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Haddadin Z, Nguyen AM, Poulikakos LV. Crafting chirality in three dimensions via a novel fabrication technique for bound states in the continuum metasurfaces. Light Sci Appl 2024; 13:45. [PMID: 38316775 PMCID: PMC10844267 DOI: 10.1038/s41377-023-01368-z] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
An additional deposition step was added to a multi-step electron beam lithographic fabrication process to unlock the height dimension as an accessible parameter for resonators comprising unit cells of quasi-bound states in the continuum metasurfaces, which is essential for the geometric design of intrinsically chiral structures.
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Affiliation(s)
- Zaid Haddadin
- Department of Electrical & Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Anna My Nguyen
- Department of Mechanical & Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
| | - Lisa V Poulikakos
- Department of Mechanical & Aerospace Engineering, University of California San Diego, La Jolla, CA, USA.
- Program of Materials Science & Engineering, University of California San Diego, La Jolla, CA, USA.
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Schuster JE, Hamdan L, Dulek DE, Kitko CL, Batarseh E, Haddadin Z, Stewart LS, Stahl A, Potter M, Rahman H, Kalams SA, Bocchini CE, Moulton EA, Coffin SE, Ardura MI, Wattier RL, Maron G, Grimley M, Paulsen G, Harrison CJ, Freedman JL, Carpenter PA, Englund JA, Munoz FM, Danziger-Isakov L, Spieker AJ, Halasa NB. The Durability of Antibody Responses of Two Doses of High-Dose Relative to Two Doses of Standard-Dose Inactivated Influenza Vaccine in Pediatric Hematopoietic Cell Transplant Recipients: A Multi-Center Randomized Controlled Trial. Clin Infect Dis 2024; 78:217-226. [PMID: 37800415 PMCID: PMC10810702 DOI: 10.1093/cid/ciad534] [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: 06/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Our previous study established a 2-dose regimen of high-dose trivalent influenza vaccine (HD-TIV) to be immunogenically superior compared to a 2-dose regimen of standard-dose quadrivalent influenza vaccine (SD-QIV) in pediatric allogeneic hematopoietic cell transplant (HCT) recipients. However, the durability of immunogenicity and the role of time post-HCT at immunization as an effect modifier are unknown. METHODS This phase II, multi-center, double-blinded, randomized controlled trial compared HD-TIV to SD-QIV in children 3-17 years old who were 3-35 months post-allogeneic HCT, with each formulation administered twice, 28-42 days apart. Hemagglutination inhibition (HAI) titers were measured at baseline, 28-42 days following each dose, and 138-222 days after the second dose. Using linear mixed effects models, we estimated adjusted geometric mean HAI titer ratios (aGMR: HD-TIV/SD-QIV) to influenza antigens. Early and late periods were defined as 3-5 and 6-35 months post-HCT, respectively. RESULTS During 3 influenza seasons (2016-2019), 170 participants were randomized to receive HD-TIV (n = 85) or SD-QIV (n = 85). HAI titers maintained significant elevations above baseline for both vaccine formulations, although the relative immunogenic benefit of HD-TIV to SD-QIV waned during the study. A 2-dose series of HD-TIV administered late post-HCT was associated with higher GMTs compared to the early post-HCT period (late group: A/H1N1 aGMR = 2.16, 95% confidence interval [CI] = [1.14-4.08]; A/H3N2 aGMR = 3.20, 95% CI = [1.60-6.39]; B/Victoria aGMR = 1.91, 95% CI = [1.01-3.60]; early group: A/H1N1 aGMR = 1.03, 95% CI = [0.59-1.80]; A/H3N2 aGMR = 1.23, 95% CI = [0.68-2.25]; B/Victoria aGMR = 1.06, 95% CI = [0.56-2.03]). CONCLUSIONS Two doses of HD-TIV were more immunogenic than SD-QIV, especially when administered ≥6 months post-HCT. Both groups maintained higher titers compared to baseline throughout the season. CLINICAL TRIALS REGISTRATION NCT02860039.
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Affiliation(s)
- Jennifer E Schuster
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Lubna Hamdan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie L Kitko
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Einas Batarseh
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anna Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Molly Potter
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spyros A Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claire E Bocchini
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth A Moulton
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
| | - Susan E Coffin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica I Ardura
- Department of Pediatrics, Division of Infectious Diseases & Host Defense, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Rachel L Wattier
- Department of Pediatrics, University of California San Francisco and Benioff Children's Hospital – San Francisco, San Francisco, California, USA
| | - Gabriela Maron
- Department of Infectious Diseases, Children's, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael Grimley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Grant Paulsen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher J Harrison
- Department of Infectious Diseases, University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Jason L Freedman
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Carpenter
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Flor M Munoz
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Lara Danziger-Isakov
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Neveu M, Quinn R, Barge LM, Craft KL, German CR, Getty S, Glein C, Parra M, Burton AS, Cary F, Corpolongo A, Fifer L, Gangidine A, Gentry D, Georgiou CD, Haddadin Z, Herbold C, Inaba A, Jordan SF, Kalucha H, Klier P, Knicely K, Li AY, McNally P, Millan M, Naz N, Raj CG, Schroedl P, Timm J, Yang Z. Future of the Search for Life: Workshop Report. Astrobiology 2024; 24:114-129. [PMID: 38227837 DOI: 10.1089/ast.2022.0158] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The 2-week, virtual Future of the Search for Life science and engineering workshop brought together more than 100 scientists, engineers, and technologists in March and April 2022 to provide their expert opinion on the interconnections between life-detection science and technology. Participants identified the advances in measurement and sampling technologies they believed to be necessary to perform in situ searches for life elsewhere in our Solar System, 20 years or more in the future. Among suggested measurements for these searches, those pertaining to three potential indicators of life termed "dynamic disequilibrium," "catalysis," and "informational polymers" were identified as particularly promising avenues for further exploration. For these three indicators, small breakout groups of participants identified measurement needs and knowledge gaps, along with corresponding constraints on sample handling (acquisition and processing) approaches for a variety of environments on Enceladus, Europa, Mars, and Titan. Despite the diversity of these environments, sample processing approaches all tend to be more complex than those that have been implemented on missions or envisioned for mission concepts to date. The approaches considered by workshop breakout groups progress from nondestructive to destructive measurement techniques, and most involve the need for fluid (especially liquid) sample processing. Sample processing needs were identified as technology gaps. These gaps include technology and associated sampling strategies that allow the preservation of the thermal, mechanical, and chemical integrity of the samples upon acquisition; and to optimize the sample information obtained by operating suites of instruments on common samples. Crucially, the interplay between science-driven life-detection strategies and their technological implementation highlights the need for an unprecedented level of payload integration and extensive collaboration between scientists and engineers, starting from concept formulation through mission deployment of life-detection instruments and sample processing systems.
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Affiliation(s)
- Marc Neveu
- Department of Astronomy, University of Maryland, College Park, Maryland, USA
- NASA Goddard Space Flight Center, Greenbelt, Maryland, USA
| | - Richard Quinn
- NASA Ames Research Center, Moffett Field, California, USA
| | - Laura M Barge
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California, USA
| | - Kathleen L Craft
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland, USA
| | | | | | | | - Macarena Parra
- NASA Ames Research Center, Moffett Field, California, USA
| | | | - Francesca Cary
- Hawai'i Institute of Geophysics and Planetology, University of Hawai'i, Mānoa, Hawaii, USA
| | - Andrea Corpolongo
- Department of Geosciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lucas Fifer
- Department of Earth and Space Sciences, University of Washington, Seattle, Washington, USA
| | - Andrew Gangidine
- Office of Development, Yale University, New Haven, Connecticut, USA
| | - Diana Gentry
- NASA Ames Research Center, Moffett Field, California, USA
| | | | - Zaid Haddadin
- Department of Electrical and Computer Engineering, University of California, San Diego, California, USA
| | - Craig Herbold
- School of Biological Sciences, University of Canterbury, Christchurch, New Zealand
| | - Aila Inaba
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Seán F Jordan
- School of Chemical Sciences, Dublin City University, Dublin, Ireland
| | - Hemani Kalucha
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, California, USA
| | - Pavel Klier
- NASA Ames Research Center, Moffett Field, California, USA
- NASA Postdoctoral Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Kas Knicely
- Geophysical Institute, University of Alaska, Fairbanks, Alaska, USA
| | - An Y Li
- Department of Earth and Space Sciences, University of Washington, Seattle, Washington, USA
| | - Patrick McNally
- Space Physics Research Laboratory, University of Michigan, Ann Arbor, Michigan, USA
| | - Maëva Millan
- Laboratory Atmosphere and Space Observations, Guyancourt, France
| | - Neveda Naz
- Department of Chemistry, Tufts University, Medford, Massachusetts, USA
| | - Chinmayee Govinda Raj
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Peter Schroedl
- Department of Biology, Boston University, Boston, Massachusetts, USA
| | - Jennifer Timm
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Ziming Yang
- Department of Chemistry, Oakland University, Rochester, Michigan, USA
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Samuels RJ, Sumah I, Alhasan F, McHenry R, Short L, Chappell JD, Haddadin Z, Halasa NB, Valério ID, Amorim G, Grant DS, Schieffelin JS, Moon TD. Respiratory virus surveillance in hospitalized children less than two-years of age in Kenema, Sierra Leone during the COVID-19 pandemic (October 2020- October 2021). PLoS One 2023; 18:e0292652. [PMID: 37816008 PMCID: PMC10564235 DOI: 10.1371/journal.pone.0292652] [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: 03/28/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra Leone, during the second year of the SARS-CoV-2 pandemic. We conducted a prospective study of children hospitalized with respiratory symptoms between October 2020 and October 2021. We collected demographic and clinical characteristics and calculated each participant´s respiratory symptom severity. Nose and throat swabs were collected at enrollment. Total nucleic acid was purified and tested for multiple respiratory viruses. Statistical analysis was performed using R version 4.2.0 software. 502 children less than two-years of age were enrolled. 376 (74.9%) had at least one respiratory virus detected. The most common viruses isolated were HRV/EV (28.2%), RSV (19.5%) and PIV (13.1%). Influenza and SARS-CoV-2 were identified in only 9.2% and 3.9% of children, respectively. Viral co-detection was common. Human metapneumovirus and RSV had more than two-fold higher odds of requiring O2 therapy while hospitalized. Viral pathogen prevalence was high (74.9%) in our study population. Despite this, 100% of children received antibiotics, underscoring a need to expand laboratory diagnostic capacity and to revisit clinical guidelines implementation in these children. Continuous surveillance and serologic studies among more diverse age groups, with greater geographic breadth, are needed in Sierra Leone to better characterize the long-term impact of COVID-19 on respiratory virus prevalence and to better characterize the seasonality of respiratory viruses in Sierra Leone.
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Affiliation(s)
- Robert J. Samuels
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Ibrahim Sumah
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Foday Alhasan
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Rendie McHenry
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Laura Short
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - James D. Chappell
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Zaid Haddadin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Natasha B. Halasa
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Inaê D. Valério
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Donald S. Grant
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - John S. Schieffelin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Tulane University, New Orleans, Louisiana, United States of America
| | - Troy D. Moon
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Tulane University, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Samuelson AG, Damron LF, Haddadin Z, Adnan SM, Neff M. Multiple Internal Hernias: A Complication of Laparoscopic Roux-en-Y Gastric Bypass. CRSLS 2023; 10:e2023.00040. [PMID: 38226185 PMCID: PMC10789439 DOI: 10.4293/crsls.2023.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Introduction Internal hernias are the most common cause of small bowel obstruction following laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP) with four distinct types. Herein, we report the clinical course of a patient with two independent hernias at the Petersen's space and a rarer subtype at the jejunojejunal window. A high index of suspicion for less common subtypes of internal hernias and the possibility of multiple, simultaneous internal hernias is critical. Case Description We describe the case of a 52-year-old female with a history of LRYGBP who presented with abdominal pain and emesis due to an internal hernia at Peterson's defect, requiring subsequent laparoscopic repair. On postoperative day three, the patient presented again with recurrent abdominal pain and emesis. Repeat exploratory laparoscopy found a separate internal hernia involving the jejunojejunal window with the previously repaired Petersen's defect intact. Discussion This case illustrates a unique scenario of a patient post-LRYGBP with multiple internal hernias at the Peterson's space and the less common jejunojejunal window, which was missed during the index surgery. Failure to identify simultaneous hernias may result in additional invasive intervention and further morbidity. Conclusion Multiple less-common variants of internal hernias may present simultaneously following LRYGBP.
