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Bliznashka L, Rattigan SM, Sudfeld CR, Isanaka S. Analysis of Postdischarge Interventions for Children Treated for Moderate or Severe Wasting, Growth Faltering or Failure, or Edema: A Systematic Review. JAMA Netw Open 2023; 6:e2315077. [PMID: 37223898 DOI: 10.1001/jamanetworkopen.2023.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Importance Children treated for acute malnutrition remain at increased risk of relapse, infection, and mortality after programmatic recovery. Global guidelines for the management of acute malnutrition currently provide no recommendations to sustain recovery following treatment discharge. Objective To inform guideline development by evaluating the evidence on postdischarge interventions to improve outcomes within 6 months after discharge. Evidence Review In this systematic review, 8 databases were searched from inception through December 2021 and included randomized and quasi-experimental studies investigating interventions delivered after discharge from nutritional treatment for children aged 0 to 59 months. Outcomes were relapse, deterioration to severe wasting, readmission, sustained recovery, anthropometry, all-cause mortality, and morbidity within 6 months after discharge. The risk of bias was assessed using Cochrane tools, and the certainty of the evidence was evaluated with the GRADE approach. Findings Of 7124 records identified, 8 studies, conducted in 7 countries between 2003 and 2019 with 5965 participants, were included. The study interventions included antibiotic prophylaxis (n = 1), zinc supplementation (n = 1), food supplementation (n = 2), psychosocial stimulation (n = 3), unconditional cash transfers (n = 1), and an integrated biomedical, food supplementation, and malaria prevention package (n = 1). Risk of bias was moderate or high for half the studies. Only unconditional cash transfers were associated with reduced relapse, while the integrated package was associated with improved sustained recovery. Zinc supplementation, food supplementation, psychosocial stimulation, and unconditional cash transfers were associated with improvements in postdischarge anthropometry, while zinc supplementation was associated with reductions in multiple postdischarge morbidities. Conclusions and Relevance In this systematic review of postdischarge interventions to reduce relapse and improve other postdischarge outcomes among children treated for acute malnutrition, evidence was limited. Biomedical, cash, and integrated interventions showed promise in improving certain postdischarge outcomes for children treated for moderate or severe acute malnutrition in single studies. Further evidence on the efficacy, effectiveness, and operational feasibility of postdischarge interventions in other contexts is needed to inform global guidance development.
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Affiliation(s)
| | - Susan M Rattigan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher R Sudfeld
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sheila Isanaka
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Research, Epicentre, Paris, France
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2
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Most ZM, Nyquist AC, Radonovich LJ, Rodriguez-Barradas MC, Price CS, Simberkoff MS, Bessesen MT, Cummings DAT, Rattigan SM, Warren-Gash C, Gaydos CA, Gibert CL, Gorse GJ, Perl TM. Preschool-Aged Household Contacts as a Risk Factor for Viral Respiratory Infections in Healthcare Personnel. Open Forum Infect Dis 2023; 10:ofad057. [PMID: 36824623 PMCID: PMC9942663 DOI: 10.1093/ofid/ofad057] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Background Viral respiratory infections (VRIs) are common and are occupational risks for healthcare personnel (HCP). VRIs can also be acquired at home and other settings among HCPs. We sought to determine if preschool-aged household contacts are a risk factor for VRIs among HCPs working in outpatient settings. Methods We conducted a secondary analysis of data from a cluster randomized trial at 7 medical centers in the United States over 4 influenza seasons from 2011-2012 to 2014-2015. Adult HCPs who routinely came within 6 feet of patients with respiratory infections were included. Participants were tested for respiratory viruses whenever symptomatic and at 2 random times each season when asymptomatic. The exposure of interest was the number of household contacts 0-5 years old (preschool-aged) at the beginning of each HCP-season. The primary outcome was the rate of polymerase chain reaction-detected VRIs, regardless of symptoms. The VRI incidence rate ratio (IRR) was calculated using a mixed-effects Poisson regression model that accounted for clustering at the clinic level. Results Among the 4476 HCP-seasons, most HCPs were female (85.4%) and between 30 and 49 years of age (54.6%). The overall VRI rate was 2.04 per 100 person-weeks. In the adjusted analysis, HCPs having 1 (IRR, 1.22 [95% confidence interval {CI}, 1.05-1.43]) and ≥2 (IRR, 1.35 [95% CI, 1.09-1.67]) preschool-aged household contacts had higher VRI rates than those with zero preschool-aged household contacts. Conclusions Preschool-aged household contacts are a risk factor for developing VRIs among HCPs working in outpatient settings.
