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Rivers P, Porter C, LeClair LB, Jeddy Z, Fowlkes AL, Lamberte JM, Herder K, Smith M, Rai R, Grant L, Hegmann KT, Jovel K, Vaughan M, Mathenge C, Phillips AL, Khan S, Britton A, Pilishvili T, Burgess JL, Newes-Adeyi G, Gaglani M, Caban-Martinez A, Yoon S, Lutrick K. Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study. Vaccine 2024; 42:1512-1520. [PMID: 38307743 DOI: 10.1016/j.vaccine.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months. METHODS The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time. RESULTS A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up. CONCLUSION The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.
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Affiliation(s)
| | | | | | - Zuha Jeddy
- Abt Associates, Rockville, MD, United States
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ramona Rai
- Abt Associates, Rockville, MD, United States
| | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | - Sana Khan
- University of Arizona, Tucson, AZ, United States
| | - Amadea Britton
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | - Sarang Yoon
- Utah University, Salt Lake City, UT, United States
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Chivu CD, Crăciun MD, Pițigoi D, Aramă V, Luminos ML, Jugulete G, Constantin C, Apostolescu CG, Streinu Cercel A. The Dynamic Risk of COVID-19-Related Events in Vaccinated Healthcare Workers (HCWs) from a Tertiary Hospital in Bucharest, Romania: A Study Based on Active Surveillance Data. Vaccines (Basel) 2024; 12:182. [PMID: 38400165 PMCID: PMC10891893 DOI: 10.3390/vaccines12020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Our study describes the frequency and severity of COVID-19 in HCWs and estimates the dynamic risk of COVID-19-related events. We actively surveyed all HCWs from a tertiary infectious disease hospital from 26 February 2020 to 31 May 2023. Of 1220 HCWs, 62.9% (767) had at least one COVID-19 episode. The under 29 years (p = 0.0001) and 40-49 years (p = 0.01) age groups, nurses (p = 0.0001), and high-risk departments (p = 0.037) were characteristics significantly more frequent in HCWs with COVID-19 history. A higher percentage of boosters (53.2%; p < 0.0001) were registered in the uninfected group. The second episode of COVID-19 was significantly milder than the first. Data regarding clinical outcomes from 31 January 2021 to 31 May 2023 were analyzed in a follow-up study to determine the risk of COVID-19-related events. The Cox regression analysis revealed that HCWs with booster shots had a lower risk of COVID-19 across all events, symptomatic events, and moderate to severe events as adjusted hazard ratio (aHR) were: 0.71 (95%CI: 0.54-0.96), 0.23 (95%CI: 0.12-0.46), and 0.17 (95%CI: 0.07-0.43), respectively. Within the vaccinated subgroup, the HCWs with hybrid immunity and booster had aHR for all followed-up events of 0.42 (95%CI: 0.30-0.58), for symptomatic events of 0.52 (95%CI: 0.36-0.74), and 0.15 (95%CI: 0.03-0.66) for moderate to severe events. The risk of COVID-19 clinical events was lower for HCWs with at least one booster than those completely vaccinated.
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Affiliation(s)
- Carmen-Daniela Chivu
- Department of Epidemiology 1, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-D.C.); (D.P.)
- Emergency Clinical Hospital for Children “Grigore Alexandrescu”, 011743 Bucharest, Romania
| | - Maria-Dorina Crăciun
- Department of Epidemiology 1, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-D.C.); (D.P.)
- Emergency Clinical Hospital for Children “Grigore Alexandrescu”, 011743 Bucharest, Romania
| | - Daniela Pițigoi
- Department of Epidemiology 1, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-D.C.); (D.P.)
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania; (V.A.); (M.L.L.); (G.J.); (C.G.A.); (A.S.C.)
| | - Victoria Aramă
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania; (V.A.); (M.L.L.); (G.J.); (C.G.A.); (A.S.C.)
- Department of Infectious Diseases 1, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Monica Luminița Luminos
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania; (V.A.); (M.L.L.); (G.J.); (C.G.A.); (A.S.C.)
- Department of Infectious Diseases 3, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gheorghiță Jugulete
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania; (V.A.); (M.L.L.); (G.J.); (C.G.A.); (A.S.C.)
- Department of Infectious Diseases 3, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ciprian Constantin
- Department of Clinical Sciences, Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania;
- Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Cătălin Gabriel Apostolescu
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania; (V.A.); (M.L.L.); (G.J.); (C.G.A.); (A.S.C.)
- Department of Infectious Diseases 1, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Streinu Cercel
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania; (V.A.); (M.L.L.); (G.J.); (C.G.A.); (A.S.C.)
- Department of Infectious Diseases 1, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Hollister J, Caban-Martinez AJ, Ellingson KD, Beitel S, Fowlkes AL, Lutrick K, Tyner HL, Naleway AL, Yoon SK, Gaglani M, Hunt D, Meece J, Mayo Lamberte J, Schaefer Solle N, Rose S, Dunnigan K, Khan SM, Kuntz JL, Fisher JM, Coleman A, Britton A, Thiese MS, Hegmann KT, Pavuk M, Ramadan FA, Fuller S, Nematollahi A, Sprissler R, Burgess JL. Serum per- and polyfluoroalkyl substance concentrations and longitudinal change in post-infection and post-vaccination SARS-CoV-2 antibodies. ENVIRONMENTAL RESEARCH 2023; 239:117297. [PMID: 37816422 PMCID: PMC10842580 DOI: 10.1016/j.envres.2023.117297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/17/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are ubiquitous throughout the United States. Previous studies have shown PFAS exposure to be associated with a reduced immune response. However, the relationship between serum PFAS and antibody levels following SARS-CoV-2 infection or COVID-19 vaccination has not been examined. We examined differences in peak immune response and the longitudinal decline of antibodies following SARS-CoV-2 infection and COVID-19 vaccination by serum PFAS levels in a cohort of essential workers in the United States. We measured serum antibodies using an in-house semi-quantitative enzyme-linked immunosorbent assay (ELISA). Two cohorts contributed blood samples following SARS-CoV-2 infection or COVID-19 vaccination. We used linear mixed regression models, adjusting for age, race/ethnicity, gender, presence of chronic conditions, location, and occupation, to estimate differences in immune response with respect to serum PFAS levels. Our study populations included 153 unvaccinated participants that contributed 316 blood draws over a 14-month period following infection, and 860 participants and 2451 blood draws over a 12-month period following vaccination. Higher perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) concentrations were associated with a lower peak antibody response after infection (p = 0.009, 0.031, 0.015). Higher PFOS, perfluorooctanoic acid (PFOA), PFHxS, and PFNA concentrations were associated with slower declines in antibodies over time after infection (p = 0.003, 0.014, 0.026, 0.025). PFOA, PFOS, PFHxS, and PFNA serum concentrations prior to vaccination were not associated with differences in peak antibody response after vaccination or with differences in decline of antibodies over time after vaccination. These results suggest that elevated PFAS may impede potential immune response to SARS-CoV-2 infection by blunting peak antibody levels following infection; the same finding was not observed for immune response to vaccination.