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Affiliation(s)
- Annika G Samuelson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. (Ms. Samuelson, Mr. Damron)
| | - Leland F Damron
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. (Ms. Samuelson and Ms. Damron)
| | - Zaid Haddadin
- Department of Surgery, Einstein Healthcare Network/Jefferson Health, Philadelphia, PA. (Drs. Haddadin and Adnan)
| | - Sakib M Adnan
- Department of Surgery, Einstein Healthcare Network/Jefferson Health, Philadelphia, PA. (Drs. Haddadin and Adnan)
| | - Marc Neff
- Department of Bariatric and General Surgery, Jefferson Health New Jersey, Cherry Hill, NJ. (Dr. Neff)
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Amarin JZ, Potter M, Thota J, Rankin DA, Probst V, Haddadin Z, Stewart LS, Yanis A, Talj R, Rahman H, Markus TM, Chappell J, Lindegren ML, Schaffner W, Spieker AJ, Halasa NB. Clinical characteristics and outcomes of children with single or co-detected rhinovirus-associated acute respiratory infection in Middle Tennessee. BMC Infect Dis 2023; 23:136. [PMID: 36882755 PMCID: PMC9990557 DOI: 10.1186/s12879-023-08084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/15/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Rhinovirus (RV) is one of the most common etiologic agents of acute respiratory infection (ARI), which is a leading cause of morbidity and mortality in young children. The clinical significance of RV co-detection with other respiratory viruses, including respiratory syncytial virus (RSV), remains unclear. We aimed to compare the clinical characteristics and outcomes of children with ARI-associated RV-only detection and those with RV co-detection-with an emphasis on RV/RSV co-detection. METHODS We conducted a prospective viral surveillance study (11/2015-7/2016) in Nashville, Tennessee. Children < 18 years old who presented to the emergency department (ED) or were hospitalized with fever and/or respiratory symptoms of < 14 days duration were eligible if they resided in one of nine counties in Middle Tennessee. Demographics and clinical characteristics were collected by parental interviews and medical chart abstractions. Nasal and/or throat specimens were collected and tested for RV, RSV, metapneumovirus, adenovirus, parainfluenza 1-4, and influenza A-C using reverse transcription quantitative polymerase chain reaction assays. We compared the clinical characteristics and outcomes of children with RV-only detection and those with RV co-detection using Pearson's χ2 test for categorical variables and the two-sample t-test with unequal variances for continuous variables. RESULTS Of 1250 children, 904 (72.3%) were virus-positive. RV was the most common virus (n = 406; 44.9%), followed by RSV (n = 207; 19.3%). Of 406 children with RV, 289 (71.2%) had RV-only detection, and 117 (28.8%) had RV co-detection. The most common virus co-detected with RV was RSV (n = 43; 36.8%). Children with RV co-detection were less likely than those with RV-only detection to be diagnosed with asthma or reactive airway disease both in the ED and in-hospital. We did not identify differences in hospitalization, intensive care unit admission, supplemental oxygen use, or length of stay between children with RV-only detection and those with RV co-detection. CONCLUSION We found no evidence that RV co-detection was associated with poorer outcomes. However, the clinical significance of RV co-detection is heterogeneous and varies by virus pair and age group. Future studies of RV co-detection should incorporate analyses of RV/non-RV pairs and include age as a key covariate of RV contribution to clinical manifestations and infection outcomes.
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Affiliation(s)
- Justin Z Amarin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA.
| | - Molly Potter
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Jyotsna Thota
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Danielle A Rankin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA.,Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Varvara Probst
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Zaid Haddadin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Laura S Stewart
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Ahmad Yanis
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Rana Talj
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Herdi Rahman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Tiffanie M Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Chappell
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
| | - Mary Lou Lindegren
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North D7235, Nashville, TN, 37232, USA
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Haddadin Z, Spieker AJ, Amarin JZ, Hall M, Thurm C, Danziger-Isakov L, Godown J, Halasa NB, Dulek DE. Incidence of and risk factors for influenza-associated hospital encounters in pediatric solid organ transplant recipients. Am J Transplant 2023; 23:659-665. [PMID: 36758752 DOI: 10.1016/j.ajt.2023.01.024] [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: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
Few studies have defined the incidence of and risk factors for influenza infection in pediatric solid organ transplant (SOT) recipients. We used a linkage between the Pediatric Health Information System and the Scientific Registry of Transplant Recipients databases to identify posttransplant influenza-associated hospital encounters (IAHEs) in pediatric SOT recipients of single-organ transplants. Among 7997 unique pediatric SOT recipients transplanted between January 01, 2006, and January 06, 2016, estimated 1- and 3-year posttransplant cumulative incidence rates of IAHEs were 2.7% (95% CI, 2.4%-3.1%) and 7.4% (95% CI, 6.8%-8.0%), respectively. One- and 3-year cumulative incidence rates of severe IAHEs were 0.3% (95% CI, 0.2%-0.5%) and 0.9% (95% CI, 0.7%-1.2%), respectively. Multivariable analysis showed that the organ type (adjusted subdistribution hazard ratio [aSHR]-kidney: reference, liver: 0.64 [95% CI, 0.49-0.84], and heart: 0.72 [95% CI, 0.57-0.93]), race/ethnicity (aSHR-non-Hispanic White: reference, non-Hispanic Black: 1.63 [95% CI, 1.29-2.07], Hispanic 1.57 [95% CI, 1.27-1.94]), and increasing age at transplant (aSHR, 0.93 [95% CI, 0.91-0.94]) were significantly associated with IAHE occurrence. Heart transplant recipients had a near statistically significant increase in hazard for severe IAHE (aSHR 1.96 [0.92-3.49]). Our findings may help guide future influenza prevention efforts and facilitate intervention impact assessment measurement in pediatric SOT recipients.
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Affiliation(s)
- Zaid Haddadin
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin Z Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | | | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Justin Godown
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Rankin DA, Spieker AJ, Perez A, Stahl AL, Rahman HK, Stewart LS, Schuster JE, Lively JY, Haddadin Z, Probst V, Michaels MG, Williams JV, Boom JA, Sahni LC, Staat MA, Schlaudecker EP, McNeal MM, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Gerber SI, McMorrow M, Rha B, Chappell JD, Selvarangan R, Midgley CM, Halasa NB. Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6:e2254909. [PMID: 36749589 PMCID: PMC10408278 DOI: 10.1001/jamanetworkopen.2022.54909] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
IMPORTANCE Rhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting. OBJECTIVE To quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought medical care for fever and/or respiratory symptoms at 7 EDs or hospitals within NVSN across the US between December 2016 and February 2021. Persons younger than 18 years were enrolled in NVSN, and respiratory specimens were collected and tested for multiple viruses. MAIN OUTCOMES AND MEASURES Proportion of patients in whom rhinovirus and/or enterovirus, or another virus, was detected by calendar month and by prepandemic (December 1, 2016, to March 11, 2020) or pandemic (March 12, 2020, to February 28, 2021) periods. Month-specific adjusted odds ratios (aORs) for rhinovirus and/or enterovirus-positive test results (among all tested) by setting (ED or inpatient) and age group (<2, 2-4, or 5-17 years) were calculated, comparing each month during the pandemic to equivalent months of previous years. RESULTS Of the 38 198 children and adolescents who were enrolled and tested, 11 303 (29.6%; mean [SD] age, 2.8 [3.7] years; 6733 boys [59.6%]) had rhinovirus and/or enterovirus-positive test results. In prepandemic and pandemic periods, rhinoviruses and/or enteroviruses were detected in 29.4% (9795 of 33 317) and 30.9% (1508 of 4881) of all patients who were enrolled and tested and in 42.2% (9795 of 23 236) and 73.0% (1508 of 2066) of those with test positivity for any virus, respectively. Rhinoviruses and/or enteroviruses were the most frequently detected viruses in both periods and all age groups in the ED and inpatient setting. From April to September 2020 (pandemic period), rhinoviruses and/or enteroviruses were detectable at similar or lower odds than in prepandemic years, with aORs ranging from 0.08 (95% CI, 0.04-0.19) to 0.76 (95% CI, 0.55-1.05) in the ED and 0.04 (95% CI, 0.01-0.11) to 0.71 (95% CI, 0.47-1.07) in the inpatient setting. However, unlike some other viruses, rhinoviruses and/or enteroviruses soon returned to prepandemic levels and from October 2020 to February 2021 were detected at similar or higher odds than in prepandemic months in both settings, with aORs ranging from 1.47 (95% CI, 1.12-1.93) to 3.01 (95% CI, 2.30-3.94) in the ED and 1.36 (95% CI, 1.03-1.79) to 2.44 (95% CI, 1.78-3.34) in the inpatient setting, and in all age groups. Compared with prepandemic years, during the pandemic, rhinoviruses and/or enteroviruses were detected in patients who were slightly older, although most (74.5% [1124 of 1508]) were younger than 5 years. CONCLUSIONS AND RELEVANCE Results of this study show that rhinoviruses and/or enteroviruses persisted and were the most common respiratory virus group detected across all pediatric age groups and in both ED and inpatient settings. Rhinoviruses and/or enteroviruses remain a leading factor in ARI health care burden, and active ARI surveillance in children and adolescents remains critical for defining the health care burden of respiratory viruses.
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Affiliation(s)
- Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ariana Perez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology Inc, Falls Church, Virginia
| | - Anna L. Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Herdi K. Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Joana Y. Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marian G. Michaels
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V. Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Leila C. Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Mary A. Staat
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth P. Schlaudecker
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Monica M. McNeal
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christopher J. Harrison
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Geoffrey A. Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G. Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children’s Hospital, UCLA, Los Angeles
| | - Janet A. Englund
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Eileen J. Klein
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rangaraj Selvarangan
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Claire M. Midgley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Schuster JE, Hamdan L, Dulek DE, Kitko CL, Batarseh E, Haddadin Z, Stewart LS, Stahl A, Potter M, Rahman H, Kalams SA, Coffin S, Ardura MI, Wattier RL, Maron G, Bocchini CE, Moulton EA, Grimley M, Paulsen G, Harrison CJ, Freedman J, Carpenter PA, Englund JA, Munoz FM, Danziger-Isakov L, Spieker AJ, Halasa N. Influenza Vaccine in Pediatric Recipients of Hematopoietic-Cell Transplants. N Engl J Med 2023; 388:374-376. [PMID: 36630610 DOI: 10.1056/nejmc2210825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | - Lubna Hamdan
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Anna Stahl
- Vanderbilt University Medical Center, Nashville, TN
| | - Molly Potter
- Vanderbilt University Medical Center, Nashville, TN
| | - Herdi Rahman
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Susan Coffin
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Rachel L Wattier
- University of California, San Francisco, Benioff Children's Hospital-San Francisco, San Francisco, CA
| | | | | | | | - Michael Grimley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Grant Paulsen
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Amarin JZ, Haddadin Z, Spieker AJ, Godown J, Halasa NB, Dulek D. 2166. Timely Antiviral Therapy for Influenza-Associated Hospitalizations in Pediatric Solid Organ Transplant Recipients in the United States. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1786] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Pediatric solid organ transplant (SOT) recipients are at high risk of complications from influenza and those with documented or suspected influenza should receive antivirals as soon as possible. We aimed to compare outcomes between pediatric SOT recipients who did or did not receive timely antiviral therapy for an influenza-associated hospitalization (IAH).
Methods
We linked the Pediatric Health Information System (PHIS) and Scientific Registry of Transplant Recipients (SRTR) databases and queried the merged database for single SOT recipients < 18 years old who were transplanted between 1/1/2006 and 6/1/2016 and had at least one IAH within 3 years. We excluded children who contracted influenza or died during the transplant encounter and those who did not have follow-up data. We defined “timely” antiviral therapy as the receipt of antivirals no more than 2 days after hospitalization and compared the outcomes of children who did or did not receive timely antiviral therapy using Pearson’s χ2 test or the two-sample t-test with unequal variances, as appropriate.
Results
Of 12,419 children, 379 (3.1%) had at least one IAH. The most common organ transplant was kidney (n=133 [35.1%]). Of 270 children (71.2%) who received antivirals, 225 (83.3%) received them within 2 days of hospitalization. Oseltamivir was the most frequently administered influenza-specific antiviral (n=268 [99.3%]). The outcomes of children who received timely antiviral therapy and those who did not are compared in Table 1. The proportion of children who received timely antiviral therapy increased over the study period from 33.3% in 2007 to 100% in 2019 (Figure 1). Table 1Outcomes of pediatric SOT recipients who did or did not receive timely antiviral therapy.Figure 1Proportions of pediatric SOT recipients who did or did not receive timely antiviral therapy.
Conclusion
Timely influenza-specific antiviral therapy was associated with better outcomes in pediatric SOT recipients with IAH. Importantly, more than one-third of children did not receive timely antiviral therapy. Further studies are needed to identify and address barriers to timely antiviral therapy.
Disclosures
Natasha B. Halasa, MD, Quidel: Grant/Research Support|Quidel: equipment donation|Sanofi: Grant/Research Support|Sanofi: HAI testing and vaccine donation Daniel Dulek, MD, Eurofins/Viracor: Grant/Research Support.
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Affiliation(s)
| | - Zaid Haddadin
- Albert Einstein Medical Center , Philadelphia, Pennsylvania
| | | | - Justin Godown
- Monroe Carell Jr. Children's Hospital at Vanderbilt , Nashville, Tennessee
| | | | - Daniel Dulek
- Vanderbilt University Medical Center , Nashville, Tennessee
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11
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Talj R, Amarin JZ, Rankin DA, Bloos SM, Shawareb Y, Rahman H, Haddadin Z, Howard LM, Probst V, Naffa RG, Johnson M, Lane S, Kinzler AJ, Spieker AJ, Faouri S, Shehabi A, Chappell J, Khuri-Bulos N, Williams JV, Halasa N. Clinical characteristics, outcomes, and seasonality of acute respiratory infection associated with single and codetected rhinovirus species among hospitalized children in Amman, Jordan. J Med Virol 2022; 94:5904-5915. [PMID: 35918790 DOI: 10.1002/jmv.28042] [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: 04/16/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 01/06/2023]
Abstract
Rhinovirus (RV)-specific surveillance studies in the Middle East are limited. Therefore, we aimed to study the clinical characteristics, outcomes, and seasonality of RV-associated acute respiratory infection among hospitalized young children in Jordan. We conducted a prospective viral surveillance study and enrolled children <2 years old admitted to a large public hospital in Amman, Jordan (2010-2013). Demographic and clinical data were collected by structured interviews and chart abstractions. Nasal and/or throat swabs were collected and tested for a panel of respiratory viruses, and RV genotyping and speciation was performed. At least one virus was detected in 2641/3168 children (83.4%). RV was the second most common virus detected (n = 1238; 46.9%) and was codetected with another respiratory virus in 730 cases (59.0%). Children with RV codetection were more likely than those with RV-only detection to have respiratory distress but had similar outcomes. RV-A accounted for about half of RV-positive cases (54.7%), while children with RV-C had a higher frequency of wheezing and reactive airway disease. RV was detected year-round and peaked during winter. In conclusion, though children with RV codetection had worse clinical findings, neither codetection nor species affected most clinical outcomes.