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Affiliation(s)
- Zachary M Most
- Pediatric Infectious Diseases Program, Children’s Health System of Texas, Dallas, Texas, USA
- Division of Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ann-Christine Nyquist
- Department of Infectious Disease, Children’s Hospital Colorado, Aurora, Colorado, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Connie Savor Price
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Infectious Disease Department, Denver Health Medical Center, Denver, Colorado, USA
| | - Michael S Simberkoff
- Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
- Division of Infectious Diseases, New York University Grossman School of Medicine, New York, New York, USA
| | - Mary T Bessesen
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Medical Service/Infectious Disease, Veterans Affairs Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan M Rattigan
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charlotte A Gaydos
- Department of Medicine and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cynthia L Gibert
- Medical Service/Infectious Disease, Veterans Affairs Medical Center, Washington, District of Columbia, USA
- Department of Medicine, George Washington University School of Medical and Health Sciences, Washington, District of Columbia, USA
| | - Geoffrey J Gorse
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Trish M Perl
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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3
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Marquer C, Guindo O, Mahamadou I, Job E, Rattigan SM, Langendorf C, Grais RF, Isanaka S. An exploratory qualitative study of caregivers' knowledge, perceptions and practices related to hospital hygiene in rural Niger. Infect Prev Pract 2021; 3:100160. [PMID: 34647010 PMCID: PMC8498679 DOI: 10.1016/j.infpip.2021.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background The risk of healthcare-associated infections is exacerbated by poor hygiene practices in health care facilities and can contribute to increased patient morbidity and mortality. In low-income settings, caregivers play a key role in maintaining proper hygiene during inpatient stays. We aimed to explore caregivers' knowledge, perceptions and practices related to hospital hygiene in a rural, sub-Saharan African setting. Methods We conducted an exploratory qualitative study among caregivers of children admitted to an inpatient therapeutic feeding center in Madarounfa, Niger. Individual interviews with 28 caregivers of hospitalized children were conducted to explore their knowledge, perceptions and practices of hygiene in the health facility. Findings Caregivers described a broad understanding of hygiene and reported knowledge of its importance in the hospital, particularly to prevent disease transmission and protect child health. Hygiene was perceived as a collective rather than individual responsibility. Caregivers reported on the poor hygiene practice of others and cited a lack of space and hygiene materials as barriers to correct hygiene practice. Caregivers described educational sessions and informal sharing with other caregivers as tools to gain knowledge and improve practice. Conclusion This exploratory study is unique in describing the perspective of caregivers in a low-resource hospital setting, a group often underrepresented when designing health interventions to improve hospital hygiene. Our findings suggest a strong knowledge of hospital hygiene among caregivers in this setting, with positive perception of its importance in health promotion. Poor individual practice was reported but may be improved through additional education and provision of hygiene materials.
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Affiliation(s)
| | | | | | | | | | | | | | - Sheila Isanaka
- Department of Research, Epicentre, Paris, France
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, USA
- Corresponding author. Address: 14-34 Avenue Jean Juarès, Paris, 75019, France. Tel.: +33 (0)1 4021 5498; fax: +33 (0)1 4021 5100.
