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Bardossy AC, Korhonen L, Schatzman S, Gable P, Herzig C, Brown NE, Beshearse E, Varela K, Sabour S, Lyons AK, Overton R, Hudson M, Hernandez-Romieu AC, Alvarez J, Roman K, Weng M, Soda E, Patel PR, Grate C, Dalrymple LS, Wingard RL, Thornburg NJ, Halpin ASL, Folster JM, Tobin-D’Angelo M, Lea J, Apata I, McDonald LC, Brown AC, Kutty PK, Novosad S. Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis. Kidney360 2021; 2:1917-1927. [PMID: 35419540 PMCID: PMC8986054 DOI: 10.34067/kid.0004372021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023]
Abstract
Background Patients with ESKD on maintenance dialysis receive dialysis in common spaces with other patients and have a higher risk of severe SARS-CoV-2 infections. They may have persistently or intermittently positive SARS-CoV-2 RT-PCR tests after infection. We describe the clinical course of SARS-CoV-2 infection and the serologic response in a convenience sample of patients with ESKD to understand the duration of infectivity. Methods From August to November 2020, we enrolled patients on maintenance dialysis with SARS-CoV-2 infections from outpatient dialysis facilities in Atlanta, Georgia. We followed participants for approximately 42 days. We assessed COVID-19 symptoms and collected specimens. Oropharyngeal (OP), anterior nasal (AN), and saliva (SA) specimens were tested for the presence of SARS-CoV-2 RNA, using RT-PCR, and sent for viral culture. Serology, including neutralizing antibodies, was measured in blood specimens. Results Fifteen participants, with a median age of 58 (range, 37‒77) years, were enrolled. Median duration of RT-PCR positivity from diagnosis was 18 days (interquartile range [IQR], 8‒24 days). Ten participants had at least one, for a total of 41, positive RT-PCR specimens ≥10 days after symptoms onset. Of these 41 specimens, 21 underwent viral culture; one (5%) was positive 14 days after symptom onset. Thirteen participants developed SARS-CoV-2-specific antibodies, 11 of which included neutralizing antibodies. RT-PCRs remained positive after seroconversion in eight participants and after detection of neutralizing antibodies in four participants; however, all of these samples were culture negative. Conclusions Patients with ESKD on maintenance dialysis remained persistently and intermittently SARS-CoV-2-RT-PCR positive. However, of the 15 participants, only one had infectious virus, on day 14 after symptom onset. Most participants mounted an antibody response, including neutralizing antibodies. Participants continued having RT-PCR-positive results in the presence of SARS-CoV-2-specific antibodies, but without replication-competent virus detected.
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Affiliation(s)
- Ana Cecilia Bardossy
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Korhonen
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sabrina Schatzman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn Herzig
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole E. Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kate Varela
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda K. Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rahsaan Overton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Hudson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alfonso C. Hernandez-Romieu
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jorge Alvarez
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaylin Roman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Weng
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Soda
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Priti R. Patel
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Natalie J. Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jennifer M. Folster
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa Tobin-D’Angelo
- Acute Disease Epidemiology Section, Georgia Department of Public Health, Atlanta, Georgia
| | - Janice Lea
- Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, Georgia
| | - Ibironke Apata
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, Georgia
| | - L. Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison C. Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Preeta K. Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Novosad
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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2
