sanyang
- Baylor College of Medicine , Houston, Texas , USA
| | - Fatimah S Dawood
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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36
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Razzaghi H, Meghani M, Crane B, Ellington S, Naleway AL, Irving SA, Patel SA. Receipt of COVID-19 Booster Dose Among Fully Vaccinated Pregnant Individuals Aged 18 to 49 Years by Key Demographics. JAMA 2022; 327:2351-2354. [PMID: 35452085 PMCID: PMC9034437 DOI: 10.1001/jama.2022.6834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study uses data from the Vaccine Safety Datalink on receipt of booster doses of COVID-19 vaccines among pregnant individuals aged 18 to 49 years.
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Affiliation(s)
- Hilda Razzaghi
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mehreen Meghani
- US Centers for Disease Control and Prevention Foundation, Atlanta, Georgia
| | - Bradley Crane
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Sascha Ellington
- National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Suchita A. Patel
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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37
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Razzaghi H, Yankey D, Vashist K, Lu PJ, Kriss JL, Nguyen KH, Lee J, Ellington S, Polen K, Bonner K, Jatlaoui TC, Wilhelm E, Meaney-Delman D, Singleton JA. COVID-19 vaccination coverage and intent among women aged 18-49 years by pregnancy status, United States, April-November 2021. Vaccine 2022; 40:4554-4563. [PMID: 35725781 PMCID: PMC9189004 DOI: 10.1016/j.vaccine.2022.06.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
Background Pregnant and postpartum women are at increased risk for severe illness from COVID-19. We assessed COVID-19 vaccination coverage, intent, and attitudes among women of reproductive age overall and by pregnancy status in the United States. Methods Data from the National Immunization Survey Adult COVID Module collected during April 22-November 27, 2021, were analyzed to assess COVID-19 vaccination (receipt of ≥1 dose), intent for vaccination, and attitudes towards vaccination among women aged 18–49 years overall and by pregnancy status (trying to get pregnant, currently pregnant, breastfeeding, and not trying to get pregnant or currently pregnant or breastfeeding). Logistic regression and predictive marginals were used to generate unadjusted and adjusted prevalence ratios (PRs and aPRs). Trend analyses were conducted to assess monthly changes in vaccination and intent. Results Our analyses included 110,925 women aged 18–49 years. COVID-19 vaccination coverage (≥1 dose) was 63.2% overall (range from 53.3% in HHS Region 4 to 76.5% in HHS Region 1). Vaccination coverage was lowest among pregnant women (45.1%), followed by women who were trying to get pregnant (49.5%), women who were breastfeeding (51.5%), and all other women (64.9%). Non-Hispanic (NH) Black women who were pregnant or breastfeeding had significantly lower vaccination coverage (aPR: 0.74 and 0.66, respectively) than NH White women. Discussion Our findings are consistent with other studies showing lower vaccination coverage among pregnant individuals, with substantially lower vaccination coverage among NH Black women who are pregnant or breastfeeding. Given the overlapping and disproportionate risks of COVID-19 and maternal mortality among Black women, it is critical that COVID-19 vaccination be strongly recommended for these populations and all women of reproductive age. Healthcare and public health providers may take advantage of every opportunity to encourage vaccination and enlist the assistance of community leaders, particularly in communities with low vaccination coverage.