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4
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Gorse GJ, Rattigan SM, Kirpich A, Simberkoff MS, Bessesen MT, Gibert C, Nyquist AC, Price CS, Gaydos CA, Radonovich LJ, Perl TM, Rodriguez-Barradas MC, Cummings DAT. Influence of Pre-Season Antibodies against Influenza Virus on Risk of Influenza Infection among Health Care Personnel. J Infect Dis 2021; 225:891-902. [PMID: 34534319 DOI: 10.1093/infdis/jiab468] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association of hemagglutination inhibition (HAI) antibodies with protection from influenza among healthcare personnel (HCP) with occupational exposure to influenza viruses has not been well-described. METHODS The Respiratory Protection Effectiveness Clinical Trial was a cluster-randomized, multi-site study that compared medical masks to N95 respirators in preventing viral respiratory infections among HCP in outpatient healthcare settings for 5,180 participant-seasons. Serum HAI antibody titers before each influenza season and influenza virus infection confirmed by polymerase chain reaction were studied over four study years. RESULTS In univariate models, the risk of influenza A(H3N2) and B virus infections was associated with HAI titers to each virus, study year, and site. HAI titers were strongly associated with vaccination. Within multivariate models, each log base 2 increase in titer was associated with 15%, 26% and 33-35% reductions in the hazard of influenza A(H3N2), A(H1N1) and B infections, respectively. Best models included pre-season antibody titers and study year, but not other variables. CONCLUSIONS HAI titers were associated with protection from influenza among HCP with routine exposure to patients with respiratory illness and influenza season contributed to risk. HCP can be reassured about receiving influenza vaccination to stimulate immunity.
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Affiliation(s)
- Geoffrey J Gorse
- Section of Infectious Diseases, Veterans Affairs St. Louis Health Care System, St. Louis, MO, 63106 USA.,Division of Infectious Diseases, Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, MO, 63104 USA
| | - Susan M Rattigan
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Alexander Kirpich
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA USA
| | - Michael S Simberkoff
- Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY, USA
| | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO, 80045 USA.,Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cynthia Gibert
- Medical Service, Washington D.C. Veterans Affairs Medical Center, Washington, DC, USA
| | - Ann-Christine Nyquist
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, Section of Pediatric Infectious Disease and Epidemiology Children's Hospital Colorado, Aurora, CO, USA
| | - Connie Savor Price
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Infectious Diseases, Denver Health, Denver, CO, USA
| | - Charlotte A Gaydos
- Department of Medicine and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV USA
| | - Trish M Perl
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Derek A T Cummings
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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5
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Huang AT, Garcia-Carreras B, Hitchings MDT, Yang B, Katzelnick LC, Rattigan SM, Borgert BA, Moreno CA, Solomon BD, Trimmer-Smith L, Etienne V, Rodriguez-Barraquer I, Lessler J, Salje H, Burke DS, Wesolowski A, Cummings DAT. A systematic review of antibody mediated immunity to coronaviruses: kinetics, correlates of protection, and association with severity. Nat Commun 2020; 11:4704. [PMID: 32943637 PMCID: PMC7499300 DOI: 10.1038/s41467-020-18450-4] [Citation(s) in RCA: 605] [Impact Index Per Article: 151.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/18/2020] [Indexed: 01/05/2023] Open
Abstract
Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS-CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time. The presence or absence of protective immunity due to infection or vaccination (when available) will affect future transmission and illness severity. Here, we review the scientific literature on antibody immunity to coronaviruses, including SARS-CoV-2 as well as the related SARS-CoV, MERS-CoV and endemic human coronaviruses (HCoVs). We reviewed 2,452 abstracts and identified 491 manuscripts relevant to 5 areas of focus: 1) antibody kinetics, 2) correlates of protection, 3) immunopathogenesis, 4) antigenic diversity and cross-reactivity, and 5) population seroprevalence. While further studies of SARS-CoV-2 are necessary to determine immune responses, evidence from other coronaviruses can provide clues and guide future research.