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Ahmed SS, Lessa FC, Coradin H, Sánchez J, Carvalho MDG, Soda E, Peña C, Fernández J, Cedano D, Whitney CG, Feris-Iglesias J. High Prevalence of Vaccine-Type Infections Among Children with Pneumococcal Pneumonia and Effusion After 13-Valent Pneumococcal Conjugate Vaccine Introduction in the Dominican Republic. J Infect Dis 2021; 224:S228-S236. [PMID: 34469563 DOI: 10.1093/infdis/jiab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2013, the Dominican Republic introduced 13-valent pneumococcal conjugate vaccine (PCV13) using a 3-dose schedule (at 2, 4 and 12 months of age). We evaluated the impact of PCV13 on serotypes causing pneumococcal pneumonia with pleural effusion. METHODS Surveillance data after PCV13 introduction (July 2014 to June 2016) were compared with data before PCV13 introduction (July 2009 to June 2011). Cases were defined as radiologic evidence of pneumonia with pleural effusion in a child aged <15 years. Pneumococcus was detected in pleural fluid by either culture or polymerase chain reaction, and serotyping was performed. The Ministry of Health's PCV13 uptake data for 2014-2016 were obtained. RESULTS The prevalence of pneumococcus among cases was similar before and after PCV13 introduction (56.4% and 52.8%, respectively). The proportion of pneumococcal cases caused by vaccine serotypes was 86% for children <2 years old both before and PCV13 introduction. Compared with before PCV13, serotype 14 accounted for a smaller (28% vs 13%, respectively; P = .02) and serotype 1 for a larger (23% vs 37%; P = .09) proportion of pneumococcal cases after PCV13 introduction. National uptake for the first, second, and third PCV13 doses was 94%, 81%, and 28%, respectively, in 2014 and 75%, 61%, and 26% in 2015. DISCUSSION While the decrease in pneumococcal pneumonia with pleural effusion caused by serotype 14 may reflect an early effect of PCV13 implementation, other vaccine serotypes, including serotype 1, are not well controlled. Better PCV13 coverage for all 3 doses is needed.
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Affiliation(s)
- Sana S Ahmed
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fernanda C Lessa
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilma Coradin
- Department of Infectious Diseases, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Jacqueline Sánchez
- Department of Infectious Diseases, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Maria da G Carvalho
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Soda
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chabela Peña
- Department of Infectious Diseases, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Josefina Fernández
- Department of Infectious Diseases, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Doraliza Cedano
- Department of Infectious Diseases, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Cynthia G Whitney
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesús Feris-Iglesias
- Department of Infectious Diseases, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
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3
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Lyman M, Forsberg K, Reuben J, Dang T, Free R, Seagle EE, Sexton DJ, Soda E, Jones H, Hawkins D, Anderson A, Bassett J, Lockhart SR, Merengwa E, Iyengar P, Jackson BR, Chiller T. Notes from the Field: Transmission of Pan-Resistant and Echinocandin-Resistant Candida auris in Health Care Facilities - Texas and the District of Columbia, January-April 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1022-1023. [PMID: 34292928 PMCID: PMC8297693 DOI: 10.15585/mmwr.mm7029a2] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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4
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Pacilli M, Kerins JL, Clegg WJ, Walblay KA, Adil H, Kemble SK, Xydis S, McPherson TD, Lin MY, Hayden MK, Froilan MC, Soda E, Tang AS, Valley A, Forsberg K, Gable P, Moulton-Meissner H, Sexton DJ, Jacobs Slifka KM, Vallabhaneni S, Walters MS, Black SR. Regional Emergence of Candida auris in Chicago and Lessons Learned From Intensive Follow-up at 1 Ventilator-Capable Skilled Nursing Facility. Clin Infect Dis 2021; 71:e718-e725. [PMID: 32291441 DOI: 10.1093/cid/ciaa435] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 01/13/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A). METHODS We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016-December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling. RESULTS During August 2016-December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23-71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. CONCLUSIONS High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.