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Affiliation(s)
- Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin Z Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sean M Bloos
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yanal Shawareb
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leigh M Howard
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Randa G Naffa
- Molecular Biology Research Laboratory, The University of Jordan School of Medicine, Amman, Jordan
| | - Monika Johnson
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sidney Lane
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amy J Kinzler
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samir Faouri
- Department of Pediatrics, Al-Bashir Hospital, Amman, Jordan
| | - Asem Shehabi
- Department of Pathology and Microbiology and Forensic Medicine, The University of Jordan School of Medicine, Amman, Jordan
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Najwa Khuri-Bulos
- Department of Pediatrics, The University of Jordan School of Medicine, Amman, Jordan
| | - John V Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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Hanna DN, Haddadin Z, Stafman L, Godfrey CM, Huang EY, Aiello B, Greeno AL, Unni P, Lovvorn HN. Sledding while towed behind motorized vehicles associates with more severe and lethal injuries ☆. J Pediatr Surg 2022; 57:644-648. [PMID: 35396085 DOI: 10.1016/j.jpedsurg.2022.03.011] [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: 12/08/2021] [Revised: 02/14/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Our institution has recently experienced an increase in sledding-related injuries, particularly when towed behind motorized vehicles. The purpose of this study was to characterize injury severity and clinical outcomes between pediatric patients who sustain injuries owing to motorized sledding accidents to aid in injury prevention messaging. METHODS This retrospective study queried all patients who presented with a sledding-related injury to a single ACS-verified Level 1 Pediatric Trauma Center located in the Southeastern United States between 01/2015 and 01/2022. Demographics, injury details, and clinical outcomes were compared between two groups: patients towed behind a motorized vehicle (MOTOR) and those who were not (GRAVITY). RESULTS Of the 67 patients included in our analysis, 15 (22%) were in the MOTOR group. Patients in the MOTOR group presented with significantly higher injury severity (ISS) and lower Glasgow coma scale (GCS) scores. Additionally, patients in this MOTOR group more often received a blood transfusion and intubation, had longer intensive care and overall hospital lengths of stay, and incurred higher hospital costs. In a multivariate analysis, the use of a motorized vehicle to sled was independently associated with increased ISS (OR: 9.7, 95% CI 1.9-17.5; p = 0.02). Two deaths occurred after sledding while being towed behind a motorized vehicle. CONCLUSION Children experiencing sledding accidents while being towed by motorized vehicles sustain significantly more severe injuries and require more intensive treatments that together lead to increased hospital costs. These findings provide the framework for community educational initiatives and injury prevention measures to mitigate risk among children engaged in sledding. LEVEL OF EVIDENCE IV retrospective cohort study.
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Affiliation(s)
- David N Hanna
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States.
| | - Zaid Haddadin
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
| | - Laura Stafman
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
| | - Caroline M Godfrey
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
| | - Eunice Y Huang
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
| | - Brittney Aiello
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
| | - Amber L Greeno
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
| | - Purnima Unni
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
| | - Harold N Lovvorn
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, 2220 Children's Way, Nashville, TN 37232, United States
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13
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Probst V, Spieker AJ, Stopczynski T, Stewart LS, Haddadin Z, Selvarangan R, Harrison CJ, Schuster JE, Staat MA, McNeal M, Weinberg GA, Szilagyi PG, Boom JA, Sahni LC, Piedra PA, Englund JA, Klein EJ, Michaels MG, Williams JV, Campbell AP, Patel M, Gerber SI, Halasa NB. Clinical Presentation and Severity of Adenovirus Detection Alone vs Adenovirus Co-detection With Other Respiratory Viruses in US Children With Acute Respiratory Illness from 2016 to 2018. J Pediatric Infect Dis Soc 2022; 11:430-439. [PMID: 35849119 DOI: 10.1093/jpids/piac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Human adenovirus (HAdV) is commonly associated with acute respiratory illnesses (ARI) in children and is also frequently co-detected with other viral pathogens. We compared clinical presentation and outcomes in young children with HAdV detected alone vs co-detected with other respiratory viruses. METHODS We used data from a multicenter, prospective, viral surveillance study of children seen in the emergency department and inpatient pediatric settings at seven US sites. Children less than 18 years old with fever and/or respiratory symptoms were enrolled between 12/1/16 and 10/31/18 and tested by molecular methods for HAdV, human rhinovirus/enterovirus (HRV/EV), respiratory syncytial virus (RSV), parainfluenza (PIV, types 1-4), influenza (flu, types A-C), and human metapneumovirus (HMPV). Our primary measure of illness severity was hospitalization; among hospitalized children, secondary severity outcomes included oxygen support and length of stay (LOS). RESULTS Of the 18,603 children enrolled, HAdV was detected in 1,136 (6.1%), among whom 646 (56.9%) had co-detection with at least one other respiratory virus. HRV/EV (n = 293, 45.3%) and RSV (n = 123, 19.0%) were the most frequent co-detections. Children with HRV/EV (aOR = 1.61; 95% CI = [1.11-2.34]), RSV (aOR = 4.48; 95% CI = [2.81-7.14]), HMPV (aOR = 3.39; 95% CI = [1.69-6.77]), or ≥ 2 co-detections (aOR = 1.95; 95% CI = [1.14-3.36]) had higher odds of hospitalization compared to children with HAdV alone. Among hospitalized children, HAdV co-detection with RSV or HMPV was each associated with higher odds of oxygen support, while co-detection with PIV or influenza viruses was each associated with higher mean LOS. CONCLUSIONS HAdV co-detection with other respiratory viruses was associated with greater disease severity among children with ARI compared to HAdV detection alone.
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Affiliation(s)
- Varvara Probst
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tess Stopczynski
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Christopher J Harrison
- Department of Pathology and Laboratory Medicine, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jennifer E Schuster
- Department of Pediatrics, University of Missouri-Kansas City and Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Mary A Staat
- Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Monica McNeal
- Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Geoffrey A Weinberg
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Peter G Szilagyi
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California, USA
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, Texas Children's Hospital, Houston, Texas, USA
| | - Leila C Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, Texas Children's Hospital, Houston, Texas, USA
| | - Pedro A Piedra
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, Texas Children's Hospital, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas. Texas Children's Hospital, Houston, Texas, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Eileen J Klein
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Marian G Michaels
- Department of Pediatrics, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John V Williams
- Department of Pediatrics, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Angela P Campbell
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish Patel
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan I Gerber
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natasha B Halasa
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, USA
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Haddadin Z, Spieker AJ, Rahman H, Rankin DA, Talj R, Yanis A, Amarin JZ, Schmitz J, Chappell J, Halasa NB. Respiratory pathogens during the COVID-19 pandemic: Alterations in detection and seasonality in Nashville, Tennessee. PLoS One 2022; 17:e0270469. [PMID: 35921608 PMCID: PMC9348857 DOI: 10.1371/journal.pone.0270469] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
Shortly after the implementation of community mitigation measures in response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), sharp declines in respiratory syncytial virus and influenza circulation were noted; post-mitigation circulation of other respiratory pathogens has gone unexplored. We retrospectively analyzed all records of a provider-ordered multiplex test between April 1, 2018, and July 31, 2021, in Nashville, Tennessee, and we noted disrupted historical seasonal patterns for common respiratory pathogens during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Justin Z. Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Jonathan Schmitz
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail:
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15
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Rankin DA, Yanis A, Haddadin Z, Talj R, Fernandez KN, Bloos SM, Stahl A, Gu W, Nicotera J, Howe HL, Salib S, Chappell J, Howard LM, Khankari NK, Halasa NB. The impact of community closures among nonessential and essential workers, Nashville, Tennessee: A cross-sectional study. Health Sci Rep 2022; 5:e658. [PMID: 35620536 PMCID: PMC9128158 DOI: 10.1002/hsr2.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Aims The effects of community closures and relaxing social distancing restrictions on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by occupational risk remain unclear. Therefore, we evaluated the impact of community closures and reopening phases with the prevalence of testing SARS-CoV-2-positive among nonessential and essential workers. Methods We constructed a cross-sectional cohort from March 20 to July 31, 2020, of 344 adults from Metropolitan Nashville, Tennessee. We performed an unconditional logistic regression model to evaluate the impact of community closures and phase implementation on testing SARS-CoV-2 positive by occupation to estimate adjusted prevalence odds ratios (aPORs) and 95% confidence intervals (CIs). Results During a stay-at-home/Phase I order, those with non-essential occupations had 59% decreased prevalence odds (aPOR:0.41; 95% CI: 0.20-0.84) of testing SARS-CoV-2-positive compared to when no restrictions were in place. Persons with essential occupations had four times the prevalence odds of testing SARS-CoV-2-positive (aPOR:4.19; 95% CI:1.57-11.18) compared with nonessential occupations when no community restrictions were established. Conclusion Stay-at-home restrictions were associated with a lower risk of SARS-CoV-2 infection in the community for nonessential workers. Essential employees remained at increased risk for SARS-CoV-2, including when no community restrictions were in place and vaccines were not available. This study supports targeting prevention measures for these high-risk occupations.
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Affiliation(s)
- Danielle A. Rankin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Epidemiology PhD ProgramVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Ahmad Yanis
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zaid Haddadin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Rana Talj
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Kailee N. Fernandez
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sean M. Bloos
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Anna Stahl
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Wenying Gu
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Janet Nicotera
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Harrison L. Howe
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Seifein Salib
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - James Chappell
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Leigh M. Howard
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Nikhil K. Khankari
- Division of Genetic Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Natasha B. Halasa
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
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16
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Probst V, Rankin DA, Haddadin Z, Hamdan L, Rahman HK, Yanis A, Talj R, Spieker AJ, Howard L, Stewart LS, Guevara C, Yepsen E, Faouri S, Shehabi A, Williams JV, Chappell J, Khuri-Bulos N, Halasa NB. Adenovirus Infection in Hospitalized Children with Acute Respiratory Infection in Jordan. Pediatr Infect Dis J 2022; 41:277-283. [PMID: 35315822 PMCID: PMC8943843 DOI: 10.1097/inf.0000000000003423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The most common clinical manifestation of adenovirus (AdV) infection is acute respiratory illness (ARI). Specific AdV species associated with ARI hospitalizations are not well defined in the Middle East. METHODS A viral surveillance study was conducted among children <2 years hospitalized in Amman, Jordan, from March 2010 to March 2013. Nasal and throat respiratory specimens were obtained from enrolled children and tested for viruses using a real-time reverse-transcription quantitative polymerase chain reaction. AdV-positive specimens were typed by partial hexon gene sequencing. Demographic and clinical features were compared between AdV detected as single pathogen versus co-detected with other respiratory viruses, and between AdV-B and AdV-C species. RESULTS AdV was detected in 475/3168 (15%) children hospitalized with ARI; of these, 216 (45%) specimens were successfully typed with AdV-C as the most common species detected (140/216; 65%). Children with AdV-single detection (88/475; 19%) had a higher frequency of fever (71% vs. 56%; P=0.015), diarrhea (18% vs. 11%; p=0.048), and/or seizures/abnormal movements (14% vs. 5%; p=0.003). Children with AdV co-detected with other viruses more likely required oxygen support [adjusted odds ratio (aOR) 1.91 (95% CI: 1.08, 3.39), P = 0.027] than those with AdV-single detection. Children with AdV-C had higher odds of co-detections with other viruses compared with those with AdV-B [aOR 4.00 (95% CI: 1.91, 8.44), P < 0.001]. CONCLUSION Clinical differences were identified between AdV-single and AdV co-detected with other viruses, and between AdV-B and AdV-C. Larger studies with AdV typing are needed to determine additional epidemiological and clinical differences between specific AdV species and types.