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Affiliation(s)
- James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences and Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, USA
| | - Katherine D Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Karen Lutrick
- College of Medicine - Tucson, University of Arizona, Tucson, AZ, USA
| | | | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Sarang K Yoon
- University of Utah Health, Rocky Mountain Center for Occupational and Environmental Health, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA
| | | | | | | | - Natasha Schaefer Solle
- Department of Public Health Sciences and Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, USA
| | | | | | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | - Alissa Coleman
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Marian Pavuk
- Agency for Toxic Substances and Disease Registry, CDC, Atlanta, GA, USA
| | - Ferris A Ramadan
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | | | - Amy Nematollahi
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ryan Sprissler
- University of Arizona Genetics Core, Office for Research, Innovation and Impact, University of Arizona, Tucson, AZ, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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4
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Rivers P, Jovel K, Ramadan F, Barnett JJA, Ellingson KD, Burgess JL, Lutrick K. Disease and social factors associated with healthcare utilization for the treatment of SARS-CoV-2 infections in a longitudinal cohort of essential workers in Arizona. BMC Health Serv Res 2023; 23:1118. [PMID: 37853403 PMCID: PMC10585717 DOI: 10.1186/s12913-023-10064-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Demands on health systems due to COVID-19 are substantial, but drivers of healthcare utilization are not well defined in non-severe SARS-CoV-2 infections. Among a prospective cohort of frontline workers from July 2020 to February 2023, we assessed predictors of healthcare utilization during SARS-CoV-2 infection. METHODS Weekly specimens tested via real-time reverse transcriptase polymerase chain reaction analysis. Participants reported sociodemographic, health status information, and illness experience information. Primary outcome was healthcare utilization during SARS-CoV-2 infection. Predictors included sociodemographic characteristics, baseline health status, and measures of illness severity. Multivariable logistic regression was utilized to generate odds ratios for predictors of healthcare utilization. RESULTS 1,923 SARS-CoV-2 infections (1,276 first infections and 647 reinfections from 4,208 participants): 1221 (63.5%) individuals were between 40 and 65 years old; 1115 (58.0%) were female; 449 (23.3%) were Hispanic and 1305 (67.9%) non-Hispanic White. 294 (15.3%) individuals sought medical care during first infection, 106 (5.5%) during reinfection. Sociodemographic and baseline health characteristics were not associated with healthcare utilization during infections from any variant for first infections, while age (OR 1.04, 95%CI 1.01-1.07) was during Omicron reinfection. In first infection, number of symptoms (OR 1.16, 95%CI 1.00-1.36 in Origin/Alpha, OR 1.12, 95%CI 1.00-1.49 in Delta, OR 1.09, 95%CI 1.01-1.16 in Omicron), number of days spent in bed (OR 1.13, 95%CI 1.02-1.33 in Origin/Alpha, OR 1.23, 95%CI 1.00-1.59 in Delta, OR 1.12, 95%CI 1.03-1.22 in Omicron), and illness duration (OR 1.01, 95%CI 1.00-1.04 in Origin/Alpha, OR 1.01, 95%CI 1.00-1.03 in Delta, OR 1.01, 95%CI 1.00-1.02 in Omicron) were related to healthcare utilization for all variants. Number of days in bed (OR 1.12, 95%CI 1.01-1.27), illness duration (OR 1.01, 95%CI 1.00-1.02), and hours of work missed (OR 2.24, 95%CI 1.11-4.74) were positively associated with healthcare utilization during Omicron reinfection. CONCLUSION The main factors associated with healthcare utilization for SARS-CoV-2 infection were symptom severity and duration. Practices and therapeutics aimed at decreasing these factors would be most helpful in easing the burden on health systems.
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Affiliation(s)
- Patrick Rivers
- College of Medicine, University of Arizona, Tucson, USA.
- Department of Family and Community Medicine, University of Arizona, 655 N. Alvernon Way, Tucson, AZ, 85712, USA.
| | - Krystal Jovel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Ferris Ramadan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | | | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Karen Lutrick
- College of Medicine, University of Arizona, Tucson, USA
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5
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Quirk GE, Schoenle MV, Peyton KL, Uhrlaub JL, Lau B, Burgess JL, Ellingson K, Beitel S, Romine J, Lutrick K, Fowlkes A, Britton A, Tyner HL, Caban-Martinez AJ, Naleway A, Gaglani M, Yoon S, Edwards L, Olsho L, Dake M, LaFleur BJ, Nikolich JŽ, Sprissler R, Worobey M, Bhattacharya D. Determinants of de novo B cell responses to drifted epitopes in post-vaccination SARS-CoV-2 infections. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.12.23295384. [PMID: 37745498 PMCID: PMC10516057 DOI: 10.1101/2023.09.12.23295384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Vaccine-induced immunity may impact subsequent de novo responses to drifted epitopes in SARS-CoV-2 variants, but this has been difficult to quantify due to the challenges in recruiting unvaccinated control groups whose first exposure to SARS-CoV-2 is a primary infection. Through local, statewide, and national SARS-CoV-2 testing programs, we were able to recruit cohorts of individuals who had recovered from either primary or post-vaccination infections by either the Delta or Omicron BA.1 variants. Regardless of variant, we observed greater Spike-specific and neutralizing antibody responses in post-vaccination infections than in those who were infected without prior vaccination. Through analysis of variant-specific memory B cells as markers of de novo responses, we observed that Delta and Omicron BA.1 infections led to a marked shift in immunodominance in which some drifted epitopes elicited minimal responses, even in primary infections. Prior immunity through vaccination had a small negative impact on these de novo responses, but this did not correlate with cross-reactive memory B cells, arguing against competitive inhibition of naïve B cells. We conclude that dampened de novo B cell responses against drifted epitopes are mostly a function of altered immunodominance hierarchies that are apparent even in primary infections, with a more modest contribution from pre-existing immunity, perhaps due to accelerated antigen clearance.