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Affiliation(s)
- Massimo Pacilli
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Janna L Kerins
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Whitney J Clegg
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Kelly A Walblay
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Hira Adil
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Sarah K Kemble
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Shannon Xydis
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Tristan D McPherson
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, USA
| | - Michael Y Lin
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Mary K Hayden
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Mary Carl Froilan
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Elizabeth Soda
- Illinois Department of Public Health, Chicago, Illinois, USA.,Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Angela S Tang
- Illinois Department of Public Health, Chicago, Illinois, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Kaitlin Forsberg
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, USA
| | - Paige Gable
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - D Joseph Sexton
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, USA
| | - Kara M Jacobs Slifka
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Snigdha Vallabhaneni
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Stephanie R Black
- Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA
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5
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Britton A, Jacobs Slifka KM, Edens C, Nanduri SA, Bart SM, Shang N, Harizaj A, Armstrong J, Xu K, Ehrlich HY, Soda E, Derado G, Verani JR, Schrag SJ, Jernigan JA, Leung VH, Parikh S. Effectiveness of the Pfizer-BioNTech COVID-19 Vaccine Among Residents of Two Skilled Nursing Facilities Experiencing COVID-19 Outbreaks - Connecticut, December 2020-February 2021. MMWR Morb Mortal Wkly Rep 2021; 70:396-401. [PMID: 33735160 PMCID: PMC7976620 DOI: 10.15585/mmwr.mm7011e3] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Residents of long-term care facilities (LTCFs), particularly those in skilled nursing facilities (SNFs), have experienced disproportionately high levels of COVID-19-associated morbidity and mortality and were prioritized for early COVID-19 vaccination (1,2). However, this group was not included in COVID-19 vaccine clinical trials, and limited postauthorization vaccine effectiveness (VE) data are available for this critical population (3). It is not known how well COVID-19 vaccines protect SNF residents, who typically are more medically frail, are older, and have more underlying medical conditions than the general population (1). In addition, immunogenicity of the Pfizer-BioNTech vaccine was found to be lower in adults aged 65-85 years than in younger adults (4). Through the CDC Pharmacy Partnership for Long-Term Care Program, SNF residents and staff members in Connecticut began receiving the Pfizer-BioNTech COVID-19 vaccine on December 18, 2020 (5). Administration of the vaccine was conducted during several on-site pharmacy clinics. In late January 2021, the Connecticut Department of Public Health (CT DPH) identified two SNFs experiencing COVID-19 outbreaks among residents and staff members that occurred after each facility's first vaccination clinic. CT DPH, in partnership with CDC, performed electronic chart review in these facilities to obtain information on resident vaccination status and infection with SARS-CoV-2, the virus that causes COVID-19. Partial vaccination, defined as the period from >14 days after the first dose through 7 days after the second dose, had an estimated effectiveness of 63% (95% confidence interval [CI] = 33%-79%) against SARS-CoV-2 infection (regardless of symptoms) among residents within these SNFs. This is similar to estimated effectiveness for a single dose of the Pfizer-BioNTech COVID-19 vaccine in adults across a range of age groups in noncongregate settings (6) and suggests that to optimize vaccine impact among this population, high coverage with the complete 2-dose series should be recommended for SNF residents and staff members.
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6