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Affiliation(s)
- Hilda Razzaghi
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - David Yankey
- Oak Ridge Institute for Science and Education, United States
| | - Kushagra Vashist
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, United States
| | - Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jennifer L Kriss
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kimberly H Nguyen
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James Lee
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, United States
| | - Kara Polen
- Division of Birth Defects and Infant Disorders, National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kimberly Bonner
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tara C Jatlaoui
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elisabeth Wilhelm
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Moro PL, Olson CK, Clark E, Marquez P, Strid P, Ellington S, Zhang B, Mba-Jonas A, Alimchandani M, Cragan J, Moore C. Post-authorization surveillance of adverse events following COVID-19 vaccines in pregnant persons in the Vaccine Adverse Event Reporting System (VAERS), December 2020 – October 2021. Vaccine 2022; 40:3389-3394. [PMID: 35489985 PMCID: PMC9001176 DOI: 10.1016/j.vaccine.2022.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/13/2022] [Accepted: 04/06/2022] [Indexed: 01/08/2023]
Abstract
Background Objective Methods Results Conclusions
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39
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Perez M, Galang RR, Snead MC, Strid P, Bish CL, Tong VT, Barfield WD, Shapiro-Mendoza CK, Zotti ME, Ellington S. Emergency Preparedness and Response: Highlights from the Division of Reproductive Health, 2011-2021. J Womens Health (Larchmt) 2021; 30:1673-1680. [PMID: 34919476 PMCID: PMC10964214 DOI: 10.1089/jwh.2021.0553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This report provides historical context and rationale for coordinated, systematic, and evidence-based public health emergency preparedness and response (EPR) activities to address the needs of women of reproductive age. Needs of pregnant and postpartum women, and infants-before, during, and after public health emergencies-are highlighted. Four focus areas and related activities are described: (1) public health science; (2) clinical guidance; (3) partnerships, communication, and outreach; and (4) workforce development. Finally, the report summarizes major activities of the Division of Reproductive Health's EPR Team at the Centers for Disease Control and Prevention.
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Affiliation(s)
- Mirna Perez
- Division of Reproductive Health, Atlanta, Georgia, USA
| | | | | | | | | | - Van T. Tong
- Division of Birth Defects and Infant Disorders, Atlanta, Georgia, USA
| | | | | | - Marianne E. Zotti
- Association of Maternal and Child Health Programs (AMCHP) Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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40
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Manning SE, Bennett A, Ellington S, Goyal S, Harvey E, Sizemore L, Wingate H. Sensitivity of Pregnancy Field on the COVID-19 Case Report Form Among Pregnancies Completed Through December 31, 2020: Illinois and Tennessee. Matern Child Health J 2021; 26:217-223. [PMID: 34761313 PMCID: PMC8580361 DOI: 10.1007/s10995-021-03263-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
Purpose The considerable volume of infections from SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has made it challenging for health departments to collect complete data for national disease reporting. We sought to examine sensitivity of the COVID-19 case report form (CRF) pregnancy field by comparing CRF data to the gold standard of CRF data linked to birth and fetal death certificates. Description CRFs for women aged 15–44 years with laboratory-confirmed SARS-CoV-2 infection were linked to birth and fetal death certificates for pregnancies completed during January 1–December 31, 2020 in Illinois and Tennessee. Among linked records, pregnancy was considered confirmed for women with a SARS-CoV-2 specimen collection date on or prior to the delivery date. Sensitivity of the COVID-19 CRF pregnancy field was calculated by dividing the number of confirmed pregnant women with SARS-CoV-2 infection with pregnancy indicated on the CRF by the number of confirmed pregnant women with SARS-CoV-2 infection. Assessment Among 4276 (Illinois) and 2070 (Tennessee) CRFs that linked with a birth or fetal death certificate, CRF pregnancy field sensitivity was 45.3% and 42.1%, respectively. In both states, sensitivity varied significantly by maternal race/ethnicity, insurance, trimester of prenatal care entry, month of specimen collection, and trimester of specimen collection. Sensitivity also varied by maternal education in Illinois but not in Tennessee. Conclusion Sensitivity of the COVID-19 CRF pregnancy field varied by state and demographic factors. To more accurately assess outcomes for pregnant women, jurisdictions might consider utilizing additional data sources and linkages to obtain pregnancy status.