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Affiliation(s)
- Grace E Quirk
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - Marta V Schoenle
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Kameron L Peyton
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jennifer L Uhrlaub
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Branden Lau
- University of Arizona Genomics Core and the Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Katherine Ellingson
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - James Romine
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Karen Lutrick
- College of Medicine-Tucson, University of Arizona, Tucson, Arizona, USA
| | - Ashley Fowlkes
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amadea Britton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harmony L Tyner
- St. Luke's Regional Health Care System, Duluth, Minnesota, USA
| | | | - Allison Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health and Texas A&M University College of Medicine, Temple, Texas, USA
| | - Sarang Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | | | - Michael Dake
- Office of the Senior Vice-President for Health Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Janko Ž Nikolich
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- University of Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Ryan Sprissler
- University of Arizona Genomics Core and the Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ, USA
| | - Michael Worobey
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
| | - Deepta Bhattacharya
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
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6
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Lyski ZL, Porter C, Uhrlaub JL, Ellingson KD, Jeddy Z, Gwynn L, Rivers P, Sprissler R, Hegmann KT, Coughlin M, Fowlkes A, Hollister J, LeClair L, Mak J, Beitel SC, Fuller S, Grant L, Newes-Adeyi G, Yoo YM, Olsho L, Burgess JL, Caban-Martinez A, Yoon S, Britton A, Gaglani M, Lutrick K. Humoral Immune Response to Messenger RNA Coronavirus Disease 2019 Vaccination Among Children Aged 5-11 Years in a Multisite Prospective Cohort Study, September 2021-September 2022. Open Forum Infect Dis 2023; 10:ofad431. [PMID: 37663086 PMCID: PMC10468733 DOI: 10.1093/ofid/ofad431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background The PROTECT study is a longitudinal cohort study initiated in July 2021 with weekly testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 4 states: Arizona, Florida, exas, and Utah. This study aims to examine vaccine-elicited antibody response against postvaccination SARS-CoV-2 infections. Methods Children aged 5-11 years had serum collected 14-59 days after their second dose of monovalent Pfizer-BioNTech coronavirus disease 2019 messenger RNA vaccine. Vaccine-elicited antibodies were measured using the area under the curve (AUC) and end-point titer using enzyme-linked immunosorbent assay (receptor-binding domain [RBD] and S2) and surrogate neutralization assays against ancestral (WA1) and Omicron (BA.2). Results 79 vaccinated participants (33 [41.7%] female; median age, 8.8 years [standard deviation, 1.9 years]), 48 (60.8%) were from Tucson, Arizona; 64 (81.0%) were non-Hispanic white; 63 (80.8%) attended school in person; 68 (86.1%) did not have any chronic conditions; and 47 (59.5%) were infected after vaccination. Uninfected children had higher AUCs against WA1 (P = .009) and Omicron (P = .02). The geometric mean and surrogate neutralization titer above the limit of detection was 346.0 for WA1 and 39.7 for Omicron, an 8.7-fold decrease (P < .001). After adjustment of covariates in the WA1-specific model, we observed a 47% reduction in the odds of postvaccination infection for every standard deviation increase in RBD AUC (aOR, 0.53 [95% confidence interval, .29-.97) and a 69% reduction in the odds of infection for every 3-fold increase in RBD end titer (0.31 [.06-1.57]). Conclusions Children with higher antibody levels experienced a lower incidence of postvaccination SARS-CoV-2 infection.
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Affiliation(s)
- Zoe L Lyski
- Immunobiology, College of Medicine–Tucson, University of Arizona, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Cynthia Porter
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer L Uhrlaub
- Immunobiology, College of Medicine–Tucson, University of Arizona, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Katherine D Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Zuha Jeddy
- Abt Associates, Rockville, Maryland, USA
| | - Lisa Gwynn
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Patrick Rivers
- Family and Community Medicine, College of Medicine–Tucson, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Ryan Sprissler
- University of Arizona Genetics Core—Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, Arizona, USA
| | - Kurt T Hegmann
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environmental Health, University of Utah Health, Salt Lake City, Utah, USA
| | - Melissa Coughlin
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Josephine Mak
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shawn C Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Lauren Grant
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Young M Yoo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Sarang Yoon
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environmental Health, University of Utah Health, Salt Lake City, Utah, USA
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University School of Medicine, Temple, Texas, USA
| | - Karen Lutrick
- Family and Community Medicine, College of Medicine–Tucson, University of Arizona Health Sciences, Tucson, Arizona, USA
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7
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Ellingson KD, Hollister J, Porter CJ, Khan SM, Feldstein LR, Naleway AL, Gaglani M, Caban-Martinez AJ, Tyner HL, Lowe AA, Olsho LEW, Meece J, Yoon SK, Mak J, Kuntz JL, Solle NS, Respet K, Baccam Z, Wesley MG, Thiese MS, Yoo YM, Odean MJ, Miiro FN, Pickett SL, Phillips AL, Grant L, Romine JK, Herring MK, Hegmann KT, Lamberte JM, Sokol B, Jovel KS, Thompson MG, Rivers P, Pilishvili T, Lutrick K, Burgess JL, Midgley CM, Fowlkes AL. Risk Factors for Reinfection with SARS-CoV-2 Omicron Variant among Previously Infected Frontline Workers. Emerg Infect Dis 2023; 29:599-604. [PMID: 36703252 PMCID: PMC9973698 DOI: 10.3201/eid2903.221314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.
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Thompson MG, Yoon SK, Naleway AL, Meece J, Fabrizio TP, Caban-Martinez AJ, Burgess JL, Gaglani M, Olsho LEW, Bateman A, Lundgren J, Grant L, Phillips AL, Groom HC, Stefanski E, Solle NS, Ellingson K, Lutrick K, Dunnigan K, Wesley MG, Guenther K, Hunt A, Mak J, Hegmann KT, Kuntz JL, Bissonnette A, Hollister J, Rose S, Morrill TC, Respet K, Fowlkes AL, Thiese MS, Rivers P, Herring MK, Odean MJ, Yoo YM, Brunner M, Bedrick EJ, Fleary DE, Jones JT, Praggastis J, Romine J, Dickerson M, Khan SM, Lamberte JM, Beitel S, Webby RJ, Tyner HL. Association of mRNA Vaccination With Clinical and Virologic Features of COVID-19 Among US Essential and Frontline Workers. JAMA 2022; 328:1523-1533. [PMID: 36255426 PMCID: PMC9579910 DOI: 10.1001/jama.2022.18550] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022]
Abstract
Importance Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance. Objective To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages. Design, Setting, and Participants A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase-polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported. Exposures SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status. Main Outcomes and Measures Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase-polymerase chain reaction testing along with viral viability. Results Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, -6.1 [95% CI, -11.8 to -0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/μL; difference, -1.0 [95% CI, -1.7 to -0.2] for Delta and 2.8 vs 3.5 log10 copies/μL, difference, -1.0 [95% CI, -1.7 to -0.3] for Omicron). Conclusions and Relevance In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.
