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Rainey JJ, Lin XM, Murphy S, Velazquez-Kronen R, Do T, Hughes C, Harris AM, Maitland A, Gundlapalli AV. Deployment of the National Notifiable Diseases Surveillance System during the 2022-23 mpox outbreak in the United States-Opportunities and challenges with case notifications during public health emergencies. PLoS One 2024; 19:e0300175. [PMID: 38603766 PMCID: PMC11008850 DOI: 10.1371/journal.pone.0300175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/23/2024] [Indexed: 04/13/2024] Open
Abstract
Timely case notifications following the introduction of an uncommon pathogen, such as mpox, are critical for understanding disease transmission and for developing and implementing effective mitigation strategies. When Massachusetts public health officials notified the Centers for Disease Control and Prevention (CDC) about a confirmed orthopoxvirus case on May 17, 2023, which was later confirmed as mpox at CDC, mpox was not a nationally notifiable disease. Because existing processes for new data collections through the National Notifiable Disease Surveillance System were not well suited for implementation during emergency responses at the time of the mpox outbreak, several interim notification approaches were established to capture case data. These interim approaches were successful in generating daily case counts, monitoring disease transmission, and identifying high-risk populations. However, the approaches also required several data collection approvals by the federal government and the Council for State and Territorial Epidemiologists, the use of four different case report forms, and the establishment of complex data management and validation processes involving data element mapping and record-level de-duplication steps. We summarize lessons learned from these interim approaches to inform and improve case notifications during future outbreaks. These lessons reinforce CDC's Data Modernization Initiative to work in close collaboration with state, territorial, and local public health departments to strengthen case-based surveillance prior to the next public health emergency.
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Affiliation(s)
- Jeanette J. Rainey
- Division of Global Health Security, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Xia Michelle Lin
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Sylvia Murphy
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Raquel Velazquez-Kronen
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, United States of America
| | - Tuyen Do
- Office of the Director, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Christine Hughes
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Aaron M. Harris
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Aaron Maitland
- Division of Health Interview Statistics, National Center of Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, United States of America
| | - Adi V. Gundlapalli
- Office of the Director, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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2
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Downie DL, Rao P, David-Ferdon C, Courtney S, Lee JS, Kugley S, MacDonald PDM, Barnes K, Fisher S, Andreadis JL, Chaitram J, Mauldin MR, Salerno RM, Schiffer J, Gundlapalli AV. Literature Review of Pathogen Agnostic Molecular Testing of Clinical Specimens From Difficult-to-Diagnose Patients: Implications for Public Health. Health Secur 2024; 22:93-107. [PMID: 38608237 PMCID: PMC11044852 DOI: 10.1089/hs.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 04/14/2024] Open
Abstract
To better identify emerging or reemerging pathogens in patients with difficult-to-diagnose infections, it is important to improve access to advanced molecular testing methods. This is particularly relevant for cases where conventional microbiologic testing has been unable to detect the pathogen and the patient's specimens test negative. To assess the availability and utility of such testing for human clinical specimens, a literature review of published biomedical literature was conducted. From a corpus of more than 4,000 articles, a set of 34 reports was reviewed in detail for data on where the testing was being performed, types of clinical specimens tested, pathogen agnostic techniques and methods used, and results in terms of potential pathogens identified. This review assessed the frequency of advanced molecular testing, such as metagenomic next generation sequencing that has been applied to clinical specimens for supporting clinicians in caring for difficult-to-diagnose patients. Specimen types tested were from cerebrospinal fluid, respiratory secretions, and other body tissues and fluids. Publications included case reports and series, and there were several that involved clinical trials, surveillance studies, research programs, or outbreak situations. Testing identified both known human pathogens (sometimes in new sites) and previously unknown human pathogens. During this review, there were no apparent coordinated efforts identified to develop regional or national reports on emerging or reemerging pathogens. Therefore, development of a coordinated sentinel surveillance system that applies advanced molecular methods to clinical specimens which are negative by conventional microbiological diagnostic testing would provide a foundation for systematic characterization of emerging and underdiagnosed pathogens and contribute to national biodefense strategy goals.