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Affiliation(s)
- Susan E Manning
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Amanda Bennett
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.,Illinois Department of Public Health, 122 South Michigan Avenue, Chicago, IL, 60603, USA
| | - Sascha Ellington
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Sonal Goyal
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.,Illinois Department of Public Health, 122 South Michigan Avenue, Chicago, IL, 60603, USA
| | - Elizabeth Harvey
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.,Tennessee Department of Health, 710 James Robertson Parkway, Nashville, TN, 37243, USA
| | - Lindsey Sizemore
- Tennessee Department of Health, 710 James Robertson Parkway, Nashville, TN, 37243, USA
| | - Heather Wingate
- Tennessee Department of Health, 710 James Robertson Parkway, Nashville, TN, 37243, USA
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41
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Dawood FS, Varner M, Tita A, Newes-Adeyi G, Gyamfi-Bannerman C, Battarbee A, Bruno A, Daugherty M, Reichle L, Vorwaller K, Vargas C, Parks M, Powers E, Lucca-Susana M, Gibson M, Subramaniam A, Cheng YJ, Feng PJ, Ellington S, Galang RR, Meece J, Flygare C, Stockwell MS. Incidence, Clinical Characteristics, and Risk Factors of SARS-CoV-2 Infection among Pregnant Individuals in the United States. Clin Infect Dis 2021; 74:2218-2226. [PMID: 34410340 PMCID: PMC8513407 DOI: 10.1093/cid/ciab713] [Citation(s) in RCA: 15] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Data about the risk of SARS-CoV-2 infection among pregnant individuals are needed to inform infection prevention guidance and counseling for this population. METHODS We prospectively followed a cohort of pregnant individuals during August 2020-March 2021 at three U.S. sites. The three primary outcomes were incidence rates of any SARS-CoV-2 infection, symptomatic infection, and asymptomatic infection, during pregnancy during periods of SARS-CoV-2 circulation. Participants self-collected weekly mid-turbinate nasal swabs for SARS-CoV-2 RT-PCR testing, completed weekly illness symptom questionnaires, and submitted additional swabs with COVID-19-like symptoms. An overall SARS-CoV-2 infection incidence rate weighted by population counts of women of reproductive age in each state was calculated. RESULTS Among 1098 pregnant individuals followed for a mean of 10 weeks, nine percent (99/1098) had SARS-CoV-2 infections during the study. Population weighted incidence rates of SARS-CoV-2 infection were 10.0 per 1,000 (95% confidence interval [CI] 5.7-14.3) person-weeks for any infection, 5.7 per 1,000 (95% CI 1.7-9.7) for symptomatic infections, and 3.5 per 1,000 (95% CI 0-7.1) for asymptomatic infections. Among 96 participants with SARS-CoV-2 infection and symptom data, the most common symptoms were nasal congestion (72%), cough (64%), headache (59%), and change in taste or smell (54%); 28% had measured or subjective fever. The median symptom duration was 10 days (IQR6-16 days). CONCLUSION Pregnant individuals had a 1% risk of SARS-CoV-2 infection per week. Study findings provide information about SARS-CoV-2 infection risk during pregnancy to inform counseling for pregnant individuals about infection prevention practices, including COVID-19 vaccination.
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Affiliation(s)
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Alan Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | | | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA.,New York-Presbyterian Hospital, New York, NY, USA
| | - Ashley Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | - Ann Bruno
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | | | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Celibell Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Mickey Parks
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | - Emily Powers
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Miriam Lucca-Susana
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA.,New York-Presbyterian Hospital, New York, NY, USA
| | - Marie Gibson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Akila Subramaniam
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | - Yiling J Cheng
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pei-Jean Feng
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Romeo R Galang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Melissa S Stockwell
- New York-Presbyterian Hospital, New York, NY, USA.,Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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42
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Galang RR, Newton SM, Woodworth KR, Griffin I, Oduyebo T, Sancken CL, Olsen EO, Aveni K, Wingate H, Shephard H, Fussman C, Alaali ZS, Silcox K, Siebman S, Halai UA, Lopez CD, Lush M, Sokale A, Barton J, Chaudhary I, Patrick PH, Schlosser L, Reynolds B, Gaarenstroom N, Chicchelly S, Read JS, de Wilde L, Mbotha D, Azziz-Baumgartner E, Hall AJ, Tong VT, Ellington S, Gilboa SM. Risk Factors for Illness Severity Among Pregnant Women With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 Infection-Surveillance for Emerging Threats to Mothers and Babies Network, 22 State, Local, and Territorial Health Departments, 29 March 2020-5 March 2021. Clin Infect Dis 2021; 73:S17-S23. [PMID: 34021332 PMCID: PMC8194562 DOI: 10.1093/cid/ciab432] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with SARS-CoV-2 infection. Methods Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during March 29, 2020–March 5, 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. Results Among 7,950 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 25 years and older, healthcare occupation, pre-pregnancy obesity, chronic lung disease, chronic hypertension, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. Conclusions Older age and having underlying medical conditions were associated with increased risk of moderate-to-severe or critical COVID-19 illness among pregnant women. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and inform targeted public health messaging.