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Affiliation(s)
- Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Lubna Hamdan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Herdi K. Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leigh Howard
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Claudia Guevara
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Erin Yepsen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan
| | - Asem Shehabi
- Department of Pediatrics, Jordan University, Amman, Jordan
| | - John V. Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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17
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Hamdan L, Probst V, Haddadin Z, Rahman H, Spieker AJ, Vandekar S, Stewart LS, Williams JV, Boom JA, Munoz F, Englund JA, Selvarangan R, Staat MA, Weinberg GA, Azimi PH, Klein EJ, McNeal M, Sahni LC, Singer MN, Szilagyi PG, Harrison CJ, Patel M, Campbell AP, Halasa NB. Influenza clinical testing and oseltamivir treatment in hospitalized children with acute respiratory illness, 2015-2016. Influenza Other Respir Viruses 2022; 16:289-297. [PMID: 34704375 PMCID: PMC8818823 DOI: 10.1111/irv.12927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Antiviral treatment is recommended for all hospitalized children with suspected or confirmed influenza, regardless of their risk profile. Few data exist on adherence to these recommendations, so we sought to determine factors associated with influenza testing and antiviral treatment in children. METHODS Hospitalized children <18 years of age with acute respiratory illness (ARI) were enrolled through active surveillance at pediatric medical centers in seven cities between 11/1/2015 and 6/30/2016; clinical information was obtained from parent interview and chart review. We used generalized linear mixed-effects models to identify factors associated with influenza testing and antiviral treatment. RESULTS Of the 2299 hospitalized children with ARI enrolled during one influenza season, 51% (n = 1183) were tested clinically for influenza. Clinicians provided antiviral treatment for 61 of 117 (52%) patients with a positive influenza test versus 66 of 1066 (6%) with a negative or unknown test result. In multivariable analyses, factors associated with testing included neuromuscular disease (aOR = 5.35, 95% CI [3.58-8.01]), immunocompromised status (aOR = 2.88, 95% CI [1.66-5.01]), age (aOR = 0.93, 95% CI [0.91-0.96]), private only versus public only insurance (aOR = 0.78, 95% CI [0.63-0.98]), and chronic lung disease (aOR = 0.64, 95% CI [0.51-0.81]). Factors associated with antiviral treatment included neuromuscular disease (aOR = 1.86, 95% CI [1.04, 3.31]), immunocompromised state (aOR = 2.63, 95% CI [1.38, 4.99]), duration of illness (aOR = 0.92, 95% CI [0.84, 0.99]), and chronic lung disease (aOR = 0.60, 95% CI [0.38, 0.95]). CONCLUSION Approximately half of children hospitalized with influenza during the 2015-2016 influenza season were treated with antivirals. Because antiviral treatment for influenza is associated with better health outcomes, further studies of subsequent seasons would help evaluate current use of antivirals among children and better understand barriers for treatment.
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Affiliation(s)
- Lubna Hamdan
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Varvara Probst
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zaid Haddadin
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Herdi Rahman
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Andrew J. Spieker
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Simon Vandekar
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Laura S. Stewart
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - John V. Williams
- Pediatric Infectious Diseases, Institute for Infection, Inflammation, and Immunity in Children, University of Pittsburgh School of MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Julie A. Boom
- Primary Care Practice at Palm Center, Immunization Project, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Flor Munoz
- Pediatrics and Molecular Virology and Microbiology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Janet A. Englund
- Department of Pediatrics, Division of Infectious DiseasesSeattle Children's HospitalSeattleWashingtonUSA
| | | | - Mary A. Staat
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Geoffrey A. Weinberg
- Pediatric Infectious DiseasesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Parvin H. Azimi
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Eileen J. Klein
- Department of Pediatrics, Division of Emergency MedicineSeattle Children's HospitalSeattleWashingtonUSA
| | - Monica McNeal
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Leila C. Sahni
- Department of Pediatrics, Section of Hematology‐Oncology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Monica N. Singer
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Peter G. Szilagyi
- Department of PediatricsUniversity of California at Los Angeles Mattel Children's HospitalLos AngelesCaliforniaUSA
| | | | - Manish Patel
- National Center for Immunization and Respiratory Diseases, Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Angela P. Campbell
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Natasha B. Halasa
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
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18
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Haddadin Z, Halasa N, McHenry R, Varjabedian R, Lynch TL, Chen H, Abdul Ghani MO, Schmitz JE, Sucre J, Isenberg K, Zamora I, Danko M, Blakely M, Olson J, Jackson GP, Lovvorn HN. SARS-CoV-2 Testing of Aerosols Emitted During Pediatric Minimally Invasive Surgery: A Prospective, Case-Controlled Study. Am Surg 2022; 88:2710-2718. [PMID: 35148619 DOI: 10.1177/00031348211067707] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic has presented significant safety concerns for healthcare providers, especially those performing aerosol-generating procedures. Several surgical societies issued early warnings that aerosols generated during minimally invasive surgery (MIS) could harbor infectious quantities of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study tested the hypothesis that MIS-aerosols contain SARS-CoV-2. METHODS To evaluate SARS-CoV-2 presence in aerosols emitted during intracavitary MIS, children <18 years who required emergent MIS and were discovered to be SARS-CoV-2-positive were enrolled. Swabs were obtained from the port in-line with a filtered smoke evacuation system, the tubing adjacent to this port, the fluid collection chamber and filter, and the distal endotracheal tube (ETT). All swabs were analyzed for SARS-CoV-2 using quantitative reverse-transcription polymerase chain reaction. To evaluate viral distribution in tissues, fluorescence in situ hybridization for SARS-CoV-2 was performed on resected specimens. Outcomes were recorded, and participating healthcare workers were tracked for SARS-CoV-2 conversion. RESULTS From July 1, 2020, to June 30, 2021, 11 children requiring emergent MIS were discovered preoperatively to be SARS-CoV-2 positive (median age: 14 years [5-17]). SARS-CoV-2 was detected only in ETT swabs and not in surgical aerosols or specimens. Median operative time was 56.5 minutes (IQR: 46-66), and postoperative stay was 21.2 hours (IQR: 1.97-57.57). No complications or viral eruption were recorded, and none of 63 healthcare workers tested positive for SARS-CoV-2 within 6 weeks. DISCUSSION SARS-CoV-2 was detected only in ETT secretions and not in surgical aerosols or specimens among a pediatric cohort of asymptomatic patients having emergent MIS.
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Affiliation(s)
- Zaid Haddadin
- Department of General Surgery, 6566Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Rendie McHenry
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Rebekkah Varjabedian
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Tricia L Lynch
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Heidi Chen
- Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Jonathan E Schmitz
- Department of Pathology, Microbiology and Immunology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Sucre
- Division of Neonatology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly Isenberg
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Irving Zamora
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Danko
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin Blakely
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacob Olson
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gretchen P Jackson
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Yanis A, Haddadin Z, Spieker AJ, Waqfi D, Rankin DA, Talj R, Thomas L, Birdwell KA, Ezzell L, Blair M, Eason J, Varjabedian R, Warren CM, Nochowicz CH, Olson EC, Simmons JD, Yoder S, Guy M, Thomsen I, Chappell JD, Kalams SA, Halasa NB. Humoral and cellular immune responses to the SARS-CoV-2 BNT162b2 vaccine among a cohort of solid organ transplant recipients and healthy controls. Transpl Infect Dis 2022; 24:e13772. [PMID: 34905653 DOI: 10.1111/tid.13772] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased morbidity and mortality in solid organ transplant (SOT) recipients. Despite exclusion from SARS-CoV-2 vaccine clinical trials, these individuals were identified as high-risk and prioritized for vaccination in public health guidelines. METHODS We prospectively evaluated humoral and cellular immune responses to two doses of the SARS-CoV-2 mRNA vaccine, BNT162b2, in 56 SOT recipients and 26 healthy controls (HCs). Blood specimens collected from participants prior to each dose and following the second dose were tested for SARS-CoV-2-specific antibodies, as well as CD4+ and CD8+ T-cell responses. RESULTS SOT recipients demonstrated lower mean anti-SARS-CoV-2 antibody levels compared to HCs after each dose, and only 21.6% achieved an antibody response after the second dose within the range of HC responses. Similarly, the percentage of responsive CD4+ and CD8+ T cells in SOT recipients was lower than in HCs. While most HCs showed notable humoral and cellular responses, responses were less concordant in SOT recipients, with some showing evidence of either humoral or cellular response, but not both. CONCLUSION Humoral and cellular immune responses to the BNT162b2 vaccine are markedly reduced in SOT recipients as compared to HCs, suggesting that SOT recipients may benefit from more tailored regimens such as higher dose and/or additional vaccinations.
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Affiliation(s)
- Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Danya Waqfi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lora Thomas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly A Birdwell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren Ezzell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marcia Blair
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joan Eason
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekkah Varjabedian
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christian M Warren
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia H Nochowicz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C Olson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua D Simmons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra Yoder
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madeline Guy
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isaac Thomsen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spyros A Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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20
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Rankin DA, Haddadin Z, Lipworth L, Stahl AL, Fryzek J, Suh M, Shepard DS, Varjabedian R, Fernandez KN, Salib S, Villarreal J, Bruce M, McHenry R, Spieker AJ, Nelson CB, Halasa NB. Comparison of clinical presentations and burden of respiratory syncytial virus in infants across three distinct healthcare settings in Davidson County, Tennessee. Ther Adv Infect Dis 2022; 9:20499361221112171. [PMID: 35875809 PMCID: PMC9297461 DOI: 10.1177/20499361221112171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The burden of respiratory syncytial virus (RSV)-associated acute respiratory illnesses among healthy infants (<1 year) in the inpatient setting is well established. The focus on RSV-associated illnesses in the outpatient (OP) and emergency department (ED) settings are however understudied. We sought to determine the spectrum of RSV illnesses in infants at three distinct healthcare settings. Methods: From 16 December 2019 through 30 April 2020, we performed an active, prospective RSV surveillance study among infants seeking medical attention from an inpatient (IP), ED, or OP clinic. Infants were eligible if they presented with fever and/or respiratory symptoms. Demographics, clinical characteristics, and illness histories were collected during parental/guardian interviews, followed by a medical chart review and illness follow-up surveys. Research nasal swabs were collected and tested for respiratory pathogens for all enrolled infants. Results: Of the 627 infants screened, 475 were confirmed eligible; 360 were enrolled and research tested. Within this final cohort, 101 (28%) were RSV-positive (IP = 37, ED = 18, and OP = 46). Of the RSV-positive infants, the median age was 4.5 months and 57% had ⩾2 healthcare encounters. The majority of RSV-positive infants were not born premature (88%) nor had underlying medical conditions (92%). RSV-positive infants, however, were more likely to have a lower respiratory tract infection than RSV-negative infants (76% vs 39%, p < 0.001). Hospitalized infants with RSV were younger, 65% required supplemental oxygen, were more likely to have lower respiratory tract symptoms, and more often had shortness of breath and rales/rhonchi than RSV-positive infants in the ED and OP setting. Conclusion: Infants with RSV illnesses seek healthcare for multiple encounters in various settings and have clinical difference across settings. Prevention measures, especially targeted toward healthy, young infants are needed to effectively reduce RSV-associated healthcare visits.
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Affiliation(s)
- Danielle A Rankin
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, 1161 21st Ave South, D7232 MCN, Nashville, TN 37232, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna L Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Mina Suh
- EpidStrategies, Rockville, MD, USA
| | - Donald S Shepard
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Rebekkah Varjabedian
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kailee N Fernandez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seifein Salib
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica Villarreal
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mercedes Bruce
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rendie McHenry
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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21
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Rankin DA, Speaker A, Perez A, Haddadin Z, Probst V, Schuster JE, Blozinski AL, Rahman HK, Stewart LS, Rha B, Michaels MG, Williams JV, Boom JA, Sahni LC, Allen Staat M, Schlaudecker EP, McNeal M, Selvarangan R, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, McMorrow M, Patel M, Chappell J, Midgley C, Halasa NB, Halasa NB. 154. Circulation of Rhinovirus/Enterovirus Respiratory Infections in Children During 2020-21 in the United States. Open Forum Infect Dis 2021. [PMCID: PMC8644659 DOI: 10.1093/ofid/ofab466.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Sharp declines in influenza and respiratory syncytial virus (RSV) circulation across the U.S. have been described during the pandemic in temporal association with community mitigation for control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to determine relative frequencies of rhinovirus/enterovirus (RV/EV) and other respiratory viruses in children presenting to emergency departments or hospitalized with acute respiratory illness (ARI) prior to and during the COVID-19 pandemic. Methods We conducted a multi-center active prospective ARI surveillance study in children as part of the New Vaccine Surveillance Network (NVSN) from December 2016 through January 2021. Molecular testing for RV/EV, RSV, influenza, and other respiratory viruses [i.e., human metapneumovirus, parainfluenza virus (Types 1-4), and adenovirus] were performed on specimens collected from children enrolled children. Cumulative percent positivity of each virus type during March 2020–January 2021 was compared from March-January in the prior seasons (2017-2018, 2018-2019, 2019-2020) using Pearson’s chi-squared. Data are provisional. Results Among 69,403 eligible children, 37,676 (54%) were enrolled and tested for respiratory viruses. The number of both eligible and enrolled children declined in early 2020 (Figure 1), but 4,691 children (52% of eligible) were enrolled and tested during March 2020-January 2021. From March 2020-January 2021, the overall percentage of enrolled children with respiratory testing who had detectable RV/EV was similar compared to the same time period in 2017-2018 and 2019-2020 (Figure 1, Table 1). In contrast, the percent positivity of RSV, influenza, and other respiratory viruses combined declined compared to prior years, (p< 0.001, Figure 1, Table 1). ![]()
Figure 1. Percentage of Viral Detection Among Enrolled Children Who Received Respiratory Testing, New Vaccine Surveillance Network (NVSN), United States, December 2016 – January 2021 ![]()
Table 1. Percent of Respiratory Viruses Circulating in March 2020– January 2021, compared to March-January in Prior Years, New Vaccine Surveillance Network (NVSN), United States, March 2017 – January 2021 Conclusion During 2020, RV/EV continued to circulate among children receiving care for ARI despite abrupt declines in other respiratory viruses within this population. These findings warrant further studies to understand virologic, behavioral, biological, and/or environmental factors associated with this continued RV/EV circulation. Disclosures Jennifer E. Schuster, MD, Merck, Sharpe, and Dohme (Individual(s) Involved: Self): Grant/Research Support Marian G. Michaels, MD, MPH, Viracor (Grant/Research Support, performs assay for research study no financial support) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Elizabeth P. Schlaudecker, MD, MPH, Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member) Christopher J. Harrison, MD, GSK (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Janet A. Englund, MD, AstraZeneca (Consultant, Grant/Research Support)GlaxoSmithKline (Research Grant or Support)Meissa Vaccines (Consultant)Pfizer (Research Grant or Support)Sanofi Pasteur (Consultant)Teva Pharmaceuticals (Consultant) Claire Midgley, PhD, Nothing to disclose Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support
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Affiliation(s)
- Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, TN
| | | | - Ariana Perez
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, TN
| | - Varvara Probst
- University of Florida, Jacksonville, Jacksonville, Florida
| | | | | | | | | | - Brian Rha
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Elizabeth P Schlaudecker
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Monica McNeal
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | - Janet A Englund
- Seattle Children’s Hospital/Univ. of Washington, Seattle, Washington
| | | | | | - Manish Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Yanis A, Haddadin Z, Speaker A, Waqfi D, Talj R, Rankin DA, Ezzell L, Blair M, Eason J, Varjabedian R, Thomas L, Chappell J, Halasa NB, Halasa NB. 568. Comparison of Humoral Immune Response to the SARS-CoV-2 BNT162b2 Vaccine Between Solid Organ Transplant Recipients and Healthy Controls. Open Forum Infect Dis 2021. [PMCID: PMC8644832 DOI: 10.1093/ofid/ofab466.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased morbidity and mortality in immunocompromised individuals, including solid organ transplant recipients (SOTR). Despite being excluded from phase 1-3 SARS-CoV-2 vaccine clinical trials, SOTR were identified as high-risk populations and prioritized for vaccination in public health guidelines. We aimed to evaluate the antibody response to two doses of the BNT162b2 (Pfizer-BioNTech) vaccine in SOTR as compared to healthy controls (HC).