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Affiliation(s)
- Diane L. Downie
- Diane L. Downie, PhD, MPH, is Deputy Associate Director for Science, Office of Readiness and Response; at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Preetika Rao
- Preetika Rao, MPH, is a Health Scientist; at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Corinne David-Ferdon
- Corinne David-Ferdon, PhD, is Associate Director of Science, Office of Public Health Data, Surveillance, and Technology; at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Sean Courtney
- Sean Courtney, PhD, is a Health Scientist, at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Justin S. Lee
- Justin Lee, DVM, PhD, is a Health Scientist, Division of Global Health Protection; at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Shannon Kugley
- Shannon Kugley, MLIS, is a Research Public Health Analyst; in Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Pia D. M. MacDonald
- Pia D. M. MacDonald, PhD, MPH, is a Senior Infectious Disease Epidemiologist; in Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Keegan Barnes
- Keegan Barnes is a Public Health Analyst; in Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Shelby Fisher
- Shelby Fisher, MPH, is an Epidemiologist; in Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Joanne L. Andreadis
- Joanne L. Andreadis, PhD, is Associate Director for Science, at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Jasmine Chaitram
- Jasmine Chaitram, MPH, is Branch Chief, at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Matthew R. Mauldin
- Matthew R. Mauldin, PhD, is Health Scientists, Office of Readiness and Response; at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Reynolds M. Salerno
- Reynolds M. Salerno, PhD, is Director, Division of Laboratory Systems; at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Jarad Schiffer
- Jarad Schiffer, MS, is Health Scientists, Office of Readiness and Response; at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Adi V. Gundlapalli
- Adi V. Gundlapalli, MD, PhD, is a Senior Advisor, Data Readiness and Response, Office of Public Health Data, Surveillance, and Technology; at the US Centers for Disease Control and Prevention, Atlanta, GA
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3
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Downie DL, Rao P, David-Ferdon C, Courtney S, Lee JS, Quiner C, MacDonald PDM, Barnes K, Fisher S, Andreadis JL, Chaitram J, Mauldin MR, Salerno RM, Schiffer J, Gundlapalli AV. Surveillance for Emerging and Reemerging Pathogens Using Pathogen Agnostic Metagenomic Sequencing in the United States: A Critical Role for Federal Government Agencies. Health Secur 2024; 22:85-92. [PMID: 38574329 PMCID: PMC11044857 DOI: 10.1089/hs.2023.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 04/06/2024] Open
Abstract
The surveillance and identification of emerging, reemerging, and unknown infectious disease pathogens is essential to national public health preparedness and relies on fluidity, coordination, and interconnectivity between public and private pathogen surveillance systems and networks. Developing a national sentinel surveillance network with existing resources and infrastructure could increase efficiency, accelerate the identification of emerging public health threats, and support coordinated intervention strategies that reduce morbidity and mortality. However, implementing and sustaining programs to detect emerging and reemerging pathogens in humans using advanced molecular methods, such as metagenomic sequencing, requires making large investments in testing equipment and developing networks of clinicians, laboratory scientists, and bioinformaticians. In this study, we sought to gain an understanding of how federal government agencies currently support such pathogen agnostic testing of human specimens in the United States. We conducted a landscape analysis of federal agency websites for publicly accessible information on the availability and type of pathogen agnostic testing and details on flow of clinical specimens and data. The website analysis was supplemented by an expert review of results with representatives from the federal agencies. Operating divisions within the US Department of Health and Human Services and the US Department of Veterans Affairs have developed and sustained extensive clinical and research networks to obtain patient specimens and perform metagenomic sequencing. Metagenomic facilities supported by US agencies were not equally geographically distributed across the United States. Although many entities have work dedicated to metagenomics and/or support emerging infectious disease surveillance specimen collection, there was minimal formal collaboration across agencies.