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Affiliation(s)
- Romeo R Galang
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M Newton
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate R Woodworth
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isabel Griffin
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Titilope Oduyebo
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina L Sancken
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily O'Malley Olsen
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn Aveni
- Division of Family Health Services, New Jersey Department of Health, Trenton, New Jersey, USA
| | - Heather Wingate
- Communicable and Environmental Disease and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Hanna Shephard
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Chris Fussman
- Maternal and Child Health Epidemiology Section, Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Zahra S Alaali
- Division of Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Kristin Silcox
- Maternal and Child Health Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Samantha Siebman
- Emerging Infections Program, Minnesota Department of Health, St Paul, Minnesota, USA
| | - Umme-Aiman Halai
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Camille Delgado Lopez
- Division of Children With Special Medical Needs, Puerto Rico Department of Health, San Juan, Puerto Rico, USA
| | - Mamie Lush
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, USA
| | - Ayomide Sokale
- Division of Maternal, Child and Family Health, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Jerusha Barton
- Epidemiology Division, Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Ifrah Chaudhary
- Division of Disease Prevention and Control, Houston Health Department, Houston, Texas, USA
| | - Paul H Patrick
- Perinatal and Reproductive Health Division, Oklahoma State Department of Health, Oklahoma City, Oklahoma, USA
| | - Levi Schlosser
- Division of Disease Control, North Dakota Department of Health, Bismarck, North Dakota, USA
| | - Bethany Reynolds
- Bureau of Epidemiology, Pennsylvania Department of Health, Pittsburgh, Pennsylvania, USA
| | | | - Sarah Chicchelly
- Infectious Disease Epidemiology and Response, Kansas Department of Health and Environment, Topeka, Kansas, USA
| | - Jennifer S Read
- Infectious Disease Epidemiology, Vermont Department of Health, Burlington, Vermont, USA.,Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Leah de Wilde
- Epidemiology Division, US Virgin Islands Department of Health, Christiansted, St Croix, US Virgin Islands
| | - Deborah Mbotha
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, Washington, USA
| | | | - Aron J Hall
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Van T Tong
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha Ellington
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M Gilboa
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ko JY, DeSisto CL, Simeone RM, Ellington S, Galang RR, Oduyebo T, Gilboa SM, Lavery AM, Gundlapalli AV, Shapiro-Mendoza CK. Adverse Pregnancy Outcomes, Maternal Complications, and Severe Illness Among US Delivery Hospitalizations With and Without a Coronavirus Disease 2019 (COVID-19) Diagnosis. Clin Infect Dis 2021; 73:S24-S31. [PMID: 33977298 PMCID: PMC8136045 DOI: 10.1093/cid/ciab344] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Evidence on risk for adverse outcomes from COVID-19 among pregnant women is still emerging. We examined the association between