Methods
SOTR and HC scheduled to receive two doses of BNT162b2 vaccine and able to complete required follow-up visits were enrolled. Blood specimens were collected from participants before receiving the first and second doses and 21-42 days after the second dose. Enzyme-linked immunosorbent assay (ELISA) was used to detect immunoglobulin G (IgG) to the SARS-CoV-2 spike receptor-binding domain (RBD). Generalized estimating equations with a working independence correlation structure were used to compare anti-RBD IgG levels between SOTR and HC at each study visit and within each group over time. All models were adjusted for age, sex, and pre-vaccination seroreactivity in the ELISA.
Results
A total of 54 SOTR and 26 HC were enrolled, with mean (SD) ages of 72 (3.6) and 62 (6.7) years, 61% and 35% were male, and 91% and 88% were white, respectively. The most common organ transplant types were kidney (41%) and liver (37%). All SOTR were receiving calcineurin inhibitors. The median time post-transplantation was 7 years. SOTR had markedly lower mean anti-RBD IgG levels when compared to HC with adjusted mean differences of -0.76 (95%CI: [-1.04, -0.47]; p < 0.001) ELISA units (EU) and -1.35 (95%CI [-1.68, -1.01]; p < 0.001) EU after the first and second doses, respectively (Figure 1). Both groups had a significant increase in anti-SARS-CoV-2 IgG levels after the second dose. However, the magnitude was lower in SOTR, 0.49 (95%CI [0.31, 0.69]; p < 0.001) EU than in HCs, 1.08 (95% CI [0.91, 1.24]; p < 0.001) EU.
Figure 1.
Anti-SARS-CoV-2 RBD IgG levels in solid organ transplant recipients and healthy controls before receiving the BNT162b2 vaccine (baseline), post-vaccine dose 1, and post-vaccine dose 2.
Conclusion
Our study showed SOTR mounted weaker humoral immune responses than HC to SARS-CoV-2 vaccines. Given a lower response, SOTR should continue to practice social distancing and masking until data on vaccine efficacy are available in this vulnerable population.
Disclosures
Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it's a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it's a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support
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Affiliation(s)
- Ahmad Yanis
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Andrew Speaker
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Danya Waqfi
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Rana Talj
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Lauren Ezzell
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Marcia Blair
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Joan Eason
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - Rebekkah Varjabedian
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Lora Thomas
- Vanderbilt University Medical Center, Nashvill, Tennessee
| | - James Chappell
- Vanderbilt University Medical Center, Nashvill, Tennessee
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23
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Haddadin Z, Batarseh E, Hamdan L, Stewart LS, Piya B, Rahman H, Spieker AJ, Chappell J, Wikswo ME, Dunn JR, Payne DC, Vinjé J, Hall AJ, Halasa N. Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA. Clin Infect Dis 2021; 73:e1525-e1531. [PMID: 32667045 PMCID: PMC8492161 DOI: 10.1093/cid/ciaa1001] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/10/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Norovirus is a leading cause of epidemic acute gastroenteritis (AGE), with most outbreaks occurring during winter. The majority of outbreaks are caused by GII.4 noroviruses; however, data to support whether this is true for sporadic medically attended AGE are limited. Therefore, we sought to compare the clinical characteristics and seasonality of GII.4 vs non-GII.4 viruses. METHODS Children aged 15 days -17 years with AGE symptoms were recruited from the outpatient, emergency department, and inpatient settings at Vanderbilt Children's Hospital, Davidson County, Nashville, Tennessee, from December 2012 -November 2015. Stool specimens were tested using qRT-PCR for GI and GII noroviruses and subsequently genotyped by sequencing a partial region of the capsid gene. RESULTS A total of 3705 patients were enrolled, and stool specimens were collected and tested from 2885 (78%) enrollees. Overall, 636 (22%) samples were norovirus-positive, of which 567 (89%) were GII. Of the 460 (81%) genotyped GII-positive samples, 233 (51%) were typed as GII.4 and 227 (49%) as non-GII.4. Compared with children with non-GII.4 infections, children with GII.4 infections were younger, more likely to have diarrhea, and more likely to receive oral rehydration fluids. Norovirus was detected year-round and peaked during winter. CONCLUSIONS Approximately 40% of sporadic pediatric norovirus AGE cases were caused by GII.4 norovirus. Children infected with GII.4 had more severe symptoms that required more medical care. Seasonal variations were noticed among different genotypes. These data highlight the importance of continuous norovirus surveillance and provide important information on which strains pediatric norovirus vaccines should protect against.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Einas Batarseh
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lubna Hamdan
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bhinnata Piya
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Herdi Rahman
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Chappell
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary E Wikswo
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John R Dunn
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Daniel C Payne
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jan Vinjé
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natasha Halasa
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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24
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Haddadin Z, Schuster JE, Spieker AJ, Rahman H, Blozinski A, Stewart L, Campbell AP, Lively JY, Michaels MG, Williams JV, Boom JA, Sahni LC, Staat M, McNeal M, Selvarangan R, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Curns AT, Rha B, Langley GE, Hall AJ, Patel MM, Halasa NB. Acute Respiratory Illnesses in Children in the SARS-CoV-2 Pandemic: Prospective Multicenter Study. Pediatrics 2021; 148:peds.2021-051462. [PMID: 33986150 PMCID: PMC8338906 DOI: 10.1542/peds.2021-051462] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 05/04/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Nonpharmaceutical interventions against coronavirus disease 2019 likely have a role in decreasing viral acute respiratory illnesses (ARIs). We aimed to assess the frequency of respiratory syncytial virus (RSV) and influenza ARIs before and during the coronavirus disease 2019 pandemic. METHODS This study was a prospective, multicenter, population-based ARI surveillance, including children seen in the emergency departments and inpatient settings in 7 US cities for ARI. Respiratory samples were collected and evaluated by molecular testing. Generalized linear mixed-effects models were used to evaluate the association between community mitigation and number of eligible and proportion of RSV and influenza cases. RESULTS Overall, 45 759 children were eligible; 25 415 were enrolled and tested; 25% and 14% were RSV-positive and influenza-positive, respectively. In 2020, we noted a decrease in eligible and enrolled ARI subjects after community mitigation measures were introduced, with no RSV or influenza detection from April 5, 2020, to April 30, 2020. Compared with 2016-2019, there was an average of 10.6 fewer eligible ARI cases per week per site and 63.9% and 45.8% lower odds of patients testing positive for RSV and influenza, respectively, during the 2020 community mitigation period. In all sites except Seattle, the proportions of positive tests for RSV and influenza in the 2020 community mitigation period were lower than predicted. CONCLUSIONS Between March and April 2020, rapid declines in ARI cases and the proportions of RSV and influenza in children were consistently noted across 7 US cities, which could be attributable to community mitigation measures against severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | | | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Anna Blozinski
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Laura Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Angela P Campbell
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Joana Y Lively
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
- IHRC, Inc, Atlanta, Georgia
| | - Marian G Michaels
- Department of Pediatrics, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V Williams
- Department of Pediatrics, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Leila C Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Mary Staat
- Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Monica McNeal
- Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Rangaraj Selvarangan
- Division of Pediatric Infectious Diseases
- Department of Pathology and Laboratory Medicine, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, Missouri
| | | | - Geoffrey A Weinberg
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Eileen J Klein
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Aaron T Curns
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Brian Rha
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Gayle E Langley
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Aron J Hall
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Manish M Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
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25
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Haddadin Z, Rankin DA, Lipworth L, Suh M, McHenry R, Blozinski A, George SS, Fernandez KN, Varjabedian R, Spieker AJ, Shepard DS, Halasa NB. Respiratory Virus Surveillance in Infants across Different Clinical Settings. J Pediatr 2021; 234:164-171.e2. [PMID: 33774057 DOI: 10.1016/j.jpeds.2021.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We aimed to evaluate the distribution, clinical presentations and severity of common acute respiratory infections (ARI) viruses in infants across 3 clinical settings. STUDY DESIGN In a prospective virus surveillance study, infants under 1 year with fever and/or respiratory symptoms were enrolled from outpatient, emergency department, and inpatient settings from December 16, 2019 through April 30, 2020. Demographic and clinical characteristics were collected through parent/guardian interviews, medical chart abstractions, and follow-up surveys. Nasal swabs were collected and tested for viruses using quantitative reverse-transcription polymerase chain reaction. RESULTS We enrolled 366 infants and tested nasal swabs on 360 (98%); median age was 6.3 months, 50% male. In total, 295 (82%) had at least 1 virus detected; rhinovirus/enterovirus (RV/EV; 42%), respiratory syncytial virus (RSV; 34%), and influenza (15%) were the most common. RSV was the most frequently detected virus in the inpatient (63%) and emergency department (37%) settings, and RV/EV was most frequently detected virus in the outpatient setting (54%). RSV-positive infants had a lower median age (4.9 months) and were more likely to have respiratory distress, and RV/EV-positive infants were less likely to have respiratory distress. Influenza-positive infants had a higher median age (8 months) and were more likely to have systemic symptoms. RSV infection and younger age were associated with higher odds of hospitalization in multivariable logistic regression. CONCLUSIONS Across 3 clinical settings, and combining virologic, patient, and health-system information, our results highlight the burden of viral ARI among infants. Overall, RSV, RV/EV, and influenza were most commonly detected, with RSV having the highest disease severity.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN
| | - Loren Lipworth
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Rendie McHenry
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Anna Blozinski
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Kailee N Fernandez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Donald S Shepard
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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26
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Haddadin Z, Spieker AJ, Schaffner W, Halasa NB. Reply to Mejias et al. Clin Infect Dis 2021; 72:e1162-e1163. [PMID: 33216146 DOI: 10.1093/cid/ciaa1753] [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: 11/12/2022] Open
Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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27
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Freeman MC, Haddadin Z, Lawrence L, Piya B, Krishnaswami S, Faouri S, Shehabi A, Williams JV, Khuri-Bulos N, Halasa N. Utility of RSV rapid diagnostic assays in hospitalized children in Amman, Jordan. J Med Virol 2021; 93:3420-3427. [PMID: 32966624 DOI: 10.1002/jmv.26546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections in children worldwide and a frequent cause of hospitalization. Rapid diagnostic assays (RDAs) are available for RSV and they help guide management; however, they are underutilized in developing countries. We compared molecular diagnostics to RSV RDA in hospitalized children in Amman, Jordan. MATERIALS AND METHODS Children under 2 years of age, admitted with fever and/or respiratory symptoms were enrolled prospectively from March 2010 to 2012. Demographic and clinical data were collected through parent/guardian interviews and medical chart abstraction. RSV RDAs were performed, and nasal/throat swabs were tested for RSV using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). RESULTS RSV RDA and PCR were performed on specimens from 1271 subjects. RSV RDA had a sensitivity of 26% and a specificity of 99%, with positive and negative predictive values of 98.6% and 43%, respectively. RDA-positive patients had fewer days of symptoms at presentation and were more likely to have a history of prematurity, lower birth weight, require supplemental oxygen, and a longer hospitalization as compared with subjects with negative RDA. Multivariate analysis showed only lower birth weight, lack of cyanosis on examination, and lower cycle threshold to be independently associated with positive RDA (p ≤ .001). CONCLUSION RSV RDAs had high specificity, but low sensitivity as compared with qRT-PCR. Positive RDA was associated with patients with a more severe disease, as indicated by oxygen use, longer length of stay, and higher viral load. Implementation of RDAs in developing countries could be an inexpensive and expedient method for predicting RSV disease severity and guiding management.