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Affiliation(s)
- Diane L. Downie
- Diane L. Downie, PhD, MPH, is Deputy Associate Director for Science, Office of Readiness and Response, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Preetika Rao
- Preetika Rao, MPH, is a Health Scientist, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Corinne David-Ferdon
- Corinne David-Ferdon, PhD, is Associate Director of Science, Office of Public Health Data, Surveillance, and Technology, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Sean Courtney
- Sean Courtney, PhD, is a Health Scientist, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Justin S. Lee
- Justin S. Lee, DVM, PhD, is a Health Scientist, Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Claire Quiner
- Claire Quiner, MPH, MCP, is a Research Public Health Analyst, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Pia D. M. MacDonald
- Pia D. M. MacDonald, PhD, MPH, is a Senior Infectious Disease Epidemiologist, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Keegan Barnes
- Keegan Barnes is a Public Health Analyst, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Shelby Fisher
- Shelby Fisher, MPH, is an Epidemiologist, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Joanne L. Andreadis
- Joanne L. Andreadis, PhD, is Associate Director for Science, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Jasmine Chaitram
- Jasmine Chaitram, MPH, is Branch Chief, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Matthew R. Mauldin
- Matthew R. Mauldin, PhD, is Health Scientists US Centers for Disease Control and Prevention, Atlanta, GA
| | - Reynolds M. Salerno
- Reynolds M. Salerno, PhD, is Director, Division of Laboratory Systems, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Jarad Schiffer
- Jarad Schiffer, MS, is Health Scientists, Office of Readiness and Response, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Adi V. Gundlapalli
- Adi V. Gundlapalli, MD, PhD, is a Senior Advisor, Data Readiness and Response, Office of Public Health Data, Surveillance, and Technology, US Centers for Disease Control and Prevention, Atlanta, GA
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4
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Zhang Y, Romieu-Hernandez A, Boehmer TK, Azziz-Baumgartner E, Carton TW, Gundlapalli AV, Fearrington J, Nagavedu K, Dea K, Moyneur E, Cowell LG, Kaushal R, Mayer KH, Puro J, Rasmussen SA, Thacker D, Weiner MG, Saydah S, Block JP. Association between SARS-CoV-2 infection and select symptoms and conditions 31 to 150 days after testing among children and adults. BMC Infect Dis 2024; 24:181. [PMID: 38341566 PMCID: PMC10859007 DOI: 10.1186/s12879-024-09076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31- to 150-day following a SARS-CoV-2 test among adults and children with positive and negative test results. METHODS We conducted a retrospective cohort study using electronic health record (EHR) data from 43 PCORnet sites participating in a national COVID-19 surveillance program. This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test during March 1, 2020-May 31, 2021 documented in their EHR. We used logistic regression to calculate the odds of having a symptom and Cox models to calculate the risk of having a newly diagnosed condition associated with a SARS-CoV-2 positive test. RESULTS After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥ 1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11-1.23]; children: aOR, 1.18[95% CI, 1.08-1.28]) or shortness of breath (adults: aOR, 1.50[95% CI, 1.38-1.63]; children: aOR, 1.40[95% CI, 1.15-1.70]) 31-150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥ 3 symptoms or fatigue compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (adjusted hazard ratio[aHR], 1.25[95% CI, 1.17-1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11-1.28]), or respiratory disease (aHR, 1.44[95% CI, 1.30-1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive test also had higher odds or increased risk of being diagnosed with certain symptoms or conditions. CONCLUSIONS Patients with SARS-CoV-2 infection, especially those who were hospitalized, were at higher risk of being diagnosed with certain symptoms and conditions after acute infection.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | | | - Tegan K Boehmer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Adi V Gundlapalli
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia Fearrington
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA
| | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA
| | | | | | - Lindsay G Cowell
- Peter O-Donnell Jr. School of Public Health, Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health, Harvard Medical School, Boston, MA, USA
| | | | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sharon Saydah
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA.
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5
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Wei SC, Freeman D, Himschoot A, Clarke KEN, Van Dyke ME, Adjemian J, Ahmad FB, Benoit TJ, Berney K, Gundlapalli AV, Hall AJ, Havers F, Henley SJ, Hilton C, Johns D, Opsomer JD, Pham HT, Stuckey MJ, Taylor CA, Jones JM. Who Gets Sick From COVID-19? Sociodemographic Correlates of Severe Adult Health Outcomes During Alpha- and Delta-Variant Predominant Periods: September 2020-November 2021. J Infect Dis 2024; 229:122-132. [PMID: 37615368 DOI: 10.1093/infdis/jiad357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Because COVID-19 case data do not capture most SARS-CoV-2 infections, the actual risk of severe disease and death per infection is unknown. Integrating sociodemographic data into analysis can show consequential health disparities. METHODS Data were merged from September 2020 to November 2021 from 6 national surveillance systems in matched geographic areas and analyzed to estimate numbers of COVID-19-associated cases, emergency department visits, and deaths per 100 000 infections. Relative risks of outcomes per infection were compared by sociodemographic factors in a data set including 1490 counties from 50 states and the District of Columbia, covering 71% of the US population. RESULTS Per infection with SARS-CoV-2, COVID-19-related morbidity and mortality were higher among non-Hispanic American Indian and Alaska Native persons, non-Hispanic Black persons, and Hispanic or Latino persons vs non-Hispanic White persons; males vs females; older people vs younger; residents in more socially vulnerable counties vs less; those in large central metro areas vs rural; and people in the South vs the Northeast. DISCUSSION Meaningful disparities in COVID-19 morbidity and mortality per infection were associated with sociodemography and geography. Addressing these disparities could have helped prevent the loss of tens of thousands of lives.