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Affiliation(s)
- Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | | | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
| | | | | | | | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Holly C Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | | | - Katherine Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Karen Lutrick
- College of Medicine - Tucson, University of Arizona, Tucson
| | | | | | | | - Angela Hunt
- St Luke's Regional Health Care System, Duluth, Minnesota
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | | | - Karley Respet
- St Luke's Regional Health Care System, Duluth, Minnesota
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Patrick Rivers
- College of Medicine - Tucson, University of Arizona, Tucson
| | | | - Marilyn J Odean
- Whiteside Institute for Clinical Research, St Luke's, Duluth, Minnesota
| | - Young M Yoo
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Matthew Brunner
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Edward J Bedrick
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | - John T Jones
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Jenna Praggastis
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - James Romine
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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Lutrick K, Fowlkes A, Rivers P, Herder K, Santibanez TA, LeClair L, Groover K, Lamberte JM, Grant L, Odame-Bamfo L, Ferraris MV, Phillips AL, Sokol B, Lowe AA, Mathenge C, Pubillones FA, Cottam B, McLeland-Wieser H, Jovel KS, Ochoa JS, Mckell J, Berry M, Khan S, Solle NS, Rai RP, Nakayima FM, Newes-Adeyi G, Porter C, Baccam Z, Ellingson KD, Burgess JL, Gaglani M, Gwynn L, Caban-Martinez A, Yoon S. Parental Intentions and Perceptions Toward COVID-19 Vaccination Among Children Aged 4 Months to 4 Years — PROTECT Cohort, Four States, July 2021–May 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1109-1114. [PMID: 36048723 PMCID: PMC9472774 DOI: 10.15585/mmwr.mm7135a2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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10
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Tyner HL, Burgess JL, Grant L, Gaglani M, Kuntz JL, Naleway AL, Thornburg NJ, Caban-Martinez AJ, Yoon SK, Herring MK, Beitel SC, Blanton L, Nikolich-Zugich J, Thiese MS, Pleasants JF, Fowlkes AL, Lutrick K, Dunnigan K, Yoo YM, Rose S, Groom H, Meece J, Wesley MG, Schaefer-Solle N, Louzado-Feliciano P, Edwards LJ, Olsho LEW, Thompson MG. Neutralizing Antibody Response to Pseudotype Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Differs Between mRNA-1273 and BNT162b2 Coronavirus Disease 2019 (COVID-19) Vaccines and by History of SARS-CoV-2 Infection. Clin Infect Dis 2022; 75:e827-e837. [PMID: 34928334 PMCID: PMC8755309 DOI: 10.1093/cid/ciab1038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Data on the development of neutralizing antibodies (nAbs) against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with mRNA COVID-19 vaccines are limited. METHODS From a prospective cohort of 3975 adult essential and frontline workers tested weekly from August 2020 to March 2021 for SARS-CoV-2 infection by reverse transcription-polymerase chain reaction assay irrespective of symptoms, 497 participants had sera drawn after infection (170), vaccination (327), and after both infection and vaccination (50 from the infection population). Serum was collected after infection and each vaccine dose. Serum-neutralizing antibody titers against USA-WA1/2020-spike pseudotype virus were determined by the 50% inhibitory dilution. Geometric mean titers (GMTs) and corresponding fold increases were calculated using t tests and linear mixed-effects models. RESULTS Among 170 unvaccinated participants with SARS-CoV-2 infection, 158 (93%) developed nAbs with a GMT of 1003 (95% confidence interval, 766-1315). Among 139 previously uninfected participants, 138 (99%) developed nAbs after mRNA vaccine dose 2 with a GMT of 3257 (2596-4052). GMT was higher among those receiving mRNA-1273 vaccine (GMT, 4698; 3186-6926) compared with BNT162b2 vaccine (GMT, 2309; 1825-2919). Among 32 participants with prior SARS-CoV-2 infection, GMT was 21 655 (14 766-31 756) after mRNA vaccine dose 1, without further increase after dose 2. CONCLUSIONS A single dose of mRNA vaccine after SARS-CoV-2 infection resulted in the highest observed nAb response. Two doses of mRNA vaccine in previously uninfected participants resulted in higher nAbs to SARS-CoV-2 than after 1 dose of vaccine or SARS-CoV-2 infection alone. nAb response also differed by mRNA vaccine product.
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Affiliation(s)
- Harmony L Tyner
- St. Luke’s Regional Health Care System, Duluth, Minnesota, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Natalie J Thornburg
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Sarang K Yoon
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Shawn C Beitel
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lenee Blanton
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Janko Nikolich-Zugich
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Matthew S Thiese
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Ashley L Fowlkes
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Karen Lutrick
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Young M Yoo
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Spencer Rose
- Baylor Scott and White Health, Temple, Texas, USA
| | - Holly Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Jennifer Meece
- the Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | | | | | | | | | | | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
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11
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High viral loads: what drives fatal cases of COVID-19 in vaccinees? - an autopsy study. Mod Pathol 2022; 35:1013-1021. [PMID: 35365771 PMCID: PMC8974809 DOI: 10.1038/s41379-022-01069-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 01/07/2023]
Abstract
The rate of SARS-CoV-2 infections in vaccinees has become a relevant serious issue. This study aimed to determine the causes of death, histological organ alteration, and viral spread in relation to demographic, clinical-pathological, viral variants, and vaccine types for deceased individuals with proven SARS-CoV-2 infection after vaccination who died between January and November 2021. Twenty-nine consecutively collected cases were analyzed and compared to 141 nonvaccinated control cases. Autopsies were performed on 16 partially and 13 fully vaccinated individuals. Most patients were elderly and suffered from several relevant comorbidities. Real-time RT-PCR (RT-qPCR) identified a significantly increased rate of generalized viral dissemination within organ systems in vaccinated cases versus nonvaccinated cases (45% vs. 16%, respectively; P = 0.008) mainly with Ct-values of higher than 25 in non-respiratory samples. However, vaccinated cases also showed high viral loads, reaching Ct-values below 10, especially in the upper airways and lungs. This was accompanied by high rates of pulmonal bacterial or mycotic superinfections and the occurrence of immunocompromising factors, such as malignancies, immunosuppressive drug intake, or decreased immunoglobulin levels. All these findings were particularly accentuated in partially vaccinated patients compared to fully vaccinated individuals. The virus dissemination observed in our case study may indicate that patients with an impaired immune system have a decreased ability to eliminate the virus. However, the potential role of antibody-dependent enhancement must also be ruled out in future studies. Fatal cases of COVID-19 in vaccinees were rare and often associated with severe comorbidities or other immunosuppressive conditions.
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12
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Burns J, Rivers P, LeClair LB, Jovel KS, Rai RP, Lowe AA, Edwards LJ, Khan SM, Mathenge C, Ferraris M, Kuntz JL, Lamberte JM, Hegmann KT, Odean MJ, McLeland-Wieser H, Beitel S, Odame-Bamfo L, Schaefer Solle N, Mak J, Phillips AL, Sokol BE, Hollister J, Ochoa JS, Grant L, Thiese MS, Jacoby KB, Lutrick K, Pubillones FA, Yoo YM, Rentz Hunt D, Ellingson K, Berry MC, Gerald JK, Lopez J, Gerald LB, Wesley MG, Krupp K, Herring MK, Madhivanan P, Caban-Martinez AJ, Tyner HL, Meece JK, Yoon SK, Fowlkes AL, Naleway AL, Gwynn L, Burgess JL, Thompson MG, Olsho LE, Gaglani M. Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study. JMIR Res Protoc 2022; 11:e37929. [PMID: 35635842 PMCID: PMC9377426 DOI: 10.2196/37929] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2. OBJECTIVE This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years, as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents. METHODS The PROTECT multisite network was initiated in July 2021, which aims to enroll approximately 2305 children across four US locations and collect data over a 2-year surveillance period. The enrollment target was based on prospective power calculations and accounts for expected attrition and nonresponse. Study sites recruit parents and legal guardians of age-eligible children participating in the existing Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (HEROES)-Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and parents/legal guardians' knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self-collected or collected by parents/legal guardians weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza, or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with permission of their parents/legal guardians, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical record (EMR) linkages where available, and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries. RESULTS Data collection began in July 2021 and is expected to continue through the spring of 2023. As of April 13, 2022, 2371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites. CONCLUSIONS As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/37929.
