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Favre G, Richardson JL, Moore A, Geissbühler Y, Jehl V, Oliver A, Shechtman S, Diav-Citrin O, Berlin M, De Haan T, Baud D, Panchaud A, Mor A, Sabidó M, de Souza S, Chambers C, van Rijt-Weetink YRJ, van Puijenbroek EP, Yates LM, Girardin F, Stellfeld M, Winterfeld U. Improving Data Collection in Pregnancy Safety Studies: Towards Standardisation of Data Elements in Pregnancy Reports from Public and Private Partners, A Contribution from the ConcePTION Project. Drug Saf 2024; 47:227-236. [PMID: 38114757 PMCID: PMC10874316 DOI: 10.1007/s40264-023-01384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION AND OBJECTIVE The ConcePTION project aims to improve the way medication use during pregnancy is studied. This includes exploring the possibility of developing a distributed data processing and analysis infrastructure using a common data model that could form a foundational platform for future surveillance and research. A prerequisite would be that data from various data access providers (DAPs) can be harmonised according to an agreed set of standard rules concerning the structure and content of the data. To do so, a reference framework of core data elements (CDEs) recommended for primary data studies on drug safety during pregnancy was previously developed. The aim of this study was to assess the ability of several public and private DAPs using different primary data sources focusing on multiple sclerosis, as a pilot, to map their respective data variables and definitions with the CDE recommendations framework. METHODS Four pregnancy registries (Gilenya, Novartis; Aubagio, Sanofi; the Organization of Teratology Information Specialists [OTIS]; Aubagio, Sanofi; the Dutch Pregnancy Drug Register, Lareb), two enhanced pharmacovigilance programmes (Gilenya PRIM, Novartis; MAPLE-MS, Merck Healthcare KGaA) and four Teratology Information Services (UK TIS, Jerusalem TIS, Zerifin TIS, Swiss TIS) participated in the study. The ConcePTION primary data source CDE includes 51 items covering administrative functions, the description of pregnancy, maternal medical history, maternal illnesses arising in pregnancy, delivery details, and pregnancy and infant outcomes. For each variable in the CDE, the DAPs identified whether their variables were: identical to the one mentioned in the CDE; derived; similar but with a divergent definition; or not available. RESULTS The majority of the DAP data variables were either directly taken (85%, n = 305/357, range 73-94% between DAPs) or derived by combining different variables (12%, n = 42/357, range 0-24% between DAPs) to conform to the CDE variables and definitions. For very few of the DAP variables, alignment with the CDE items was not possible, either because of divergent definitions (1%, n = 3/357, range 0-2% between DAPs) or because the variables were not available (2%, n = 7/357, range 0-4% between DAPs). CONCLUSIONS Data access providers participating in this study presented a very high proportion of variables matching the CDE items, indicating that alignment of definitions and harmonisation of data analysis by different stakeholders to accelerate and strengthen pregnancy pharmacovigilance safety data analyses could be feasible.