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Crist MB, McQuiston JR, Walters MS, Soda E, Moulton-Meissner H, Nicholson A, Perkins K. 868. Investigations of Healthcare-Associated Elizabethkingia Infections – United States, 2013-2019. Open Forum Infect Dis 2020. [PMCID: PMC7776229 DOI: 10.1093/ofid/ofaa439.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Elizabethkingia (EK) are non-motile gram-negative rods found in soil and water and are an emerging cause of healthcare-associated infections (HAIs). We describe Centers for Disease Control and Prevention (CDC) consultations for healthcare-associated EK infections and outbreaks. Methods CDC maintains records of consultations with state or local health departments related to HAI outbreaks and infection control breaches. We reviewed consultations involving EK species as the primary pathogen of concern January 1, 2013 to December 31, 2019 and summarized data on healthcare settings, infection types, laboratory analysis, and control measures. Results We identified 9 consultations among 8 states involving 73 patient infections. Long-term acute-care hospitals (LTACHs) accounted for 4 consultations and 32 (43%) infections, and skilled nursing facilities with ventilated patients (VSNFs) accounted for 2 consultations and 31 (42%) infections. Other settings included an acute care hospital, an assisted living facility, and an outpatient ear, nose, and throat clinic. Culture sites included the respiratory tract (n=7 consultations), blood (n=4), and sinus tract (n=1), and E. anophelis was the most commonly identified species. Six consultations utilized whole genome sequencing (WGS); 4 identified closely related isolates from different patients and 2 also identified closely related environmental and patient isolates. Mitigation measures included efforts to reduce EK in facility water systems, such as the development of water management plans, consulting water management specialists, flushing water outlets, and monitoring water quality, as well as efforts to minimize patient exposure such as cleaning of shower facilities and equipment, storage of respiratory therapy supplies away from water sources, and use of splash guards on sinks. Conclusion EK is an important emerging pathogen that causes HAI outbreaks, particularly among chronically ventilated patients. LTACHs and VSNFs accounted for the majority of EK consultations and patient infections. Robust water management plans and infection control practices to minimize patient exposure to contaminated water in these settings are important measures to reduce infection risk among vulnerable patients. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Matthew B Crist
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Elizabeth Soda
- Cemters for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kiran Perkins
- Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Mwenda JM, Soda E, Weldegebriel G, Katsande R, Biey JNM, Traore T, de Gouveia L, du Plessis M, von Gottberg A, Antonio M, Kwambana-Adams B, Worwui A, Gierke R, Schwartz S, van Beneden C, Cohen A, Serhan F, Lessa FC. Pediatric Bacterial Meningitis Surveillance in the World Health Organization African Region Using the Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2011-2016. Clin Infect Dis 2020; 69:S49-S57. [PMID: 31505629 PMCID: PMC6736400 DOI: 10.1093/cid/ciz472] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Bacterial meningitis is a major cause of morbidity and mortality in sub-Saharan Africa. We analyzed data from the World Health Organization's (WHO) Invasive Bacterial Vaccine-preventable Diseases Surveillance Network (2011-2016) to describe the epidemiology of laboratory-confirmed Streptococcus pneumoniae (Spn), Neisseria meningitidis, and Haemophilus influenzae meningitis within the WHO African Region. We also evaluated declines in vaccine-type pneumococcal meningitis following pneumococcal conjugate vaccine (PCV) introduction. METHODS Reports of meningitis in children <5 years old from sentinel surveillance hospitals in 26 countries were classified as suspected, probable, or confirmed. Confirmed meningitis cases were analyzed by age group and subregion (South-East and West-Central). We described case fatality ratios (CFRs), pathogen distribution, and annual changes in serotype and serogroup, including changes in vaccine-type Spn meningitis following PCV introduction. RESULTS Among 49 844 reported meningitis cases, 1670 (3.3%) were laboratory-confirmed. Spn (1007/1670 [60.3%]) was the most commonly detected pathogen; vaccine-type Spn meningitis cases declined over time. CFR was the highest for Spn meningitis: 12.9% (46/357) in the South-East subregion and 30.9% (89/288) in the West-Central subregion. Meningitis caused by N. meningitidis was more common in West-Central than South-East Africa (321/954 [33.6%] vs 110/716 [15.4%]; P < .0001). Haemophilus influenzae (232/1670 [13.9%]) was the least prevalent organism. CONCLUSIONS Spn was the most common cause of pediatric bacterial meningitis in the African region even after reported cases declined following PCV introduction. Sustaining robust surveillance is essential to monitor changes in pathogen distribution and to inform and guide vaccination policies.