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Affiliation(s)
- Joy Burns
- Abt Associates, Atlanta, GA, United States
| | - Patrick Rivers
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Krystal S Jovel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Ashley A Lowe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Clare Mathenge
- College of Medicine, Texas A&M University, Temple, TX, United States
| | - Maria Ferraris
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Julie Mayo Lamberte
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Marilyn J Odean
- St. Luke's Regional Health Care System, Duluth, MN, United States
- Whiteside Institute for Clinical Research, St. Luke's, Duluth, MN, United States
| | | | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leah Odame-Bamfo
- College of Medicine, Texas A&M University, Temple, TX, United States
| | | | - Josephine Mak
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jezahel S Ochoa
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lauren Grant
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Felipe A Pubillones
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Young M Yoo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Katherine Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Karl Krupp
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Purnima Madhivanan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Harmony L Tyner
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | - Jennifer K Meece
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Ashley L Fowlkes
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Lisa Gwynn
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Mark G Thompson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Manjusha Gaglani
- College of Medicine, Texas A&M University, Temple, TX, United States
- Baylor Scott and White Health, Temple, TX, United States
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Caban-Martinez AJ, Gaglani M, Olsho LEW, Grant L, Schaefer-Solle N, Thompson MG, Burgess JL. COVID-19 Vaccination Perspectives and Illnesses Among Law Enforcement Officers, Firefighters, and Other First Responders in the US, January to September 2021. JAMA Netw Open 2022; 5:e2222640. [PMID: 35852804 PMCID: PMC9297116 DOI: 10.1001/jamanetworkopen.2022.22640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study assesses attitudes toward COVID-19 vaccination and illness burden among vaccinated and unvaccinated law enforcement officers, firefighters, and other first responders in the US.
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Affiliation(s)
- Alberto J. Caban-Martinez
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple
| | | | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Natasha Schaefer-Solle
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Mark G. Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
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14
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Veguilla V, Fowlkes AL, Bissonnette A, Beitel S, Gaglani M, Porucznik CA, Stockwell MS, Tyner HL, Naleway AL, Yoon SK, Caban-Martinez AJ, Wesley MG, Duque J, Jeddy Z, Stanford JB, Daugherty M, Dixon A, Burgess JL, Odean M, Groom HC, Phillips AL, Schaefer-Solle N, Mistry P, Rolfes MA, Thompson M, Dawood FS, Meece J. Detection and Stability of SARS-CoV-2 in Three Self-Collected Specimen Types: Flocked Midturbinate Swab (MTS) in Viral Transport Media, Foam MTS, and Saliva. Microbiol Spectr 2022; 10:e0103322. [PMID: 35665629 PMCID: PMC9241800 DOI: 10.1128/spectrum.01033-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
Respiratory specimen collection materials shortages hampers severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We compared specimen alternatives and evaluated SARS-CoV-2 RNA stability under simulated shipping conditions. We compared concordance of RT-PCR detection of SARS-CoV-2 from flocked midturbinate swabs (MTS) in viral transport media (VTM), foam MTS without VTM, and saliva. Specimens were collected between August 2020 and April 2021 from three prospective cohorts. We compared RT-PCR cycle quantification (Cq) for Spike (S), Nucleocapsid (N), and the Open Reading Frame 1ab (ORF) genes for flocked MTS and saliva specimens tested before and after exposure to a range of storage temperatures (4-30°C) and times (2, 3, and 7 days). Of 1,900 illnesses with ≥2 specimen types tested, 335 (18%) had SARS-CoV-2 detected in ≥1 specimen; 304 (91%) were concordant across specimen types. Among illnesses with SARS-CoV-2 detection, 97% (95% confidence interval [CI]: 94-98%) were positive on flocked MTS, 99% (95% CI: 97-100%) on saliva, and 89% (95% CI: 84-93%) on foam MTS. SARS-CoV-2 RNA was detected in flocked MTS and saliva stored up to 30°C for 7 days. All specimen types provided highly concordant SARS-CoV-2 results. These findings support a range of viable options for specimen types, collection, and transport methods that may facilitate SARS-CoV-2 testing during supply and personnel shortages. IMPORTANCE Findings from this analysis indicate that (1) self-collection of flocked and foam MTS and saliva samples is feasible in both adults and children, (2) foam MTS with VTM and saliva are both viable and reasonable alternatives to traditional flocked MTS in VTM for SARS-CoV-2 detection, and (3) these sample types may be stored and transported at ambient temperatures for up to 7 days without compromising sample quality. These findings support methods of sample collection for SARS-CoV-2 detection that may facilitate widespread community testing in the setting of supply and personnel shortages during the current pandemic.
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Affiliation(s)
- Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Adam Bissonnette
- Integrated Research & Development Laboratory, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Christina A. Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Allison L. Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Sarang K. Yoon
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | - Jazmin Duque
- Abt Associates, Inc., Cambridge, Massachusetts, USA
| | - Zuha Jeddy
- Abt Associates, Inc., Cambridge, Massachusetts, USA
| | - Joseph B. Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Ashton Dixon
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Marilyn Odean
- St. Luke’s Regional Health Care System, Duluth, Minnesota, USA
- The Whiteside Institute for Clinical Research, Duluth, Minnesota, USA
| | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Andrew L. Phillips
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Mark Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jennifer Meece
- Integrated Research & Development Laboratory, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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15
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Li ZN, Liu F, Jefferson S, Horner L, Carney P, Johnson MDL, King JP, Martin ET, Zimmerman RK, Wernli K, Gaglani M, Thompson M, Flannery B, Stevens J, Tumpey T, Levine MZ. Multiplex Detection of Antibody Landscapes to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/Influenza/Common Human Coronaviruses Following Vaccination or Infection With SARS-CoV-2 and Influenza. Clin Infect Dis 2022; 75:S271-S284. [PMID: 35684961 PMCID: PMC9214136 DOI: 10.1093/cid/ciac472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza viruses continue to co-circulate, representing 2 major public health threats from respiratory infections with similar clinical presentations. SARS-CoV-2 and influenza vaccines can also now be co-administered. However, data on antibody responses to SARS-CoV-2 and influenza coinfection and vaccine co-administration remain limited. METHODS We developed a 41-plex antibody immunity assay that can simultaneously characterize antibody landscapes to SARS-CoV-2/influenza/common human coronaviruses. We analyzed sera from 840 individuals (11-93 years), including sera from reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2-positive (n = 218) and -negative (n = 120) cases, paired sera from SARS-CoV-2 vaccination (n = 29) and infection (n = 11), and paired sera from influenza vaccination (n = 56) and RT-PCR-confirmed influenza infection (n = 158) cases. Last, we analyzed sera collected from 377 individuals who exhibited acute respiratory illness (ARI) in 2020. RESULTS This 41-plex assay has high sensitivity and specificity in detecting SARS-CoV-2 infections. It differentiated SARS-CoV-2 vaccination (antibody responses only to spike protein) from infection (antibody responses to both spike and nucleoprotein). No cross-reactive antibodies were induced to SARS-CoV-2 from influenza vaccination and infection, and vice versa, suggesting no interaction between SARS-CoV-2 and influenza antibody responses. However, cross-reactive antibodies were detected between spike proteins of SARS-CoV-2 and common human coronaviruses that were removed by serum adsorption. Among 377 individuals who exhibited ARI in 2020, 129 were influenza positive; none had serological evidence of SARS-CoV-2/influenza coinfections. CONCLUSIONS Multiplex detection of antibody landscapes can provide in-depth analysis of the antibody protective immunity to SARS-CoV-2 in the context of other respiratory viruses, including influenza.