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Affiliation(s)
- Megan C Freeman
- Division of Pediatric Infectious Diseases, The UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zaid Haddadin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsey Lawrence
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bhinnata Piya
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shanthi Krishnaswami
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan
| | - Asem Shehabi
- Department of Pathology and Microbiology, The University of Jordan, Amman, Jordan
| | - John V Williams
- Division of Pediatric Infectious Diseases, The UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Najwa Khuri-Bulos
- Division of Infectious Disease, Department of Pediatrics, Jordan University, Amman, Jordan
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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28
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Howard LM, Rankin DA, Spieker AJ, Gu W, Haddadin Z, Probst V, Rahman H, McHenry R, Pulido CG, Williams JV, Faouri S, Shehabi A, Khuri-Bulos N, Halasa NB. Clinical features of parainfluenza infections among young children hospitalized for acute respiratory illness in Amman, Jordan. BMC Infect Dis 2021; 21:323. [PMID: 33827449 PMCID: PMC8024934 DOI: 10.1186/s12879-021-06001-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background Parainfluenza virus (PIV) is a leading cause of acute respiratory illness (ARI) in children. However, few studies have characterized the clinical features and outcomes associated with PIV infections among young children in the Middle East. Methods We conducted hospital-based surveillance for ARI among children < 2 years of age in a large referral hospital in Amman, Jordan. We systematically collected clinical data and respiratory specimens for pathogen detection using reverse transcription polymerase chain reaction. We compared clinical features of PIV-associated ARI among individual serotypes 1, 2, 3, and 4 and among PIV infections compared with other viral ARI and ARI with no virus detected. We also compared the odds of supplemental oxygen use using logistic regression. Results PIV was detected in 221/3168 (7.0%) children hospitalized with ARI. PIV-3 was the most commonly detected serotype (125/221; 57%). Individual clinical features of PIV infections varied little by individual serotype, although admission diagnosis of ‘croup’ was only associated with PIV-1 and PIV-2. Children with PIV-associated ARI had lower frequency of cough (71% vs 83%; p < 0.001) and wheezing (53% vs 60% p < 0.001) than children with ARI associated with other viruses. We did not find a significant difference in supplemental oxygen use between children with PIV-associated infections (adjusted odds ratio [aOR] 1.12, 95% CI 0.66–1.89, p = 0.68) and infections in which no virus was detected. Conclusions PIV is frequently associated with ARI requiring hospitalization in young Jordanian children. Substantial overlap in clinical features may preclude distinguishing PIV infections from other viral infections at presentation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06001-1.
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Affiliation(s)
- Leigh M Howard
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA.,Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Wenying Gu
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Varvara Probst
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Rendie McHenry
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Claudia Guevara Pulido
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - John V Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan
| | - Asem Shehabi
- Department of Pathology and Microbiology, University of Jordan, Amman, Jordan
| | | | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN, 37232, USA.
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Haddadin Z, Blozinski A, Fernandez K, Vittetoe K, Greeno AL, Halasa NB, Lovvorn HN. Changes in Pediatric Emergency Department Visits During the COVID-19 Pandemic. Hosp Pediatr 2021; 11:e57-e60. [PMID: 33436415 DOI: 10.1542/hpeds.2020-005074] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 06/12/2023]
Abstract
OBJECTIVES Community mitigation measures were implemented to decrease the spread of severe acute respiratory syndrome coronavirus 2. In this study, we aimed to evaluate changes in pediatric emergency department (ED) visits, secondary to acute respiratory illnesses (ARIs) and trauma, before and during the pandemic. We hypothesized that the numbers of ED visits and ARIs would decrease, whereas the proportion of trauma visits would increase. METHODS A retrospective study from 2018 to 2020 was performed on children 18 years and younger presenting to the ED either for ARI or trauma at a high-volume comprehensive pediatric hospital between March and May each year. International Classification of Diseases, 10th Revision, Clinical Modification admission diagnosis codes were used to identify ARI, trauma, and injury mechanisms. Pearson's χ2 test was used to compare proportions between categorical variables. RESULTS Overall, 6393 total ED visits occurred in 2020, compared with 11 758 and 12 138 in 2018 and 2019, respectively. In 2020, the total ARI number declined by 58%, and ARI frequency decreased significantly, whereas the total trauma number declined by 34%, and the proportion of trauma visits significantly increased. In addition, the number and proportion of recreational vehicle crashes increased, whereas the number and proportion decreased for all intentional and animal-related traumas. CONCLUSIONS The total number of pediatric ED visits dropped precipitously in 2020, but the proportion of trauma visits increased significantly in 2020, accounting for greater than one-quarter of all ED visits. Injury mechanism varied significantly compared to previous years. Future studies are needed to confirm these findings and evaluate the benefits of community mitigation to decrease ARIs and strategies directed to reduce mechanism-specific trauma.
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Affiliation(s)
| | | | | | - Kelly Vittetoe
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Amber L Greeno
- Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | | | - Harold N Lovvorn
- Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
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Haddadin Z, Krueger K, Thomas LD, Overton ET, Ison M, Halasa N. Alternative strategies of posttransplant influenza vaccination in adult solid organ transplant recipients. Am J Transplant 2021; 21:938-949. [PMID: 32885604 DOI: 10.1111/ajt.16295] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 06/05/2020] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 01/25/2023]
Abstract
Solid organ transplant (SOT) recipients are at increased risk of influenza disease and associated complications. The mainstay of prevention is the annual standard-dose influenza vaccine, as studies showed decreased influenza-related morbidity and mortality in vaccinated SOT recipients compared to those unvaccinated. Nonetheless, the immune response in this high-risk population is suboptimal compared to healthy individuals. Over the past two decades, several vaccination strategies have been investigated to overcome this inadequate immune response in SOT recipients. Howbeit, the best vaccination strategy and optimal timing of influenza vaccination remain unclear. This review will provide a detailed summary of studies of various influenza vaccination strategies in adult SOT recipients, discussing immunogenicity results, and addressing their limitations and knowledge gaps.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen Krueger
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lora D Thomas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Ison
- Division of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Natasha Halasa
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
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Probst V, Datyner EK, Haddadin Z, Rankin DA, Hamdan L, Rahman HK, Spieker A, Stewart LS, Guevara C, Yepsen E, Schmitz JE, Halasa NB. Human adenovirus species in children with acute respiratory illnesses. J Clin Virol 2021; 134:104716. [PMID: 33360858 PMCID: PMC8324062 DOI: 10.1016/j.jcv.2020.104716] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/21/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Human adenovirus (HAdV) species B, C, and E are commonly associated with acute respiratory illnesses (ARI). We sought to determine the association between HAdV species and ARI severity in children over one respiratory season at Monroe Carell Jr. Children's Hospital at Vanderbilt. METHODS We conducted a retrospective cohort study of children with HAdV from a provider-ordered BioFire® FilmArray Respiratory Pathogen Panel 2.0 (RPP) from 05/2018-06/2019. Type-specific PCR assays for HAdV-B3, B7, B11, B14, B16, B21, HAdV-C1, C2, C5, C6, and HAdV-E4 were performed. Demographics, clinical characteristics, and outcome data were compared between HAdV species. RESULTS Of 4514 respiratory specimens collected, 2644 (59 %) had at least one pathogen detected by RPP, and 384 (15 %) were HAdV-positive; 342 (89 %) were available for research testing with 306 (89 %) specimens from unique symptomatic individuals; 237 (77 %) were positive for the following species: 104 (44 %) HAdV-B, 114 (48 %) HAdV-C, 9 (4%) HAdV-E, and 10 (4%) with co-detection between species. The majority with identified HAdV species were seen in the ED (62 %), and approximately one-third were hospitalized. Patients with HAdV-C were more likely to be younger, hospitalized, and have a higher frequency of seizures compared to HAdV-B. CONCLUSION HAdV-C and HAdV-B were the most common species detected, with differences in clinical characteristics and outcomes noted. Additional studies with larger sample sizes focusing on a high-risk pediatric population are necessary to determine if differences in illness severity across individual HAdV types exist to guide further type-specific HAdV vaccine development.
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Affiliation(s)
- Varvara Probst
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA.
| | - Emily K Datyner
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
| | - Zaid Haddadin
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
| | - Danielle A Rankin
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA; Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, 1161 21st Ave S, Nashville, TN, 37232, USA
| | - Lubna Hamdan
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
| | - Herdi K Rahman
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
| | - Andrew Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave #1100, Nashville, TN, 37203, USA
| | - Laura S Stewart
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
| | - Claudia Guevara
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
| | - Erin Yepsen
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
| | - Jonathan E Schmitz
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| | - Natasha B Halasa
- Departments of Pediatrics, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN, 37232, USA
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Rankin DA, Haddadin Z, lipworth L, Fryzek J, Suh M, Shepard DS, McHenry R, Varjabedian R, Fernandez KN, Rizzo C, Nelson C, Halasa NB. 1406. Comparison of Clinical Presentations and Burden of Respiratory Syncytial Virus in Infants Across Three Distinct Healthcare Settings. Open Forum Infect Dis 2020. [PMCID: PMC7776683 DOI: 10.1093/ofid/ofaa439.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) accounts for the majority of lower respiratory tract illnesses in hospitalized infants. In the U.S., RSV hospitalizations are well characterized; yet, emergency department (ED) and outpatient (OP) visits are underrecognized. We evaluated the burden of RSV across three distinct healthcare settings during one respiratory season. Methods From 12/16/19-4/30/20, we conducted a prospective RSV surveillance study among Davidson County, TN infants under one year who presented to an inpatient (IP), ED, or one of four OP clinics with either fever or any upper respiratory (i.e., cough, earache, nasal congestion, rhinorrhea, sore throat) and/or lower respiratory [i.e., wheezing, crackles, rales, diminished breath sounds, shortness of breath (SOB)] symptoms. Demographic and illness history were collected during parental/guardian interviews, followed by medical chart abstraction. Nasal swabs were collected and tested for RSV using Luminex® NxTAG RPP. Due to the COVID-19 pandemic, on 3/16/20 enrollment at three of the four OP clinics ceased. Results A total of 627 infants were screened, of whom 473 (75%) were confirmed eligible, 364 (77%) enrolled, 361 (99%) were tested for RSV of which 101 (28%) were RSV+ (IP=37, ED=18, OP=46) (Figure 1). Compared to RSV-negative subjects, RSV+ subjects were younger (6.6 vs. 4.9 months, p< 0.001), 56% were male and 48% white. By setting, infants in the OP setting were older than those seen in the IP and ED [(p=0.002), Figure 2]. Compared to infants in the OP setting, hospitalized infants were more likely to present with SOB and rhonchi/rales, but less likely to have only upper respiratory symptoms (Figure 3) and be African American (p=0.046). Infants in the IP setting had a higher proportion of clinical RSV diagnostic testing (73%) compared to the ED (39%) and OP (28%) settings (p< 0.001). Figure 1. Davidson County Infants with RSV by MMWR Week and Healthcare Setting (n=101) ![]()
Figure 2. Cumulative Enrollment of Davidson County Infants with RSV by Age in Months and Healthcare Setting (n=101) ![]()
Figure 3. Proportion of Davidson County Infants with RSV Showing each Clinical Symptom, by Healthcare Setting ![]()
Conclusion Two-thirds of RSV+ infants sought care from either an OP or ED setting, with nearly all hospitalized infants presenting with both upper and lower respiratory symptoms. The underutilization of diagnostic testing in the OP settings may underestimate the true burden of RSV. Future studies are essential to document the true prevalence of RSV in order to assess the need and impact of new interventions (e.g., immunizations, antivirals). Disclosures Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Donald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | | | - Jon Fryzek
- EpidStrategies, A Division of ToxStrategies, Inc., Rockville, MD
| | - Mina Suh
- Epidstrategies, Mission Viejo, California
| | | | - Rendie McHenry
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Rebekkah Varjabedian
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Kailee N Fernandez
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
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Haddadin Z, Schuster JE, Spieker AJ, Rahman HK, Stewart LS, Campbell AP, Rha B, Lively JY, Langley GE, Michaels MG, Williams JV, Boom JA, Sahni LC, Staat MA, McNeal M, Selvarangan R, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Patel M, Halasa NB. 78. Acute Respiratory Illnesses in Children During the sars-cov-2 Pandemic: A Prospective Multicenter Surveillance Study. Open Forum Infect Dis 2020. [PMCID: PMC7778072 DOI: 10.1093/ofid/ofaa439.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background A state of emergency was declared in the United States (US) on March 13, 2020 in response to the SARS-CoV-2 pandemic. Healthcare providers had to alter practice patterns and research priorities. We assessed the frequency of acute respiratory illnesses (ARI) in children, notably those due to respiratory syncytial virus (RSV) and influenza, before and during the pandemic. Methods We conducted multi-center active prospective ARI surveillance in children as part of the New Vaccine Surveillance Network. Children < 18 years with fever and/or respiratory symptoms were enrolled in emergency department and inpatient settings at seven US medical centers over four respiratory seasons during 2016–2020 (Fig 1). Pandemic-related restrictions to patient access limited enrollment in some sites beginning March 2020. Respiratory specimens were collected and tested at each site for RSV and influenza by qRT-PCR. Data were analyzed by calendar weeks. We compared the cumulative proportions of RSV and influenza detection after week 13 in 2020 to the previous seasons using Fisher’s exact test. Figure 1. Numbers of Eligible and Enrolled Acute Respiratory Illness Cases, and Proportions of RSV and Influenza Detection by Week, Stratified by Study Season ![]()