COVID-19 at delivery and adverse pregnancy outcomes, maternal complications, and severe illness, whether these associations differ by race/ethnicity; and described discharge status by COVID-19 diagnosis and maternal complications. Methods Data from 703 hospitals in the Premier Healthcare Database during March–September 2020 were included. Adjusted risk ratios overall and stratified by race/ethnicity were estimated using Poisson regression with robust standard errors. Proportion not discharged home was calculated by maternal complications, stratified by COVID-19 diagnosis. Results Among 489,471 delivery hospitalizations, 6,550 (1.3%) had a COVID-19 diagnosis. In adjusted models, COVID-19 was associated with increased risk for: acute respiratory distress syndrome (adjusted risk ratio [aRR] = 34.4), death (aRR = 17.0), sepsis (aRR = 13.6), mechanical ventilation (aRR = 12.7), shock (aRR = 5.1), intensive care unit admission (aRR = 3.6), acute renal failure (aRR = 3.5), thromboembolic disease (aRR = 2.7), adverse cardiac event/outcome (aRR = 2.2) and preterm labor with preterm delivery (aRR = 1.2). Risk for any maternal complications or for any severe illness did not significantly differ by race/ethnicity. Discharge status did not differ by COVID-19; however, among women with concurrent maternal complications, a greater proportion of those with (versus without) COVID-19 were not discharged home. Conclusions These findings emphasize the importance of implementing recommended mitigation strategies to reduce risk for SARS-CoV-2 infection and further inform counseling and clinical care for pregnant women during the COVID-19 pandemic.
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Affiliation(s)
- Jean Y Ko
- CDC COVID-19 Response Team, Atlanta, Georgia, USA.,US Public Health Service, Commissioned Corps, Rockville, Maryland, USA
| | | | | | | | | | | | | | - Amy M Lavery
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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Otieno NA, Azziz-Baumgartner E, Nyawanda BO, Oreri E, Ellington S, Onyango C, Emukule GO. SARS-CoV-2 Infection among Pregnant and Postpartum Women, Kenya, 2020-2021. Emerg Infect Dis 2021; 27:2497-2499. [PMID: 34193338 PMCID: PMC8386793 DOI: 10.3201/eid2709.210849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We determined incidence of severe acute respiratory syndrome coronavirus 2 and influenza virus infections among pregnant and postpartum women and their infants in Kenya during 2020–2021. Incidence of severe acute respiratory syndrome coronavirus 2 was highest among pregnant women, followed by postpartum women and infants. No influenza virus infections were identified.
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Kortsmit K, Salvesen von Essen B, Warner L, D'Angelo DV, Smith RA, Shapiro-Mendoza CK, Shulman HB, Virella WH, Taraporewalla A, Harrison L, Ellington S, Barfield WD, Jamieson DJ, Cox S, Pazol K, Garcia Díaz P, Herrera BR, Bernal MV. Preventing Vector-Borne Transmission of Zika Virus Infection During Pregnancy, Puerto Rico, USA, 2016-2017 1. Emerg Infect Dis 2021; 26:2717-2720. [PMID: 33079044 PMCID: PMC7588518 DOI: 10.3201/eid2611.201614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We examined pregnant women’s use of personal protective measures to prevent mosquito bites during the 2016–2017 Zika outbreak in Puerto Rico. Healthcare provider counseling on recommended measures was associated with increased use of insect repellent among pregnant women but not with wearing protective clothing.