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Affiliation(s)
- Zhu-Nan Li
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Feng Liu
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Stacie Jefferson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Lauren Horner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Paul Carney
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Michael D. L. Johnson
- Department of Immunobiology, BIO5 Institute, Valley Fever Center for Excellence, and Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Jennifer P King
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Richard K Zimmerman
- University of Pittsburgh, Schools of Health Sciences, Pittsburgh, Pennsylvania, USA
| | - Karen Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas. USA,Texas A&M University University College of Medicine, Temple, Texas, USA
| | - Mark Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - James Stevens
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Terrence Tumpey
- Influenza Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Min Z. Levine
- Corresponding author: Min Z Levine, PhD Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329. , Tel: 404-639-3504
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16
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Jergović M, Coplen CP, Uhrlaub JL, Beitel SC, Burgess JL, Lutrick K, Ellingson KD, Watanabe M, Nikolich-Žugich J. Cutting Edge: T Cell Responses to B.1.1.529 (Omicron) SARS-CoV-2 Variant Induced by COVID-19 Infection and/or mRNA Vaccination Are Largely Preserved. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:2461-2465. [PMID: 35562119 PMCID: PMC9179171 DOI: 10.4049/jimmunol.2200175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/30/2022] [Indexed: 12/31/2022]
Abstract
Several studies have demonstrated that the SARS-CoV-2 variant-of-concern B.1.1.529 (Omicron) exhibits a high degree of escape from Ab neutralization. Therefore, it is critical to determine how well the second line of adaptive immunity, T cell memory, performs against Omicron. To this purpose, we analyzed a human cohort (n = 327 subjects) of two- or three-dose mRNA vaccine recipients and COVID-19 postinfection subjects. We report that T cell responses against Omicron were largely preserved. IFN-γ-producing T cell responses remained equivalent to the response against the ancestral strain (WA1/2020), with some (∼20%) loss in IL-2 single or IL-2+IFN-γ+ polyfunctional responses. Three-dose vaccinated participants had similar responses to Omicron relative to post-COVID-19 participants and exhibited responses significantly higher than those receiving two mRNA vaccine doses. These results provide further evidence that a three-dose vaccine regimen benefits the induction of optimal functional T cell immune memory.
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Affiliation(s)
- Mladen Jergović
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ
- University of Arizona Center on Aging, University of Arizona, College of Medicine-Tucson, Tucson, AZ
| | - Christopher P Coplen
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ
- University of Arizona Center on Aging, University of Arizona, College of Medicine-Tucson, Tucson, AZ
| | - Jennifer L Uhrlaub
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ
- University of Arizona Center on Aging, University of Arizona, College of Medicine-Tucson, Tucson, AZ
| | - Shawn C Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ; and
| | - Karen Lutrick
- Department of Family and Community Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ
| | | | - Makiko Watanabe
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ
- University of Arizona Center on Aging, University of Arizona, College of Medicine-Tucson, Tucson, AZ
| | - Janko Nikolich-Žugich
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ;
- University of Arizona Center on Aging, University of Arizona, College of Medicine-Tucson, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ; and
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17
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Yoon SK, Hegmann KT, Thiese MS, Burgess JL, Ellingson K, Lutrick K, Olsho LEW, Edwards LJ, Sokol B, Caban-Martinez AJ, Schaefer-Solle N, Jones JM, Tyner H, Hunt A, Respet K, Gaglani M, Dunnigan K, Rose S, Naleway A, Groom H, Kuntz J, Fowlkes AL, Thompson MG, Yoo YM. Protection with a Third Dose of mRNA Vaccine against SARS-CoV-2 Variants in Frontline Workers. N Engl J Med 2022; 386:1855-1857. [PMID: 35385628 PMCID: PMC9006784 DOI: 10.1056/nejmc2201821] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Hunt
- St. Luke's Regional Health Care System, Duluth, MN
| | | | | | | | | | | | | | | | | | | | - Young M Yoo
- Centers for Disease Control and Prevention, Atlanta, GA
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18
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Naleway AL, Grant L, Caban‐Martinez AJ, Wesley MG, Burgess JL, Groover K, Gaglani M, Yoon SK, Tyner HL, Meece J, Kuntz JL, Yoo YM, Schaefer‐Solle N, Olsho LEW, Gerald JK, Rose S, Thiese MS, Lundgren J, Groom HC, Mak J, Louzado Feliciano P, Edwards LJ, Lutrick K, Dunnigan K, Phillips AL, Lamberte JM, Noriega R, Sokol BE, Odean M, Ellingson KD, Smith M, Hegmann KT, Respet K, Dickerson M, Cruz A, Fleary DE, Murthy K, Hunt A, Azziz‐Baumgartner E, Gallimore‐Wilson D, Harder JA, Odame‐Bamfo L, Viergutz J, Arvay M, Jones JM, Mistry P, Thompson MG, Fowlkes AL. Incidence of SARS-CoV-2 infection among COVID-19 vaccinated and unvaccinated healthcare personnel, first responders, and other essential and frontline workers: Eight US locations, January-September 2021. Influenza Other Respir Viruses 2022; 16:585-593. [PMID: 35023288 PMCID: PMC8983896 DOI: 10.1111/irv.12956] [Citation(s) in RCA: 2] [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] [Received: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2. METHODS We analyzed data from a prospective frontline worker cohort to estimate the incidence of COVID-19 by month as well as the association of COVID-19 vaccination, occupation, demographics, physical distancing, and mask use with infection risk. Participants completed baseline and quarterly surveys, and each week self-collected mid-turbinate nasal swabs and reported symptoms. RESULTS Among 1018 unvaccinated and 3531 fully vaccinated workers, the monthly incidence of laboratory-confirmed SARS-CoV-2 infection in January 2021 was 13.9 (95% confidence interval [CI]: 10.4-17.4), declining to 0.5 (95% CI -0.4-1.4) per 1000 person-weeks in June. By September 2021, when the Delta variant predominated, incidence had once again risen to 13.6 (95% CI 7.8-19.4) per 1000 person-weeks. In contrast, there was no reportable incidence among fully vaccinated participants at the end of January 2021, and incidence remained low until September 2021 when it rose modestly to 4.1 (95% CI 1.9-3.8) per 1000. Below average facemask use was associated with a higher risk of infection for unvaccinated participants during exposure to persons who may have COVID-19 and vaccinated participants during hours in the community. CONCLUSIONS COVID-19 vaccination was significantly associated with a lower risk of SARS-CoV-2 infection despite Delta variant predominance. Our data demonstrate the added protective benefit of facemask use among both unvaccinated and vaccinated frontline workers.