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Affiliation(s)
- Angkana T Huang
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Bernardo Garcia-Carreras
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Matt D T Hitchings
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Bingyi Yang
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Leah C Katzelnick
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Susan M Rattigan
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Brooke A Borgert
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Carlos A Moreno
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Benjamin D Solomon
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Luke Trimmer-Smith
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Veronique Etienne
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Comparative, Diagnostic & Population Medicine, University of Florida, Gainesville, FL, USA
| | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henrik Salje
- Department of Biology, University of Florida, Gainesville, FL, USA
- Department of Genetics, University of Cambridge, Cambridge, UK
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Donald S Burke
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA.
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
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6
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Cummings DAT, Radonovich LJ, Gorse GJ, Gaydos CA, Bessesen MT, Brown AC, Gibert CL, Hitchings MDT, Lessler J, Nyquist AC, Rattigan SM, Rodriguez-Barradas MC, Price CS, Reich NG, Simberkoff MS, Perl TM. Risk Factors for Healthcare Personnel Infection with Endemic Coronaviruses (HKU1, OC43, NL63, 229E): Results from the Respiratory Protection Effectiveness Clinical Trial (ResPECT). Clin Infect Dis 2020; 73:e4428-e4432. [PMID: 32645144 PMCID: PMC7454439 DOI: 10.1093/cid/ciaa900] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background SARS-CoV-2 presents a large risk to healthcare personnel. Quantifying the risk of coronavirus infection associated with workplace activities is an urgent need. Methods We assessed the association of worker characteristics, occupational roles and behaviors, and participation in procedures with the risk of endemic coronavirus infection among healthcare personnel who participated in the Respiratory Protection Effectiveness Trial (ResPECT), a cluster randomized trial to assess personal protective equipment to prevent respiratory infections and illness conducted from 2011 to 2016. Results Among 4,689 HCP-seasons, we detected coronavirus infection in 387 (8%). HCP who participated in an aerosol generation procedure (AGP) at least once during the viral respiratory season were 105% (95% CI 21%, 240%) more likely to be diagnosed with a laboratory-confirmed coronavirus infection. Younger individuals, those who saw pediatric patients and those with household members under the age of five were at increased risk of coronavirus infection. Conclusions Our analysis suggests the risk of HCP becoming infected with an endemic coronavirus increases approximately two-fold with exposures to AGP. Our findings may be relevant to the Coronavirus Disease 2019 (COVID-19) pandemic; however, SARS-COV-2, the virus that causes COVID-19, may differ from endemic coronaviruses in important ways.
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Affiliation(s)
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Geoffrey J Gorse
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA.,Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cynthia L Gibert
- Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University School of Medical and Health Sciences, Washington, DC, USA
| | | | - Justin Lessler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | | | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Connie Savor Price
- University of Colorado School of Medicine, Aurora, CO, USA.,Denver Health Medical Center, Denver, CO, USA
| | | | - Michael S Simberkoff
- Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,NYU School of Medicine, New York, NY, USA
| | - Trish M Perl
- Johns Hopkins School of Medicine, Baltimore, MD, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
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7
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Huang AT, Garcia-Carreras B, Hitchings MD, Yang B, Katzelnick LC, Rattigan SM, Borgert BA, Moreno CA, Solomon BD, Rodriguez-Barraquer I, Lessler J, Salje H, Burke D, Wesolowski A, Cummings DA. A systematic review of antibody mediated immunity to coronaviruses: antibody kinetics, correlates of protection, and association of antibody responses with severity of disease. medRxiv 2020:2020.04.14.20065771. [PMID: 32511434 PMCID: PMC7217088 DOI: 10.1101/2020.04.14.20065771] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The duration and nature of immunity generated in response to SARS-CoV-2 infection is unknown. Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARSCoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time. The timescale of protection is a critical determinant of the future impact of the pathogen. The presence or absence of protective immunity due to infection or vaccination (when available) will affect future transmission and illness severity. The dynamics of immunity and nature of protection are relevant to discussions surrounding therapeutic use of convalescent sera as well as efforts to identify individuals with protective immunity. Here, we review the scientific literature on antibody immunity to coronaviruses, including SARS-CoV-2 as well as the related SARS-CoV-1, MERS-CoV and human endemic coronaviruses (HCoVs). We reviewed 1281 abstracts and identified 322 manuscripts relevant to 5 areas of focus: 1) antibody kinetics, 2) correlates of protection, 3) immunopathogenesis, 4) antigenic diversity and cross-reactivity, and 5) population seroprevalence. While studies of SARS-CoV-2 are necessary to determine immune responses to it, evidence from other coronaviruses can provide clues and guide future research.