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Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, Woodworth KR, Nahabedian JF, Azziz-Baumgartner E, Gilboa SM, Meaney-Delman D. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1641-1647. [PMID: 33151921 PMCID: PMC7643892 DOI: 10.15585/mmwr.mm6944e3] [Citation(s) in RCA: 775] [Impact Index Per Article: 193.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Delahoy MJ, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Monroe ML, Ryan PA, Fox K, Kim S, Lynfield R, Siebman S, Davis SS, Sosin DM, Barney G, Muse A, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Schaffner W, Talbot HK, George A, Spencer M, Ellington S, Galang RR, Gilboa SM, Tong VT, Piasecki A, Brammer L, Fry AM, Hall AJ, Wortham JM, Kim L, Garg S. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1347-1354. [PMID: 32970655 PMCID: PMC7727497 DOI: 10.15585/mmwr.mm6938e1] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Li R, Ellington S, Galang R, Romero L. Economic Evaluation of the Zika Contraception Access Network—A Primary Public Health Intervention to Increase Access to Contraception in Puerto Rico during the 2016–17 Zika Virus Outbreak. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- R. Li
- Centers for Disease Control and Prevention Atlanta GA United States
| | - S. Ellington
- Centers for Disease Control and Prevention Atlanta GA United States
| | - R. Galang
- Centers for Disease Control and Prevention Atlanta GA United States
| | - L. Romero
- Centers for Disease Control and Prevention Atlanta GA United States
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Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, Nahabedian J, Anderson K, Gilboa SM. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:769-775. [PMID: 32584795 PMCID: PMC7316319 DOI: 10.15585/mmwr.mm6925a1] [Citation(s) in RCA: 584] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Werner AK, Koumans EH, Chatham-Stephens K, Salvatore PP, Armatas C, Byers P, Clark CR, Ghinai I, Holzbauer SM, Navarette KA, Danielson ML, Ellington S, Moritz ED, Petersen EE, Kiernan EA, Baldwin GT, Briss P, Jones CM, King BA, Krishnasamy V, Rose DA, Reagan-Steiner S. Hospitalizations and Deaths Associated with EVALI. N Engl J Med 2020; 382:1589-1598. [PMID: 32320569 PMCID: PMC8826745 DOI: 10.1056/nejmoa1915314] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [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: 11/19/2022]
Abstract
BACKGROUND As of January 7, 2020, a total of 2558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) had been reported to the Centers for Disease Control and Prevention (CDC). METHODS In a national study, we compared the characteristics of patients with fatal cases of EVALI with those of patients with nonfatal cases to improve the ability of clinicians to identify patients at increased risk for death from the condition. Health departments reported cases of EVALI to the CDC and included, when available, data from medical-record abstractions and patient interviews. Analyses included all the patients with fatal or nonfatal cases of EVALI that were reported to the CDC as of January 7, 2020. We also present three case reports of patients who died from EVALI to illustrate the clinical characteristics common among such patients. RESULTS Most of the patients with fatal or nonfatal cases of EVALI were male (32 of 60 [53%] and 1666 of 2498 [67%], respectively). The proportion of patients with fatal or nonfatal cases was higher among those who were non-Hispanic white (39 of 49 [80%] and 1104 of 1818 [61%], respectively) than among those in other race or ethnic groups. The proportion of patients with fatal cases was higher among those 35 years of age or older (44 of 60 [73%]) than among those younger than 35 years, but the proportion with nonfatal cases was lower among those 35 years of age or older (551 of 2514 [22%]). Among the patients who had an available medical history, a higher proportion of those with fatal cases than those with nonfatal cases had a history of asthma (13 of 57 [23%] vs. 102 of 1297 [8%]), cardiac disease (26 of 55 [47%] vs. 115 of 1169 [10%]), or a mental health condition (32 of 49 [65%] vs. 575 of 1398 [41%]). A total of 26 of 50 patients (52%) with fatal cases had obesity. Half the patients with fatal cases (25 of 54 [46%]) were seen in an outpatient setting before hospitalization or death. CONCLUSIONS Chronic conditions, including cardiac and respiratory diseases and mental health conditions, were common among hospitalized patients with EVALI.
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Affiliation(s)
- Angela K Werner
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Emilia H Koumans
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Kevin Chatham-Stephens
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Phillip P Salvatore
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Christina Armatas
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Paul Byers
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Charles R Clark
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Isaac Ghinai
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Stacy M Holzbauer
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Kristen A Navarette
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Melissa L Danielson
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Sascha Ellington
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Erin D Moritz
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Emily E Petersen
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Emily A Kiernan
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Grant T Baldwin
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Peter Briss
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Christopher M Jones
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Brian A King
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Vikram Krishnasamy
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Dale A Rose
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Sarah Reagan-Steiner
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
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