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Affiliation(s)
- Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Elizabeth Soda
- Epidemic Intelligence Service, and, Atlanta, Georgia.,Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Goitom Weldegebriel
- World Health Organization (WHO) Regional Office for Africa, Intercountry Support Team, Harare, Zimbabwe
| | - Regis Katsande
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Tieble Traore
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Linda de Gouveia
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Mignon du Plessis
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Martin Antonio
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul
| | - Brenda Kwambana-Adams
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul
| | - Archibald Worwui
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul
| | - Ryan Gierke
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie Schwartz
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chris van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Fernanda C Lessa
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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8
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Mpabalwani EM, Lukwesa-Musyani C, Imamba A, Nakazwe R, Matapo B, Muzongwe CM, Mufune T, Soda E, Mwenda JM, Lutz CS, Pondo T, Lessa FC. Declines in Pneumonia and Meningitis Hospitalizations in Children Under 5 Years of Age After Introduction of 10-Valent Pneumococcal Conjugate Vaccine in Zambia, 2010-2016. Clin Infect Dis 2020; 69:S58-S65. [PMID: 31505628 PMCID: PMC6761309 DOI: 10.1093/cid/ciz456] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Pneumococcus is a leading cause of pneumonia and meningitis. Zambia introduced a 10-valent pneumococcal conjugate vaccine (PCV10) in July 2013 using a 3-dose primary series at ages 6, 10, and 14 weeks with no booster. We evaluated the impact of PCV10 on meningitis and pneumonia hospitalizations. Methods Using hospitalization data from first-level care hospitals, available at the Ministry of Health, and from the largest pediatric referral hospital in Lusaka, we identified children aged <5 years who were hospitalized with pneumonia or meningitis from January 2010–December 2016. We used time-series analyses to measure the effect of PCV10 on monthly case counts by outcome and age group (<1 year, 1–4 years), accounting for seasonality. We defined the pre- and post-PCV10 periods as January 2010–June 2013 and July 2014–December 2016, respectively. Results At first-level care hospitals, pneumonia and meningitis hospitalizations among children aged <5 years accounted for 108 884 and 1742 admissions in the 42 months pre-PCV10, respectively, and 44 715 and 646 admissions in the 30 months post-PCV10, respectively. Pneumonia hospitalizations declined by 37.8% (95% confidence interval [CI] 21.4–50.3%) and 28.8% (95% CI 17.7–38.7%) among children aged <1 year and 1–4 years, respectively, while meningitis hospitalizations declined by 72.1% (95% CI 63.2–79.0%) and 61.6% (95% CI 50.4–70.8%), respectively, in these age groups. In contrast, at the referral hospital, pneumonia hospitalizations remained stable and a smaller but significant decline in meningitis was observed among children aged 1–4 years (39.3%, 95% CI 16.2–57.5%). Conclusions PCV10 introduction was associated with declines in meningitis and pneumonia hospitalizations in Zambia, especially in first-level care hospitals.
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Affiliation(s)
- Evans M Mpabalwani
- University of Zambia, School of Medicine, Department of Pediatrics & Child Health Unit, Ministry of Health, Ndeke House, Lusaka, Zambia.,Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Chileshe Lukwesa-Musyani
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Akakambama Imamba
- Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Ruth Nakazwe
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Belem Matapo
- World Health Organization Zambia Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Chilweza M Muzongwe
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Trust Mufune
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Elizabeth Soda
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Chelsea S Lutz
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, United States Department of Energy, Washington, DC
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fernanda C Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Smithee RB, Markus TM, Soda E, Grijalva CG, Xing W, Shang N, Griffin MR, Lessa FC. Pneumonia Hospitalization Coding Changes Associated With Transition From the 9th to 10th Revision of International Classification of Diseases. Health Serv Res Manag Epidemiol 2020; 7:2333392820939801. [PMID: 32782916 PMCID: PMC7383658 DOI: 10.1177/2333392820939801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/10/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate the impact of International Classification of Disease, 10th revision, Clinical Modification (ICD-10-CM) implementation on pneumonia hospitalizations rates, which had declined following pneumococcal conjugate vaccine introduction for infants in 2000. Methods: We randomly selected records from a single hospital 1 year before (n = 500) and after (n = 500) October 2015 implementation of ICD-10-CM coding. We used a validated ICD-9-CM algorithm and translation of that algorithm to ICD-10-CM to identify pneumonia hospitalizations pre- and post-implementation, respectively. We recoded ICD-10-CM records to ICD-9-CM and vice versa. We calculated sensitivity and positive predictive value (PPV) of the ICD-10-CM algorithm using ICD-9-CM coding as the reference. We used sensitivity and PPV values to calculate an adjustment factor to apply to ICD-10 era rates to enable comparison with ICD-9-CM rates. We reviewed primary diagnoses of charts not meeting the pneumonia definition when recoded. Results: Sensitivity and PPV of the ICD-10-CM algorithm were 94% and 92%, respectively, for young children and 74% and 79% for older adults. The estimated adjustment factor for ICD-10-CM period rates was −2.09% (95% credible region [CR], −7.71% to +3.0%) for children and +6.76% (95% CR, −3.06% to +16.7%) for older adults. We identified a change in coding adult charts that met the ICD-9-CM pneumonia definition that led to recoding in ICD-10-CM as chronic obstructive pulmonary disease (COPD) exacerbation. Conclusions: The ICD-10-CM algorithm derived from a validated ICD-9-CM algorithm should not introduce substantial bias for evaluating pneumonia trends in children. However, changes in coding of pneumonia associated with COPD in adults warrant further study.