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Affiliation(s)
- Angkana T. Huang
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Bernardo Garcia-Carreras
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Matt D.T. Hitchings
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Bingyi Yang
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Leah C. Katzelnick
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Susan M. Rattigan
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Brooke A. Borgert
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Carlos A. Moreno
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
| | - Benjamin D. Solomon
- National Human Genome Research Institute, National Institutes of Health, USA
| | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Donald Burke
- Department of Epidemiology, University of Pittsburgh, USA
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Derek A.T. Cummings
- Department of Biology, University of Florida, USA
- Emerging Pathogens Institute, University of Florida, USA
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8
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Nyquist AC, Rattigan SM, Gibert CL, Gorse G, Perl TM, Perl TM, Price CS, Radonovich L, Rodriguez-Barradas MC, Simberkoff M, Bessesen MT, Gaydos CA, Cummings D. 1204. Increased Risk of Respiratory Infections Among Healthcare Personnel (HCP) Caring for Children. Open Forum Infect Dis 2019. [PMCID: PMC6809447 DOI: 10.1093/ofid/ofz360.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015. Methods Swabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults. Results The main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses. Conclusion The risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections. Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
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Affiliation(s)
| | | | - Cynthia L Gibert
- George Washington University School of Medicine and Health Sciences, Washington DC
| | - Geoffrey Gorse
- Saint Louis University School of Medicine and St. Louis VA Health Care System, Saint Louis, Missouri
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Connie S Price
- Denver Health and Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Lewis Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
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9
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Bessesen MT, Radonovich L, Rattigan SM, Cummings D, Rodriguez-Barradas MC, Simberkoff M, Gibert CL, Nyquist AC, Price CS, Gorse G, Gaydos CA, Perl TM, Perl TM. 1205. Healthcare Personnel Knowledge, Attitudes, and Beliefs Towards Infection Prevention and Control Measures for Protection from Respiratory Infections. Open Forum Infect Dis 2019. [PMCID: PMC6809034 DOI: 10.1093/ofid/ofz360.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare personnel (HCP) knowledge and attitudes toward Infection Prevention and Control (IPC) measures are important determinants of practices that can protect them from acquisition of infectious diseases from patients. We aimed to describe HCP knowledge and attitudes concerning IPC measures over time in the context of a clinical trial. Methods ResPECT was a multi-center, multi-season cluster randomized clinical trial designed to compare the effectiveness of medical masks (MM) and N95 respirators (N95) for preventing acute respiratory illnesses in HCP employed in outpatient clinical settings. At the beginning of each respiratory virus season, participants completed a survey instrument to measure IPC knowledge. At the beginning and end of each season participants completed a survey to assess attitudes and beliefs about IPC measures, especially MM and N95. Results A pre-study and post-study survey pair was available for 88.1% of participant seasons. There were no significant differences in demographic variables or job assignment between survey respondents and nonrespondents for each participant season. Participants correctly identified 59.8% to 63.4% of IPC measures that should be used by HCP when exposed to patients with symptoms of acute respiratory illness, or at high risk of infection. There was modest improvement in the knowledge score over time among providers who participated for multiple years in the study. In the first pre-study survey of IPC attitudes and beliefs, 88.5% and 87.9% of participants identified at least one reason to avoid using either MM and N95, respectively (Figure 1). At the post-season survey, the proportion of participants reporting a reason to avoid MM fell to 39.6% (IRR for pre- vs. post-season 0.15, 95% CI 0.13–0.17) and 53.6% reported a reason to avoid N95 (IRR 0.57, 95% CI 0.51–0.66). Conclusion HCPknowledge of IPC precautions was poor, suggesting a need for better IPC education and accountability in the outpatient setting. When given incentives to comply with processes toward which they had negative attitudes at baseline, HCP realized that medical masks and N95 respirators were comfortable enough to wear for patient encounters and interfered with their work processes less than expected. ![]()
Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
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Affiliation(s)
| | - Lewis Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | | | | | | | | | - Cynthia L Gibert
- George Washington University School of Medicine and Health Sciences, Washington DC
| | | | - Connie S Price
- Denver Health and Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Geoffrey Gorse
- Saint Louis University School of Medicine and St. Louis VA Health Care System, Saint Louis, Missouri
| | | | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
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Ellerton CR, Rattigan SM, Chapman FM, Chitkara DK, Smerdon DL. Secondary implantation of open-loop, flexible, anterior chamber intraocular lenses. J Cataract Refract Surg 1996; 22:951-4. [PMID: 9041088 DOI: 10.1016/s0886-3350(96)80197-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess the results of implantation of secondary, open-loop, flexible, anterior chamber intraocular lenses (IOLs) and compare the findings with those of other published studies. SETTING A combined ophthalmology and ear, nose, and throat hospital in Middlesbrough, Cleveland, England. METHODS This retrospective study comprised 81 patients who had secondary implantation of a flexible, open-loop, anterior chamber IOL by the one surgeon. The incidence of postoperative complications was ascertained, and best corrected preoperative and postoperative visual acuities were compared. RESULTS Two serious complications occurred: one severe loss of vision that is still under investigation and one retinal detachment that was repaired with good residual visual function. Of all 81 patients, 92.5% were within one Snellen line of their preoperative best corrected visual acuity. These results compare favorably with those of other published studies. CONCLUSION Using an open-loop, flexible, anterior chamber lens for secondary implantation is still an acceptable way to treat aphakia. The poor reputation of these lenses is undeserved.
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Affiliation(s)
- C R Ellerton
- North Riding Infirmary, Middlesbrough, Cleveland, England
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11
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Rattigan SM, Ellerton CR, Chitkara DK, Smerdon DL. Flexible open-loop anterior chamber intraocular lens implantation after posterior capsule complications in extracapsular cataract extraction. J Cataract Refract Surg 1996; 22:243-6. [PMID: 8656392 DOI: 10.1016/s0886-3350(96)80226-4] [Citation(s) in RCA: 29] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To analyze 50 cases of flexible open-loop anterior chamber intraocular lens (IOL) implantation after posterior capsule rupture and vitreous loss and compare the results with those of other published series. SETTING North Riding Infirmary, Cleveland, England. METHODS This retrospective study, with a follow-up between 3 and 81 months, comprised all patients who had a flexible open-loop anterior chamber IOL implanted because of significant posterior capsule problems during extracapsular cataract extraction. The incidence of postoperative complications and best corrected visual acuity results were determined. RESULTS Three patients with cystoid macular edema achieved final best corrected visual acuity of 6/9 (20/30). There was one retinal detachment and one traumatic incision rupture with IOL loss 6 weeks postoperatively and subsequent retinal detachment and phthisis. Seventy-two percent achieved a best corrected visual acuity of 6/9 (20/30). CONCLUSIONS Our results agree with those of other published series. Implantation of a flexible open-loop anterior chamber IOL as a primary lens is still an acceptable way of treating posterior capsule complications in cataract surgery.
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