Results Of 44,247 eligible children, 25,375 (57%) were enrolled and tested for RSV and/or influenza. A total of 6351/25375 (25%) and 3446/25372 (14%) children were RSV and influenza-positive over the four seasons, respectively. In 2020, we noted a rapid drop in eligible and enrolled ARI subjects after weeks 11–13 (Fig 1). During weeks 13–18 in 2016–2019, the three-year average of eligible and enrolled subjects was 1802 and 978, respectively. However, over the same period in 2020, there were 675 eligible and 278 enrolled subjects, representing declines of 62.5% and 71.6% respectively (Fig 1). In 2020, there were no RSV or influenza cases detected in weeks 15–18, and the cumulative proportions of RSV and influenza detection after week 13 were lower compared to previous seasons (p< 0.001) (Figs 1 and 2). Figure 2. Cumulative Proportions of Weekly RSV and Influenza Detection by Study Season ![]()
Conclusion There was a considerable decline in ARI visits and the proportion of RSV and influenza detection across seven distinct geographic sites during the pandemic compared with previous seasons. These findings might be attributable to social distancing measures to lessen the spread of SARS-CoV-2, changes in healthcare-seeking behaviors, and limited access to medical care. Disclosures Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member)IDConnect (Advisor or Review Panel member)Quidel (Advisor or Review Panel member) Christopher J. Harrison, MD, GSK (Grant/Research Support, Infant menigiciccal B conjugate vaccine trial)Merck (Research Grant or Support, Infant pneumococcal conjugate vaccine trial) Janet A. Englund, MD, AstraZeneca (Scientific Research Study Investigator)GSK group of companies (Scientific Research Study Investigator)Meissa vaccines (Consultant)Merck (Scientific Research Study Investigator)Sanofi Pasteur (Consultant) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | | | | | | | | | | | - Brian Rha
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joana Y Lively
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gayle E Langley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Julie A Boom
- Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | | | - Mary A Staat
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Monica McNeal
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | - Janet A Englund
- Seattle Children’s Hospital/Univ. of Washington, Seattle, Washington
| | | | - Manish Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Rankin DA, Howard L, Fernandez KN, Talj R, Haddadin Z, Spieker AJ, Halasa NB. 480. Outbreak of COVID-19 Among School Auction Attendees: Was it a “Silent Auction” or “Silent Transmission”? Open Forum Infect Dis 2020. [PMCID: PMC7776509 DOI: 10.1093/ofid/ofaa439.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background One day after the pandemic was announced, Tennessee declared a state of emergency on March 12, 2020 with implementation of a stay-at-home order on March 23, 2020. Data regarding the routes and patterns of community transmission of SARS-CoV-2 are limited. We initiated an investigation after clusters of confirmed COVID-19 cases attended a large social gathering. Methods We were notified of clinical providers who attended a “Silent School Auction” on March 7, 2020, of which several confirmed-cases were identified as targeted participants. To derive a standardized REDCap web-survey, we conducted a hypothesis-generating interview with three confirmed attendees to collect event details. Once finalized, enrollment included collecting sociodemographic, epidemiologic, and clinical data. Attendees were classified as: 1) confirmed if they had a positive SARS-CoV-2 test; 2) suspected if they developed symptoms 21-days before or after the auction; and 3) asymptomatic if no symptoms were noted. Results From March 20-June 16, 100/166 (60%) of attendees were enrolled, with a median age of 41 years, 54% female, and 99% white. Of those, 34 and 32 were confirmed- and suspect-cases, respectively. Table 1 compares sociodemographic behaviors of all attendees, with the majority of confirmed-cases eating late in the evening. From March 6 to March 8, 58 participants reported attending other social events, of which three (i.e., church service, women’s retreat, and a birthday party) were common among 43 attendees and five individuals reported onset of mild respiratory symptoms prior to the event (Figure 1). Confirmed-cases were more likely to report having shortness of breath, chest tightness, loss of taste, loss of smell, and fever compared to suspect-cases (Figure 2) and no one required hospitalization. Dining tables from the school auction depicted a clustering of cases occurring at each table, with some individuals visiting more than one table during the event (Figure 3). Conclusion We identified several COVID-19 cases from a single event that occurred prior to social mitigation strategies. Our investigation highlights the importance of staying home when sick and the significance of social distancing to halt transmission of COVID-19. Disclosures Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Leigh Howard
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kailee N Fernandez
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Rana Talj
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
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Haddadin Z, Rankin DA, lipworth L, Fryzek J, Suh M, Shepard DS, McHenry R, Varjabedian R, Fernandez KN, Nelson C, Halasa NB. 1507. Clinical Characteristics of Common Respiratory Viruses Detected in Infants Across Different Clinical Settings. Open Forum Infect Dis 2020. [PMCID: PMC7778076 DOI: 10.1093/ofid/ofaa439.1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Viral acute respiratory infections (ARI) continues to be a significant cause of healthcare visits in young children. We evaluated the clinical presentation and disease severity of common respiratory viruses associated with medically attended ARI in infants. Methods We conducted a prospective viral surveillance study in Davidson County, TN. Infants under one year with fever and/or respiratory symptoms were enrolled from the outpatient (OP), emergency department (ED), or inpatient (IP) settings from 12/16/2019 through 4/30/2020. Nasal swabs were collected and tested for common viral pathogens using Luminex® NxTAG Respiratory Pathogen Panel. Demographic and clinical characteristics were collected through parent/guardian interviews and medical chart abstractions. Results In total, 364 participants were enrolled, and 361 (99%) had nasal swabs collected and tested. Overall, mean age was 6±3.3 months, 50% were female, 45% White, and 27% Hispanic. Of the 295 (82%) virus-positive specimens; the three most common viruses were rhinovirus/enterovirus (RV/EV), respiratory syncytial virus (RSV), and influenza (flu) [124, 101, and 44, respectively]. Compared to virus-negative infants, virus-positive infants were more likely to have more severe ARI symptoms and to be admitted to the intensive care unit (Table 1). Compared to other virus-positive infants: RV/EV-positive infants were more likely to be White, attend daycare, but less likely to present with respiratory distress, or require oxygen or admission; flu-positive infants were older and more likely to have systemic symptoms rather than ARI symptoms, and RSV-positive infants were more likely to present with respiratory distress, receive oxygen and be hospitalized (Table 1). Table 1. Demographic and Clinical Characteristics of Study Subjects ![]()
Conclusion The majority of ARI in infants are due to respiratory viruses, with RSV, RV/EV, and flu accounting for over three-quarters of these viruses. The clinical presentations and disease severity differed across the clinical settings and the three main viruses, with RSV being most severe. To decrease the burden of medically attended viral ARI, preventive measures (i.e., developing new vaccines and antivirals), refining current vaccination strategies, and infection control measures are needed. Disclosures Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Donald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | | | - Jon Fryzek
- EpidStrategies, A Division of ToxStrategies, Inc., Rockville, MD
| | - Mina Suh
- Epidstrategies, Mission Viejo, California
| | | | - Rendie McHenry
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Rebekkah Varjabedian
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Kailee N Fernandez
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
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Yepsen E, Haddadin Z, Rankin DA, McHenry R, Stewart LS, Halasa NB. 685. Comparison of Singleplex qPCR and the Luminex MAGPIX Platform for the Detection of Viral Pathogens. Open Forum Infect Dis 2020. [PMCID: PMC7778027 DOI: 10.1093/ofid/ofaa439.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Various respiratory molecular assays are available, each with different characteristics and advantages that make them uniquely valuable. The objective of this study was to compare rates of viral detection using singleplex and multiplex platforms in a research setting.
Methods
A prospective viral surveillance study was conducted in Davidson County, TN. Infants under one year who presented with fever and/or respiratory symptoms were enrolled from the outpatient, emergency department and inpatient settings. Nasal swabs were collected and tested for influenza A (FluA), influenza B (FluB), human metapneumovirus (MPV), respiratory syncytial virus A and B (RSVA and RSVB), human adenovirus (AdV), parainfluenza 1, 2, 3, and 4 (PIV1-4) and SARS-2-CoV by both singleplex qPCR and the Luminex NxTAG Respiratory Pathogen and NxTAG CoV Extended panels. The rhinovirus/enterovirus, human bocavirus, Chlamydophila pneumoniae, Mycoplasma pneumoniae and coronavirus HKU1, NL63, 229E and OC43 results from the Luminex panel were excluded because singleplex qPCR was not performed on those targets. For singleplex qPCR results, cycle threshold (Ct) values were used as a surrogate for viral load, with a higher Ct value indicating a lower viral load.
Results
A total of 112 nasal specimens were tested by both singleplex qPCR and Luminex, of which 65 were positive for at least one virus by either platform and 56 had a virus detected on both platforms (Figure 1). Seven specimens were positive by singleplex qPCR only and two were positive by Luminex only (Figure 1). The targets positive by singleplex qPCR only included FluB, RSVA, AdV and PIV2 and those positive by Luminex only included FluA H1N1 and RSVB (Figure 2). Specimens that were positive only on the singleplex assay had a higher average Ct value than those that were positive on both assays, indicating a lower viral load (Figure 3).
Figure 1
Figure 2
Figure 3
Conclusion
The multiplex assay identified 89% of the total viruses detected while singleplex qPCR identified 97% of the total viruses detected. Lower viral loads may contribute to false negative results on the multiplex platforms. Future studies with larger sample sizes are needed in order validate our findings.
Disclosures
Erin Yepsen, BS, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Erin Yepsen
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Rendie McHenry
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
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Haddadin Z, Rankin DA, lipworth L, Fryzek J, Suh M, Shepard DS, McHenry R, Varjabedian R, Fernandez KN, Nelson C, Halasa NB. 913. Distribution of Respiratory Viral Pathogens in Infants Across Different Clinical Settings from December 2019 to April 2020. Open Forum Infect Dis 2020. [PMCID: PMC7776031 DOI: 10.1093/ofid/ofaa439.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Acute respiratory infections (ARI) are a major cause of morbidity and mortality in young children, with viral pathogens being the most common etiologies. However, due to limited and inconsistent clinical diagnostic viral testing in the outpatient (OP) setting compared to the inpatient (IP) setting, the actual burden and distribution of viral pathogens across these clinical settings remain largely underreported. We aimed to evaluate the frequency of common respiratory viruses in medically attended ARI in infants. Methods We conducted a prospective viral surveillance study in Davidson County, TN. Eligible infants under one year presenting with fever and/or respiratory symptoms were enrolled from OP, emergency department (ED), or IP settings. Nasal swabs were collected and tested for common viral pathogens using Luminex® NxTAG Respiratory Pathogen Panel and for SARS-CoV-2 using Luminex® NxTAG CoV extended panel. Results From 12/16/2019 to 4/30/2020, 364 infants were enrolled, and 361 (99%) had nasal swabs collected and tested. Of those, 295 (82%) had at least one virus detected; rhinovirus/enterovirus (RV/EV) [124 (42%)], respiratory syncytial virus (RSV) [101 (32%)], and influenza (flu) [44 (15%)] were the three most common pathogens detected. No samples tested positive for SARS-CoV-2. Overall, the mean age was 6.1 months, 50% were male, 45% White and 27% Hispanic. Figure 1 shows the total number of PCR viral testing results by month. RSV was the most frequent virus detected in the IP (63%) and ED (37%) settings, while RV/EV was the most common in the OP setting (Figure 2). Figure 3 displays viral seasonality by clinical setting, showing an abrupt decrease in virus-positive cases following the implementation of a stay-at-home order on March 23, 2020 in Nashville, TN. ![]()
Distribution of Respiratory Viruses in Different Settings ![]()
Distribution of Respiratory Viruses in Different Settings by Season ![]()
Conclusion Most medical encounters in infants are due to viral pathogens, with RSV, RV/EV, and flu being the most common. However, distributions differed by clinical setting, with RSV being the most frequently detected in the IP and ED settings, and second to RV/EV in the OP setting. Continued active viral ARI surveillance in various clinical settings is warranted. Preventative measures such as vaccines and infection control measures deserve study to reduce viral ARI burden. Disclosures Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Donald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | | | - Jon Fryzek
- EpidStrategies, A Division of ToxStrategies, Inc., Rockville, MD
| | - Mina Suh
- Epidstrategies, Mission Viejo, California
| | | | - Rendie McHenry
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Rebekkah Varjabedian
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Kailee N Fernandez
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
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Haddadin Z, Rankin DA, Yanis A, Shawareb Y, Hamdan O, Saada M, Hilal S, Alhajajra A, Marar B, Khuri-Bulos N. 772. Respiratory Syncytial Virus Acute Respiratory Infections in Young Children in Jordan: A Prospective Surveillance Study. Open Forum Infect Dis 2020. [PMCID: PMC7777532 DOI: 10.1093/ofid/ofaa439.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections (ARI) hospitalizations in young children and is associated with increased severity compared to other viruses. The aim of this study was to evaluate the utilization of a rapid RSV diagnostic test and clinical characteristics and disease severity of children who were hospitalized during one respiratory season in Amman, Jordan.
Methods
Children less than two years hospitalized with fever and/or respiratory symptoms were recruited at Al-Bashir Government Hospital from January 8, 2020, to March 17, 2020. Nasal swabs were collected and tested by Sofia-2 RSV Fluorescent Immunoassay. Demographic information and clinical history were obtained through parental interviews. A validated severity score was used to assess disease severity, and the treating physician prospectively collected the necessary information to calculate the score at admission. Disease severity was categorized based on the total score into 0-5 mild, 6-9 moderate, and ≥ 10 severe. Molecular testing and medical chart reviews are still in process.
Results
A total of 532 subjects were enrolled, and nasal swabs were collected and tested from 458 (86%) of enrollees. The most common admission diagnoses were pneumonia (25%), bronchopneumonia (21%), bronchiolitis (19%) and sepsis (17%). Demographic and clinical characteristics are included in Table 1. Overall, 276 (60%) subjects were RSV-positive. The most common admission diagnoses were pneumonia (33%), sepsis (25%), bronchiolitis (24%) and bronchopneumonia (24%). Compared to RSV-negative children, RSV-positive children were younger (Table 1), and more likely to present with cough, nasal congestion, and appetite loss (Figure 1). There were no differences in severity score or direct intensive care unit admission between the two groups (Table 1).