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Affiliation(s)
- Ryan B Smithee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Tiffanie M Markus
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Elizabeth Soda
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Wei Xing
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nong Shang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie R Griffin
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Fernanda C Lessa
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Novosad SA, Lake J, Nguyen D, Soda E, Moulton-Meissner H, Pho MT, Gualandi N, Bepo L, Stanton RA, Daniels JB, Turabelidze G, Van Allen K, Arduino M, Halpin AL, Layden J, Patel PR. Multicenter Outbreak of Gram-Negative Bloodstream Infections in Hemodialysis Patients. Am J Kidney Dis 2019; 74:610-619. [PMID: 31375298 PMCID: PMC10826890 DOI: 10.1053/j.ajkd.2019.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/05/2019] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE Contaminated water and other fluids are increasingly recognized to be associated with health care-associated infections. We investigated an outbreak of Gram-negative bloodstream infections at 3 outpatient hemodialysis facilities. STUDY DESIGN Matched case-control investigations. SETTING & PARTICIPANTS Patients who received hemodialysis at Facility A, B, or C from July 2015 to November 2016. EXPOSURES Infection control practices, sources of water, dialyzer reuse, injection medication handling, dialysis circuit priming, water and dialysate test findings, environmental reservoirs such as wall boxes, vascular access care practices, pulsed-field gel electrophoresis, and whole-genome sequencing of bacterial isolates. OUTCOMES Cases were defined by a positive blood culture for any Gram-negative bacteria drawn July 1, 2015 to November 30, 2016 from a patient who had received hemodialysis at Facility A, B, or C. ANALYTICAL APPROACH Exposures in cases and controls were compared using matched univariate conditional logistic regression. RESULTS 58 cases of Gram-negative bloodstream infection occurred; 48 (83%) required hospitalization. The predominant organisms were Serratia marcescens (n=21) and Pseudomonas aeruginosa (n=12). Compared with controls, cases had higher odds of using a central venous catheter for dialysis (matched odds ratio, 54.32; lower bound of the 95% CI, 12.19). Facility staff reported pooling and regurgitation of waste fluid at recessed wall boxes that house connections for dialysate components and the effluent drain within dialysis treatment stations. Environmental samples yielded S marcescens and P aeruginosa from wall boxes. S marcescens isolated from wall boxes and case-patients from the same facilities were closely related by pulsed-field gel electrophoresis and whole-genome sequencing. We identified opportunities for health care workers' hands to contaminate central venous catheters with contaminated fluid from the wall boxes. LIMITATIONS Limited patient isolates for testing, on-site investigation occurred after peak of infections. CONCLUSIONS This large outbreak was linked to wall boxes, a previously undescribed source of contaminated fluid and biofilms in the immediate patient care environment.
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Affiliation(s)
- Shannon A Novosad
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Jason Lake
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Duc Nguyen
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth Soda
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, GA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mai T Pho
- Illinois Department of Public Health, Chicago, IL
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lurit Bepo
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Richard A Stanton
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jonathan B Daniels
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Matthew Arduino
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Priti R Patel
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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11
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Soda E, Barskey A, Shah P, Cooley L. Health Care-Associated Legionnaires’ Disease: Surveillance Data from 20 States and a Large Metropolitan Area—United States, 2015. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.478] [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: 11/14/2022] Open
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