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Muñoz-Ramírez S, Escribano-López B, Rodrigo-Casares V, Vergara-Hernández C, Gil-Mary D, Sorribes-Monrabal I, Garcés-Sánchez M, Muñoz-Del-Barrio MJ, Albors-Fernández AM, Úbeda-Sansano MI, Planelles-Cantarino MV, Largo-Blanco EM, Suárez-Vicent E, García-Rubio J, Bruijning-Verhagen P, Orrico-Sánchez A, Díez-Domingo J. Feasibility of a hybrid clinical trial for respiratory virus detection in toddlers during the influenza season. BMC Med Res Methodol 2021; 21:273. [PMID: 34865624 PMCID: PMC8645221 DOI: 10.1186/s12874-021-01474-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional clinical trials are conducted at investigator sites. Participants must visit healthcare facilities several times for the trial procedures. Decentralized clinical trials offer an interesting alternative. They use telemedicine and other technological solutions (apps, monitoring devices or web platforms) to decrease the number of visits to study sites, minimise the impact on daily routine, and decrease geographical barriers for participants. Not much information is available on the use of decentralization in randomized clinical trials with vaccines. METHODS A hybrid clinical trial may be assisted by parental recording of symptoms using electronic log diaries in combination with home collected nasal swabs. During two influenza seasons, children aged 12 to 35 months with a history of recurrent acute respiratory infections were recruited in 12 primary health centers of the Valencia Region in Spain. Parents completed a symptom diary through an ad hoc mobile app that subsequently assessed whether it was an acute respiratory infection and requested collection of a nasal swab. Feasibility was measured using the percentage of returned electronic diaries and the validity of nasal swabs collected during the influenza season. Respiratory viruses were detected by real-time PCR. RESULTS Ninety-nine toddlers were enrolled. Parents completed 10,476 electronic diaries out of the 10,804 requested (97%). The mobile app detected 188 potential acute respiratory infections (ARIs) and requested a nasal swab. In 173 (92%) ARI episodes a swab was taken. 165 (95.4%) of these swabs were collected at home and 144 (87.3%) of them were considered valid for laboratory testing. Overall, 152 (81%) of the ARIs detected in the study had its corresponding valid sample collected. CONCLUSIONS Hybrid procedures used in this clinical trial with the influenza vaccine in toddlers were considered adequate, as we diagnosed most of the ARI cases on time, and had a valid swab in 81% of the cases. Hybrid clinical trials improve participant adherence to the study procedures and could improve recruitment and quality of life of the participants and the research team by decreasing the number of visits to the investigator site. This report emphasises that the conduct of hybrid CTs is a valid alternative to traditional CTs with vaccines. This hybrid CT achieved high adherence of participant to the study procedures. TRIAL REGISTRATION 2019-001186-33 (EudraCT).
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Affiliation(s)
- Soledad Muñoz-Ramírez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain.
| | - Begoña Escribano-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Vallivana Rodrigo-Casares
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Carlos Vergara-Hernández
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | | | | | | | | | | | | | | | | | - Javier García-Rubio
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | - Alejandro Orrico-Sánchez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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Suntarattiwong P, Mott JA, Mohanty S, Sinthuwattanawibool C, Srisantiroj N, Patamasingh Na Ayudhaya O, Klungthong C, Fernandez S, Kim L, Hunt D, Hombroek D, Brummer T, Chotpitayasunondh T, Dawood FS, Kittikraisak W. Feasibility and Performance of Self-Collected Nasal Swabs for Detection of Influenza Virus, Respiratory Syncytial Virus, and Human Metapneumovirus. J Infect Dis 2021; 224:831-838. [PMID: 34467984 DOI: 10.1093/infdis/jiab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed performance of participant-collected midturbinate nasal swabs compared to study staff-collected midturbinate nasal swabs for the detection of respiratory viruses among pregnant women in Bangkok, Thailand. METHODS We enrolled pregnant women aged ≥18 years and followed them throughout the 2018 influenza season. Women with acute respiratory illness self-collected midturbinate nasal swabs at home for influenza viruses, respiratory syncytial viruses (RSV), and human metapneumoviruses (hMPV) real-time RT-PCR testing and the study nurse collected a second midturbinate nasal swab during home visits. Paired specimens were processed and tested on the same day. RESULTS The majority (109, 60%) of 182 participants were 20-30 years old. All 200 paired swabs had optimal specimen quality. The median time from symptom onsets to participant-collected swabs was 2 days and to staff-collected swabs was also 2 days. The median time interval between the 2 swabs was 2 hours. Compared to staff-collected swabs, the participant-collected swabs were 93% sensitive and 99% specific for influenza virus detection, 94% sensitive and 99% specific for RSV detection, and 100% sensitive and 100% specific for hMPV detection. CONCLUSIONS Participant-collected midturbinate nasal swabs were a valid alternative approach for laboratory confirmation of influenza-, RSV-, and hMPV-associated illnesses among pregnant women in a community setting.