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Affiliation(s)
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | | | - Manjusha Gaglani
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Sarang K. Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Jennifer Meece
- Marshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Jennifer L. Kuntz
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Young M. Yoo
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Joe K. Gerald
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Spencer Rose
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Kayan Dunnigan
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Andrew L. Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Roger Noriega
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Marilyn Odean
- Whiteside Institute for Clinical Research, St. Luke'sDuluthMinnesotaUSA
| | | | | | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Karley Respet
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Alexandra Cruz
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | | | - Angela Hunt
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | | | | | | | | | | | - Melissa Arvay
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - John M. Jones
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Mark G. Thompson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Ashley L. Fowlkes
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
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19
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Lutrick K, Groom H, Fowlkes AL, Groover KD, Gaglani M, Rivers P, Naleway AL, Nguyen K, Herring M, Dunnigan K, Phillips A, Parker J, Mayo Lamberte J, Prather K, Thiese MS, Baccam Z, Tyner H, Yoon S. COVID-19 vaccine perceptions and uptake in a national prospective cohort of essential workers. Vaccine 2022; 40:494-502. [PMID: 34906392 PMCID: PMC8665770 DOI: 10.1016/j.vaccine.2021.11.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In a multi-center prospective cohort of essential workers, we assessed knowledge, attitudes, and practices (KAP) by vaccine intention, prior SARS-CoV-2 positivity, and occupation, and their impact on vaccine uptake over time. METHODS Initiated in July 2020, the HEROES-RECOVER cohort provided socio-demographics and COVID-19 vaccination data. Using two follow-up surveys approximately three months apart, COVID-19 vaccine KAP, intention, and receipt was collected; the first survey categorized participants as reluctant, reachable, or endorser. RESULTS A total of 4,803 participants were included in the analysis. Most (70%) were vaccine endorsers, 16% were reachable, and 14% were reluctant. By May 2021, 77% had received at least one vaccine dose. KAP responses strongly predicted vaccine uptake, particularly positive attitudes about safety (aOR = 5.46, 95% CI: 1.4-20.8) and effectiveness (aOR = 5.0, 95% CI: 1.3-19.1). Participants' with prior SARS-CoV-2 infection were 22% less likely to believe the COVID-19 vaccine was effective compared with uninfected participants (aOR 0.78, 95% CI: 0.64-0.96). This was even more pronounced in first responders compared with other occupations, with first responders 42% less likely to believe in COVID-19 vaccine effectiveness (aOR = 0.58, 95% CI 0.40-0.84). Between administrations of the two surveys, 25% of reluctant, 56% reachable, and 83% of endorser groups received the COVID-19 vaccine. The reachable group had large increases in positive responses for questions about vaccine safety (10% of vaccinated, 34% of unvaccinated), and vaccine effectiveness (12% of vaccinated, 27% of unvaccinated). DISCUSSION Our study demonstrates attitudes associated with COVID-19 vaccine uptake and a positive shift in attitudes over time. First responders, despite potential high exposure to SARS-CoV-2, and participants with a history of SARS-CoV-2 infection were more vaccine reluctant. CONCLUSIONS Perceptions of the COVID-19 vaccine can shift over time. Targeting messages about the vaccine's safety and effectiveness in reducing SARS-CoV-2 virus infection and illness severity may increase vaccine uptake for reluctant and reachable participants.
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Key Words
- fda, u.s. food and drug administration
- cdc, centers for disease control and prevention
- eua, emergency use authorization
- kap, knowledge, attitudes, and practices
- heroes, arizona healthcare, emergency response and other essential workers surveillance recover study and research on the epidemiology of sars-cov-2 in essential response personnel
- h-r, heroes-recover
- hcp, health care personnel
- fw, frontline workers
- ppe, personal protective equipment
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Affiliation(s)
- Karen Lutrick
- Family & Community Medicine, College of Medicine - Tucson, University of Arizona, Tucson, AZ, 655 N Alvernon Way, Suite 228, Tucson, AZ, 85721, United States.
| | - Holly Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States.
| | - Ashley L Fowlkes
- Epidemiology Prevention Branch, Influenza Division, Centers of Disease Control and Prevention, Atlanta, GA, United States.
| | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, United States.
| | - Patrick Rivers
- Family & Community Medicine, College of Medicine - Tucson, University of Arizona, Tucson, AZ, United States.
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States.
| | - Kimberly Nguyen
- Assessment Branch, Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | | | - Kayan Dunnigan
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, United States.
| | - Andrew Phillips
- Occupational and Environmental Health, School of Medicine, University of Utah, Salt Lake City, UT, United States.
| | - Joel Parker
- Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, United States.
| | - Julie Mayo Lamberte
- Epidemiology Prevention Branch, Influenza Division, Centers of Disease Control and Prevention, Atlanta, GA, United States.
| | | | - Matthew S Thiese
- Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, United States.
| | - Zoe Baccam
- St. Luke's Infectious Disease Associates, St. Luke's Hospital, Duluth, MN, United States.
| | - Harmony Tyner
- Occupational and Environmental Health, School of Medicine, University of Utah, Salt Lake City, UT, United States.
| | - Sarang Yoon
- St. Luke's Infectious Disease Associates, St. Luke's Hospital, Duluth, MN, United States.
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20
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Xiao Y, Lidsky PV, Shirogane Y, Aviner R, Wu CT, Li W, Zheng W, Talbot D, Catching A, Doitsh G, Su W, Gekko CE, Nayak A, Ernst JD, Brodsky L, Brodsky E, Rousseau E, Capponi S, Bianco S, Nakamura R, Jackson PK, Frydman J, Andino R. A defective viral genome strategy elicits broad protective immunity against respiratory viruses. Cell 2021; 184:6037-6051.e14. [PMID: 34852237 PMCID: PMC8598942 DOI: 10.1016/j.cell.2021.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/18/2022]
Abstract
RNA viruses generate defective viral genomes (DVGs) that can interfere with replication of the parental wild-type virus. To examine their therapeutic potential, we created a DVG by deleting the capsid-coding region of poliovirus. Strikingly, intraperitoneal or intranasal administration of this genome, which we termed eTIP1, elicits an antiviral response, inhibits replication, and protects mice from several RNA viruses, including enteroviruses, influenza, and SARS-CoV-2. While eTIP1 replication following intranasal administration is limited to the nasal cavity, its antiviral action extends non-cell-autonomously to the lungs. eTIP1 broad-spectrum antiviral effects are mediated by both local and distal type I interferon responses. Importantly, while a single eTIP1 dose protects animals from SARS-CoV-2 infection, it also stimulates production of SARS-CoV-2 neutralizing antibodies that afford long-lasting protection from SARS-CoV-2 reinfection. Thus, eTIP1 is a safe and effective broad-spectrum antiviral generating short- and long-term protection against SARS-CoV-2 and other respiratory infections in animal models.