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Affiliation(s)
- Guillaume Favre
- Swiss Teratology Information Service and Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jonathan L Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle upon Tyne, UK
| | | | | | | | - Alison Oliver
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Svetlana Shechtman
- The Israeli Teratology Information Service, Ministry of Health, Jerusalem, Israel
| | - Orna Diav-Citrin
- The Israeli Teratology Information Service, Ministry of Health, Jerusalem, Israel
| | - Maya Berlin
- Clinical Pharmacology and Toxicology Unit, Drug Consultation Center, Shamir Medical Center (Assaf Harofeh), Affiliated with the Sackler Faculty of Medicine, Zerifin TIS, Tel Aviv University, Tel Aviv, Israel
| | - Tal De Haan
- Clinical Pharmacology and Toxicology Unit, Drug Consultation Center, Shamir Medical Center (Assaf Harofeh), Affiliated with the Sackler Faculty of Medicine, Zerifin TIS, Tel Aviv University, Tel Aviv, Israel
| | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anil Mor
- Epidemiology and Benefit Risk, Sanofi, North York, ON, Canada
| | | | | | - Christina Chambers
- Organization of Teratology Information Specialists (OTIS), University of California San Diego, San Diego, CA, USA
| | | | | | - Laura M Yates
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- KRISP, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - François Girardin
- Swiss Teratology Information Service and Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Ursula Winterfeld
- Swiss Teratology Information Service and Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Sengasai C, Chokephaibulkit K, Plipat N, Wongsiridej P. Serial head circumference measurements should be used to classify congenital microcephaly. BMC Pediatr 2023; 23:490. [PMID: 37759153 PMCID: PMC10523790 DOI: 10.1186/s12887-023-04315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Measuring the maximum occipitofrontal circumference only once at birth or within 24 h after birth may lead to misclassifications of microcephaly. This study compared the head circumference (HC) of newborns at birth or within 24 h after birth to their third day of life (DOL3) as well as evaluated maternal- and infant-specific factors associated with increased HC by DOL3. METHODS This prospective study included 1131 live births between February and May 2019 with a gestational age > 27 weeks. All newborns had their HC measured at birth or within 24 h after birth as well as on DOL3 before discharge. HC measurements were performed by trained personnel using non-elastic tape measures. The World Health Organization (WHO) and Fenton Growth Charts were used as reference ranges for interpretation of full-term and preterm neonates, respectively. RESULTS Paired sample t-test analyses found a statistically significant increase in HC measured on the DOL3 compared with HCs of the same newborns at birth or within 24 h of birth. The mean HC increase was 0.17 cm (95% confidence interval [0.13, 0.21], P < 0.001). The mean ± standard deviation HC within 24 h of birth and at DOL3 were 33.58 ± 1.53 cm and 33.75 ± 1.37 cm, respectively. Thirty-two newborns had HCs less than the third percentile (< P3) at birth, 25 of which had HC ≥ P3 at DOL3. After adjusting for mode of and presentation at delivery, newborns whose mothers experienced labor pains (β = 0.31, P < 0.001) and were either symmetrically (β = 0.59, P = 0.002) or asymmetrically small-for-gestational age (SGA; β = 0.37, P = 0.03) had significantly increased HC at DOL3. On average, newborns whose mothers experienced labor pain had 0.31 cm increases in HC at DOL3. Symmetrical SGA newborns also had an average 0.59 cm increase in HC at DOL3. Parity and gestational age were not associated with changes in HC. CONCLUSIONS Serial HC measurements on DOL3 or before newborns' discharge is crucial to classifying congenital microcephaly.
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Affiliation(s)
- Chutima Sengasai
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok-Noi District, Bangkok, 10700, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok-Noi District, Bangkok, 10700, Thailand
- Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok-noi District, Bangkok, 10700, Thailand
| | - Nottasorn Plipat
- Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok-noi District, Bangkok, 10700, Thailand
| | - Pimol Wongsiridej
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok-Noi District, Bangkok, 10700, Thailand.
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Mulkey SB, DeBiasi RL. New Insights into Zika in Infants and Children. Trop Med Infect Dis 2022; 7:tropicalmed7080158. [PMID: 36006250 PMCID: PMC9412678 DOI: 10.3390/tropicalmed7080158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
In the original article [...].
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Affiliation(s)
- Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Correspondence: (S.B.M.); (R.L.D.)
| | - Roberta L. DeBiasi
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Division of Pediatric Infectious Diseases, Children’s National Hospital, Washington, DC 20010, USA
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Correspondence: (S.B.M.); (R.L.D.)