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Affiliation(s)
| | - Joshua A Mott
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarita Mohanty
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chalinthorn Sinthuwattanawibool
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Lindsay Kim
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Fatimah S Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
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3
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Los J, Gaydos CA, Gibert CL, Gorse GJ, Lykken J, Nyquist AC, Price CS, Radonovich LJ, Rattigan S, Reich N, Rodriguez-Barradas M, Simberkoff M, Bessesen M, Brown A, Cummings DAT, Perl TM. Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial. Am J Infect Control 2021; 49:893-899. [PMID: 33581146 PMCID: PMC7874979 DOI: 10.1016/j.ajic.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Health care personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP. METHODS The Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction. RESULTS Among 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained research assistants in the workplace (P < .001). CONCLUSIONS In this randomized clinical trial, take-home kits were an easily implemented, effective method to self-collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples.
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Affiliation(s)
- Jenna Los
- Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | | | - Geoffrey J Gorse
- VA St. Louis Health Care System and Saint Louis University School of Medicine St. Louis, MO
| | | | - Ann-Christine Nyquist
- Children's Hospital Colorado, Aurora, CO; University of Colorado School of Medicine, Aurora, CO
| | - Connie S Price
- University of Colorado School of Medicine, Aurora, CO; Denver Health and Hospital, Denver, CO
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Mary Bessesen
- University of Colorado School of Medicine, Aurora, CO; VA-Eastern Colorado Healthcare System, Denver, CO
| | | | | | - Trish M Perl
- Johns Hopkins University School of Medicine, Baltimore, MD; University of Texas Southwestern Medical Center, Dallas, TX
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Russell KE, Fowlkes A, Stockwell MS, Vargas CY, Saiman L, Larson EL, LaRussa P, Di Lonardo S, Popowich M, St. George K, Steffens A, Reed C. Comparison of outpatient medically attended and community-level influenza-like illness-New York City, 2013-2015. Influenza Other Respir Viruses 2018; 12:336-343. [PMID: 29350791 PMCID: PMC5907822 DOI: 10.1111/irv.12540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI. OBJECTIVES To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza-Like Illness in the Community (MoSAIC) Study. METHODS The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community-based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. RESULTS Five-hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. CONCLUSIONS Outpatient and community-based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly.
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Affiliation(s)
- Kate E. Russell
- Epidemic Intelligence ServiceCenters for Disease Control and PreventionAtlantaGAUSA
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Ashley Fowlkes
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Melissa S. Stockwell
- Columbia University Medical CenterNew YorkNYUSA
- NewYork‐Presbyterian HospitalNew YorkNYUSA
| | | | - Lisa Saiman
- Columbia University Medical CenterNew YorkNYUSA
- NewYork‐Presbyterian HospitalNew YorkNYUSA
| | | | | | - Steve Di Lonardo
- New York City Department of Health and Mental HygieneNew YorkNYUSA
| | | | | | - Andrea Steffens
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Carrie Reed
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
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Glisovic S, Eintracht S, Longtin Y, Oughton M, Brukner I. Rectal swab screening assays of public health importance in molecular diagnostics: Sample adequacy control. J Infect Public Health 2017; 11:234-237. [PMID: 28801105 DOI: 10.1016/j.jiph.2017.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/16/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022] Open
Abstract
Rectal swabs are routinely used by public health authorities to screen for multi-drug resistant enteric bacteria including vancomycin-resistant enterococci (VRE) and carbapenem-resistant enterobacteriaceae (CRE). Screening sensitivity can be influenced by the quality of the swabbing, whether performed by the patient (self-swabbing) or a healthcare practitioner. One common exclusion criterion for rectal swabs is absence of "visible soiling" from fecal matter. In our institution, this criterion excludes almost 10% of rectal swabs received in the microbiology laboratory. Furthermore, over 30% of patients in whom rectal swabs are cancelled will not be re-screened within the next 48h, resulting in delays in removing infection prevention measures. We describe two quantitative polymerase chain reaction (qPCR)-based assays, human RNAse P and eubacterial 16S rDNA, which might serve as suitable controls for sampling adequacy. However, lower amounts of amplifiable human DNA make the 16s rDNA assay a better candidate for sample adequacy control.
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Affiliation(s)
| | - Shaun Eintracht
- Medical Faculty, McGill University, Montreal, Quebec, Canada; SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - Yves Longtin
- Medical Faculty, McGill University, Montreal, Quebec, Canada; SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - Matthew Oughton
- Medical Faculty, McGill University, Montreal, Quebec, Canada; SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - Ivan Brukner
- Medical Faculty, McGill University, Montreal, Quebec, Canada; SMBD-Jewish General Hospital, Montreal, Quebec, Canada.
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