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Affiliation(s)
- Yinghong Xiao
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Peter V Lidsky
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Yuta Shirogane
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA; Department of Virology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | - Ranen Aviner
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA; Department of Biology and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Chien-Ting Wu
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University, Stanford, CA 94305, USA
| | - Weiyi Li
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Weihao Zheng
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Dale Talbot
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA; Aleph Therapeutics, Inc., Stanford, CA 94305, USA
| | - Adam Catching
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Gilad Doitsh
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Weiheng Su
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA; School of Life Sciences, Jilin University, Changchun, China
| | - Colby E Gekko
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Arabinda Nayak
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA; Department of Biology and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Joel D Ernst
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Leonid Brodsky
- Tauber Bioinformatics Research Center and Department of Evolutionary & Environmental Biology, University of Haifa, Mount Carmel, Haifa 31905, Israel
| | | | - Elsa Rousseau
- Functional Genomics and Cellular Engineering, AI and Cognitive Software, IBM Almaden Research Center, San Jose, CA 95120, USA
| | - Sara Capponi
- Functional Genomics and Cellular Engineering, AI and Cognitive Software, IBM Almaden Research Center, San Jose, CA 95120, USA
| | - Simone Bianco
- Functional Genomics and Cellular Engineering, AI and Cognitive Software, IBM Almaden Research Center, San Jose, CA 95120, USA
| | | | - Peter K Jackson
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University, Stanford, CA 94305, USA
| | - Judith Frydman
- Department of Biology and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Raul Andino
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94158, USA.
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21
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Ellingson KD, Gerald JK, Sun X, Hollister J, Lutrick K, Parker J, Rivers P, Beitel SC, Baccam Z, Lamberte JM, Grant L, Kim E, Bhattarai R, Komatsu K, Meece J, Kutty PK, Thompson MG, Burgess JL. Incidence of SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential Workers During a Prevaccination COVID-19 Surge in Arizona. JAMA HEALTH FORUM 2021; 2:e213318. [PMID: 35977166 PMCID: PMC8727035 DOI: 10.1001/jamahealthforum.2021.3318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Question Before COVID-19 vaccine availability, how comparable were rates of SARS-CoV-2 infection among health care personnel, first responders, and other essential workers? Findings This prospective cohort study of 1766 unvaccinated seronegative Arizona workers using self-administered reverse-transcription polymerase chain reaction testing found that first responders had a significantly higher incidence of SARS-CoV-2 infection than health care personnel, even after controlling for sociodemographic characteristics and underlying health and exposure indicators. Meaning The findings of this cohort study indicate that first responders warrant greater public health attention in context of the COVID-19 pandemic given their higher rates of SARS-CoV-2 infection. Importance Understanding the relative risk of SARS-CoV-2 infection across occupations can inform guidance to protect workers and communities. Less is known about infection risk for first responders and other essential workers than for health care personnel. Objective To compare the prevaccination incidence of SARS-CoV-2 infection among first responders and other essential workers with incidence among health care personnel. Design, Setting, and Participants This was a prospective cohort study of health care personnel, first responders, and other essential workers in Arizona from July 20, 2020, to March 14, 2021. Participants were seronegative at enrollment, had frequent direct contact with others at work, worked at least 20 hours per week, and submitted weekly nasal swab specimens for real-time reverse transcriptase polymerase chain reaction analysis. Data analyses were performed from April 19, 2021, to June 4, 2021. Exposures Occupation was the primary exposure of interest. Confounders assessed were sociodemographic characteristics, health status, community exposure, and work exposure. Main Outcomes and Measures Crude incidence of SARS-CoV-2 infection was defined as the sum of first positive SARS-CoV-2 infections in participants divided by person-weeks at risk. Negative binomial regression was used to model SARS-CoV-2 infection by occupation to estimate unadjusted and adjusted incidence rate ratios (IRRs). The least absolute shrinkage and selection operator (LASSO) method was used to generate a parsimonious multivariable model. Results The study cohort comprised 1766 Arizona workers (mean age [SD], 43.8 [11.1] years; 1093 [61.9%] female; 401 [22.7%] were Hispanic and 1530 [86.6%] were White individuals) of whom 44.2% were health care personnel, 22.4% first responders, and 33.4% other essential workers. The cohort was followed up for 23 393 person-weeks. Crude incidence of SARS-CoV-2 infection was 6.7, 13.2, and 7.4 per 1000 person-weeks at risk for health care personnel, first responders, and other essential workers, respectively. In unadjusted models, first responders had twice the incidence of infection as health care personnel (IRRs, 2.01; 95% CI, 1.44-2.79). While attenuated, this risk remained elevated in adjusted LASSO-optimized models (IRR, 1.60; 95% CI, 1.07-2.38). Risk of infection among other essential workers was no different than for health care personnel in unadjusted or adjusted models. Conclusions and Relevance This prospective cohort study found that first responders had a higher incidence of SARS-CoV-2 infection than health care personnel, even after adjusting for potential confounding factors. Given their frequent contact with each other and with the public and their high rates of SARS-CoV-2 infection, the safety challenges for first responders warrant greater public health attention and research.
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Affiliation(s)
- Katherine D. Ellingson
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Joe K. Gerald
- Department of Community, Environment and Policy, University of Arizona, Tucson
| | - Xiaoxiao Sun
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - James Hollister
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Karen Lutrick
- Department of Family and Community Medicine, University of Arizona, Tucson
| | - Joel Parker
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Patrick Rivers
- Department of Health Promotion Sciences, University of Arizona, Tucson
| | - Shawn C. Beitel
- Department of Community, Environment and Policy, University of Arizona, Tucson
| | - Zoe Baccam
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | | | - Lauren Grant
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Preeta K. Kutty
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jefferey L. Burgess
- Department of Community, Environment and Policy, University of Arizona, Tucson
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22
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Fowlkes A, Gaglani M, Groover K, Thiese MS, Tyner H, Ellingson K. Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance - Eight U.S. Locations, December 2020-August 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1167-1169. [PMID: 34437521 PMCID: PMC8389394 DOI: 10.15585/mmwr.mm7034e4] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
During December 14, 2020-April 10, 2021, data from the HEROES-RECOVER Cohorts,* a network of prospective cohorts among frontline workers, showed that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines were approximately 90% effective in preventing symptomatic and asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, in real-world conditions (1,2). This report updates vaccine effectiveness (VE) estimates including all COVID-19 vaccines available through August 14, 2021, and examines whether VE differs for adults with increasing time since completion of all recommended vaccine doses. VE before and during SARS-CoV-2 B.1.617.2 (Delta) variant predominance, which coincided with an increase in reported COVID-19 vaccine breakthrough infections, were compared (3,4).
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Affiliation(s)
| | | | | | | | | | | | - HEROES-RECOVER Cohorts
- CDC COVID-19 Response Team; Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas; Abt Associates, Inc., Rockville, Maryland; University of Utah, Salt Lake City, Utah; St. Luke’s Regional Health Care System, Duluth, Minnesota; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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