Figure 1. Symptom Distribution in RSV-Positive and RSV-Negative Subjects
Conclusion
Nearly 2/3 of children enrolled were RSV-positive via rapid diagnostic testing. The majority of RSV-ARI admissions were classified as mild. Further analysis of other clinical parameters, including oxygen use, intravenous fluids administration and length of stay, and molecular testing are needed to support these findings and further evaluate the utility of rapid diagnostic testing.
Disclosures
Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Ahmad Yanis, MD, Quidel Corporation (Grant/Research Support) Yanal Shawareb, MD, Quidel (Grant/Research Support)Quidel (Grant/Research Support, Research Grant or Support, Sanofi) Olla Hamdan, BS, Quidel (Grant/Research Support, Research Grant or Support) Malek Saada, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Sara Hilal, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Ahmad Alhajajra, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Basima Marar, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Najwa Khuri-Bulos, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support)
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Affiliation(s)
- Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Ahmad Yanis
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Yanal Shawareb
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | - Olla Hamdan
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, Tennessee
| | | | - Sara Hilal
- Al Bashir Hospital, amman, ‘Amman, Jordan
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Fadugba OO, Haddadin Z, Muhimpundu S, Faouri S, Shehabi A, Rahman H, Williams JV, Miller EK, Khuri-Bulos N, Halasa NB. Respiratory Viruses Associated With Acute Wheezing in Hospitalized Young Children in Jordan. J Pediatric Infect Dis Soc 2020; 10:525-528. [PMID: 33340313 PMCID: PMC8087140 DOI: 10.1093/jpids/piaa143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022]
Abstract
A cross-sectional viral surveillance study of hospitalized children less than 2 years of old in Amman, Jordan, noted that respiratory syncytial virus and human metapneumovirus, but not human rhinovirus, were associated with higher odds of acute wheezing. Future longitudinal studies are needed to evaluate the association between early childhood viral acute respiratory infections and recurrent wheezing later in childhood.
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Affiliation(s)
- Olajumoke O Fadugba
- Department of Medicine, Division of Allergy and Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee USA,Corresponding Author: Zaid Haddadin, MD, Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases; 1161 21st Ave South, Medical Center North D7232; Nashville, TN 37232, USA. E-mail:
| | - Sylvie Muhimpundu
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan,Department of Pathology-Microbiology, The University of Jordan, Amman, Jordan
| | - Asem Shehabi
- Department of Pathology-Microbiology, The University of Jordan, Amman, Jordan
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | - John V Williams
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - E Kathryn Miller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee USA
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Rolsma SL, Rankin DA, Haddadin Z, Hamdan L, Rahman HK, Faouri S, Shehabi A, Williams JV, Khuri-Bulos N, Halasa NB. Assessing the epidemiology and seasonality of influenza among children under two hospitalized in Amman, Jordan, 2010-2013. Influenza Other Respir Viruses 2020; 15:284-292. [PMID: 33175456 PMCID: PMC7902256 DOI: 10.1111/irv.12813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/18/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background The disease burden of influenza‐associated hospitalizations among children in Jordan is not well established. We aimed to characterize hospitalizations attributed to influenza in a pediatric population. Methods We conducted a cross‐sectional study from our viral surveillance cohort in children under 2 years hospitalized with acute respiratory symptoms and/or fever from March 2010 to March 2013. We collected demographic and clinical characteristics, and calculated the frequency of children who met the severe acute respiratory illness (SARI) criteria. Nasal specimens were tested using real‐time reverse transcriptase polymerase chain reaction to detect influenza A, B, or C. Further subtyping for influenza A‐positive isolates was conducted. Results Of the 3168 children enrolled in our study, 119 (4%) were influenza‐positive. Influenza types and subtypes varied by season but were predominantly detected between December and February. Codetection of multiple respiratory pathogens was identified in 58% of children with the majority occurring among those <6 months. Bronchopneumonia and rule‐out sepsis were the most common admission diagnoses, with influenza A accounting for over 2/3 of children with a rule‐out sepsis admission status. One‐third of children under 6 months compared to 3/4 of children 6‐23 months met the SARI criteria. Conclusions Influenza was an important cause of acute respiratory illness in children under 2 years. Children <6 months had the highest burden of influenza‐associated hospitalizations and were less likely to meet the SARI global surveillance case definition. Additional surveillance is needed in the Middle East to determine the true influenza burden on a global scale.
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Affiliation(s)
- Stephanie L Rolsma
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danielle A Rankin
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zaid Haddadin
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lubna Hamdan
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Herdi K Rahman
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan
| | - Asem Shehabi
- Department Pathology and Microbiology and Forensic Medicine, Jordan University, Amman, Jordan
| | - John V Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Natasha B Halasa
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
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Haddadin Z, Beveridge S, Fernandez K, Rankin DA, Probst V, Spieker AJ, Markus TM, Stewart LS, Schaffner W, Lindegren ML, Halasa N. Respiratory Syncytial Virus Disease Severity in Young Children. Clin Infect Dis 2020; 73:e4384-e4391. [PMID: 33095882 DOI: 10.1093/cid/ciaa1612] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections (ARI) in hospitalized children. Although prematurity and underlying medical conditions are known risk factors, most of these children are healthy, and factors including RSV load and subgroups may contribute to RSV-ARI severity. Therefore, we aimed to evaluate the role of RSV in ARI disease severity and determine factors associated with increased RSV-ARI severity in young children. METHOD Children less than five years with fever and/or ARI symptoms were recruited from the emergency department (ED) or inpatient settings at Vanderbilt Children's Hospital. Nasal and/or throat swabs were tested by qRT-PCR for common respiratory viruses, including RSV. A severity score was calculated for RSV-positive children. RESULTS From 11/2015 through 07/2016, 898 participants were enrolled, and 681 (76%) had at least one virus detected, with 191 (28%) testing positive for RSV. RSV-positive children were more likely to be hospitalized, require intensive care unit (ICU) admission, and receive oxygen compared to other-virus-positive children. Higher viral load, White race, younger age, and higher severity score were independently associated with hospitalization in RSV-positive children. No differences in disease severity were noted among children infected with RSV A and B. CONCLUSION RSV was associated with increased ARI severity in young children enrolled from ED and inpatient settings, but no differences in disease severity were noted between RSV A and B. . These findings emphasize the need for effective antiviral therapy and/or preventive measures such as vaccines against RSV in young children.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kailee Fernandez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tiffanie M Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Lou Lindegren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Hamdan L, Vandekar S, Spieker AJ, Rahman H, Ndi D, Shekarabi ES, Thota J, Rankin DA, Haddadin Z, Markus T, Aronoff DM, Schaffner W, Gaddy JA, Halasa NB. Epidemiological Trends of Racial Differences in Early- and Late-Onset Group B Streptococcus Disease in Tennessee. Clin Infect Dis 2020; 73:e3634-e3640. [PMID: 33031511 DOI: 10.1093/cid/ciaa1511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The rates of early-onset Group B Streptococcus (GBS) disease (EOGBS) have declined since the implementation of universal screening and intrapartum antibiotic prophylaxis guidelines but late-onset (LOGBS) rates remain unchanged. Racial differences in GBS disease rates have been previously documented with Black infants having higher rates of EOGBS and LOGBS, but it is not known if these have persisted. Therefore, we sought to determine the differences of EOGBS and LOGBS disease by race over the past decade in Tennessee. METHODS This study used active population-based and laboratory-based surveillance data for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties across Tennessee. We included infants younger than 90 days and who had invasive GBS disease between 2009-2018. RESULTS A total of 356 GBS cases were included, with 60% having LOGBS. EOGBS and LOGBS had decreasing temporal trends over the study period. Overall, there were no changes of temporal trend noted in the rates of EOGBS and LOGBS among White race. However, Black infants had a significantly decreasing EOGBS and LOGBS temporal trends, [(RR=0.87, 95% CI= [0.79, 0.96], P-value=0.007), (RR= 0.90, 95% CI= [0.84, 0.97], P-value=0.003)], respectively. CONCLUSIONS Years after the successful implementation of the universal screening guidelines, our data revealed an overall decrease in LOGBS rates, primarily driven by changes among infants of Black race. More studies are needed to characterize the racial disparities in GBS rates, and factors driving them. Prevention measures such as vaccination are needed to have a further impact on disease rates.
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Affiliation(s)
- Lubna Hamdan
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Herdi Rahman
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Danielle Ndi
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Emily S Shekarabi
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Jyotsna Thota
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Danielle A Rankin
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
| | - Zaid Haddadin
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Tiffanie Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - David M Aronoff
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Jennifer A Gaddy
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Tennessee Valley Healthcare Systems, Department of Veterans Affairs, Nashville, Tennessee, U.S.A
| | - Natasha B Halasa
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Shen Q, Niederstrasser H, Barakat R, Haddadin Z, Miller SR, Posner B, Kim YT. Single-cell-level screening method for migratory cancer cells and its potential feasibility in high-throughput manner. Biofabrication 2020; 12:035019. [PMID: 32408287 DOI: 10.1088/1758-5090/ab9315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High-throughput screening (HTS) is a well-established approach for tumor-specific drug development because of its high efficiency and customizable selection of antineoplastic drugs. However, there is still a lack of an appropriate cell-based HTS specific for migratory cancer cells. In the study presented here, we created a novel assay (mHTS): a single-cell-level screening method targeting migratory cancer cells and can be applied in a high-throughput manner. This mHTS platform is based on microchannel devices (providing physical confinement during cell migration and limit migrating cells' proliferation rate) assembled 96-well plate (fitting to HTS manner). To determine the feasibility of this assay, we quantified the anti-migratory and anti-viability effects of several molecules (Cytochalasin D, Doxorubicin and AZD-6244) on migrating (creeping inside microchannel) glioblastoma multiforme (GBM) cells. After analyzing migration screening data that was collected on a single-cell-level, we were able to compare those drug's effects on cancer cells' migration velocity and uncovered the migration inhibiting potential of AZD (500 nM and 1000 nM). Viability data based on single-cell-level screening also allowed us to further understand the same drug's different lethality toward migrating and normal 2D cultured cancer cells. The Pre-classification of subpopulations enables us to study the heterogeneity of cancer and ensures our method's feasibility for a high-throughput manner. All these results proved our mHTS platform is suitable for single-cell-level anti-migration drug screening and has potential feasibility in promoting the development of anti-migratory-cancer-drug in a high-throughput manner.
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Affiliation(s)
- Qionghua Shen
- Department of Bioengineering, University of Texas, Arlington, TX, United States of America
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Patel M, Chen J, Kim S, Garg S, Flannery B, Haddadin Z, Rankin D, Halasa N, Talbot HK, Reed C. Analysis of MarketScan Data for Immunosuppressive Conditions and Hospitalizations for Acute Respiratory Illness, United States. Emerg Infect Dis 2020; 26:1720-1730. [PMID: 32348234 PMCID: PMC7392442 DOI: 10.3201/eid2608.191493] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 12/25/2022] Open
Abstract
Increasing use of immunosuppressive biologic therapies poses a challenge for infectious diseases. Immunosuppressed patients have a high risk for influenza complications and an impaired immune response to vaccines. The total burden of immunosuppressive conditions in the United States, including those receiving emerging biologic therapies, remains unknown. We used the national claims database MarketScan to estimate the prevalence of immunosuppressive conditions and risk for acute respiratory illnesses (ARIs). We studied 47.2 million unique enrollees, representing 115 million person-years of observation during 2012–2017, and identified immunosuppressive conditions in 6.2% adults 18–64 years of age and 2.6% of children <18 years of age. Among 542,105 ARI hospitalizations, 32% of patients had immunosuppressive conditions. The risk for ARI hospitalizations was higher among enrollees with immunosuppression than among nonimmunosuppressed enrollees. Future efforts should focus on developing improved strategies, including vaccines, for preventing influenza in immunosuppressed patients, who are an increasing population in the United States.
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Haddadin Z, Hanna K, Gries LM, Zeeshan M, Tang A, Ditillo M, Castanon L, Hamidi MK, Kulvatunyou N, Joseph B. Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the US: Analysis of 16,866 Abdominal Gunshot Wounds. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Astarabadi M, Haddadin Z, Tang AL, Hamidi MK, Gries LM, Hanna K, O’Keeffe T, Kulvatunyou N, Zeeshan M, Joseph B. Impact of Non-Neurologic Organ Dysfunction on Outcomes in Severe Isolated Traumatic Brain Injury. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Anand T, Haddadin Z, Tang AL, Saljuqi ATK, Hamidi MK, Ditillo M, Kulvatunyou N, Gries LM, Northcutt A, Joseph B. Association of Racial, Ethnic Disparities, and Frailty in Geriatric Trauma Patients. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lokhandwala A, Hanna K, Haddadin Z, O’Keeffe T, Zeeshan M, Hamidi MK, Joseph B, Gries LM, Ditillo M, Northcutt A. Strict Resuscitation Strategies Improve Outcomes in Patients with Severe Traumatic Brain Injury. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Hanna K, Haddadin Z, Ditillo M, Hamidi MK, O’Keeffe T, Zeeshan M, Gries LM, Tang AL, Kulvatunyou N, Joseph B. Readmission with Major Abdominal Complications after Penetrating Abdominal Trauma. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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50
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Zeeshan M, Haddadin Z, Tang AL, Hanna K, O’Keeffe T, Kulvatunyou N, Hamidi MK, Northcutt A, Zakaria ER, Joseph B. Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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