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Roth NM, Woodworth KR, Godfred-Cato S, Delaney AM, Olson SM, Nahabedian JF, Reynolds MR, Jones AM, Neelam V, Valencia-Prado M, Delgado-López C, Lee EH, Ellis EM, Lake-Burger H, Tonzel JL, Higgins CA, Chan RL, Tong VT, Gilboa SM, Cragan JD, Honein MA, Moore CA. Identifying possible inaccuracy in reported birth head circumference measurements among infants in the US Zika Pregnancy and Infant Registry. Birth Defects Res 2022; 114:314-318. [PMID: 35332688 PMCID: PMC10391875 DOI: 10.1002/bdr2.1997] [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: 12/23/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The US Zika Pregnancy and Infant Registry (USZPIR) monitors infants born to mothers with confirmed or possible Zika virus infection during pregnancy. The surveillance case definition for Zika-associated birth defects includes microcephaly based on head circumference (HC). METHODS We assessed birth and follow-up data from infants with birth HC measurements <3rd percentile and birthweight ≥10th percentile to determine possible misclassification of microcephaly. We developed a schema informed by literature review and expert opinion to identify possible HC measurement inaccuracy using HC growth velocity and longitudinal HC measurements between 2 and 12 months of age. Two or more HC measurements were required for assessment. Inaccuracy in birth HC measurement was suspected if growth velocity was >3 cm/month in the first 3 months or HC was consistently >25th percentile during follow-up. RESULTS Of 6,799 liveborn infants in USZPIR, 351 (5.2%) had Zika-associated birth defects, of which 111 had birth HC measurements <3rd percentile and birthweight ≥10th percentile. Of 84/111 infants with sufficient follow-up, 38/84 (45%) were classified as having possible inaccuracy of birth HC measurement, 19/84 (23%) had HC ≥3rd percentile on follow-up without meeting criteria for possible inaccuracy, and 27/84 (32%) had continued HC <3rd percentile. After excluding possible inaccuracies, the proportion of infants with Zika-associated birth defects including microcephaly decreased from 5.2% to 4.6%. CONCLUSIONS About one-third of infants in USZPIR with Zika-associated birth defects had only microcephaly, but indications of possible measurement inaccuracy were common. Implementation of this schema in longitudinal studies can reduce misclassification of microcephaly.
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Affiliation(s)
- Nicole M Roth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Augustina M Delaney
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Eagle Global Scientific, LLC, Alpharetta, Georgia, USA
| | - Samantha M Olson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- G2S Corporation, San Antonio, Texas, USA
| | | | - Megan R Reynolds
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Abbey M Jones
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Ellen H Lee
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Esther M Ellis
- US Virgin Islands Department of Health, Christiansted, US Virgin Islands, USA
| | | | | | | | - Ronna L Chan
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet D Cragan
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia A Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Mercado-Reyes M, Gilboa SM, Valencia D, Daza M, Tong VT, Galang RR, Winfield CM, Godfred-Cato S, Benavides M, Villanueva JM, Thomas JD, Daniels J, Zaki S, Reagan-Steiner S, Bhatnagar J, Schiffer J, Steward-Clark E, Ricaldi JN, Osorio J, Sancken CL, Pardo L, Tinker SC, Anderson KN, Rico A, Burkel VK, Hojnacki J, Delahoy MJ, González M, Osorio MB, Moore CA, Honein MA, Ospina Martinez ML. Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016-2018. Trop Med Infect Dis 2021; 6:183. [PMID: 34698287 PMCID: PMC8544689 DOI: 10.3390/tropicalmed6040183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/18/2021] [Accepted: 10/07/2021] [Indexed: 01/16/2023] Open
Abstract
Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May-November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia's existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.
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Affiliation(s)
- Marcela Mercado-Reyes
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Marcela Daza
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Van T. Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Romeo R. Galang
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Christina M. Winfield
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Mónica Benavides
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Julie M. Villanueva
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jennifer D. Thomas
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jonathan Daniels
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sherif Zaki
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sarah Reagan-Steiner
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Julu Bhatnagar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jarad Schiffer
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Evelene Steward-Clark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Jessica N. Ricaldi
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Johana Osorio
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Christina L. Sancken
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Lissethe Pardo
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Kayla N. Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Angelica Rico
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | | | - Jacob Hojnacki
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA;
| | | | - Maritza González
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - May B. Osorio
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Margaret A. Honein
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Martha Lucia Ospina Martinez
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
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