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Affiliation(s)
- Stanley C Wei
- COVID-19 Response Team, Centers for Disease Control and Prevention
| | - Dane Freeman
- Information and Communications Laboratory, Georgia Tech Research Institute
| | - Austin Himschoot
- Information and Communications Laboratory, Georgia Tech Research Institute
| | | | | | | | - Farida B Ahmad
- COVID-19 Response Team, Centers for Disease Control and Prevention
| | - Tina J Benoit
- COVID-19 Response Team, Centers for Disease Control and Prevention
| | - Kevin Berney
- Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry
| | | | - Aron J Hall
- COVID-19 Response Team, Centers for Disease Control and Prevention
| | - Fiona Havers
- COVID-19 Response Team, Centers for Disease Control and Prevention
| | - S Jane Henley
- COVID-19 Response Team, Centers for Disease Control and Prevention
| | - Charity Hilton
- Information and Communications Laboratory, Georgia Tech Research Institute
| | - Dylan Johns
- COVID-19 Response Team, Centers for Disease Control and Prevention
- Health, Environment, Economics, and Development, ICF International, Reston, Virginia
| | - Jean D Opsomer
- Center of Statistics and Data Science, WESTAT Inc, Rockville, Maryland, USA
| | - Huong T Pham
- COVID-19 Response Team, Centers for Disease Control and Prevention
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6
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Wang L, Patrone PN, Kearsley AJ, Izac JR, Gaigalas AK, Prostko JC, Kwon HJ, Tang W, Kosikova M, Xie H, Tian L, Elsheikh EB, Kwee EJ, Kemp T, Jochum S, Thornburg N, McDonald LC, Gundlapalli AV, Lin-Gibson S. Monoclonal Antibodies as SARS-CoV-2 Serology Standards: Experimental Validation and Broader Implications for Correlates of Protection. Int J Mol Sci 2023; 24:15705. [PMID: 37958688 PMCID: PMC10650176 DOI: 10.3390/ijms242115705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
COVID-19 has highlighted challenges in the measurement quality and comparability of serological binding and neutralization assays. Due to many different assay formats and reagents, these measurements are known to be highly variable with large uncertainties. The development of the WHO international standard (WHO IS) and other pool standards have facilitated assay comparability through normalization to a common material but does not provide assay harmonization nor uncertainty quantification. In this paper, we present the results from an interlaboratory study that led to the development of (1) a novel hierarchy of data analyses based on the thermodynamics of antibody binding and (2) a modeling framework that quantifies the probability of neutralization potential for a given binding measurement. Importantly, we introduced a precise, mathematical definition of harmonization that separates the sources of quantitative uncertainties, some of which can be corrected to enable, for the first time, assay comparability. Both the theory and experimental data confirmed that mAbs and WHO IS performed identically as a primary standard for establishing traceability and bridging across different assay platforms. The metrological anchoring of complex serological binding and neuralization assays and fast turn-around production of an mAb reference control can enable the unprecedented comparability and traceability of serological binding assay results for new variants of SARS-CoV-2 and immune responses to other viruses.
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Affiliation(s)
- Lili Wang
- Biosystems and Biomaterials Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (J.R.I.); (A.K.G.); (L.T.); (E.B.E.); (E.J.K.)
| | - Paul N. Patrone
- Applied and Computational Mathematics Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (P.N.P.); (A.J.K.)
| | - Anthony J. Kearsley
- Applied and Computational Mathematics Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (P.N.P.); (A.J.K.)
| | - Jerilyn R. Izac
- Biosystems and Biomaterials Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (J.R.I.); (A.K.G.); (L.T.); (E.B.E.); (E.J.K.)
| | - Adolfas K. Gaigalas
- Biosystems and Biomaterials Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (J.R.I.); (A.K.G.); (L.T.); (E.B.E.); (E.J.K.)
| | | | - Hyung Joon Kwon
- Laboratory of Pediatric and Respiratory Viral Diseases, Office of Vaccines Research and Review, Center for Biologics Evaluation, Food and Drug Administration (FDA), Silver Spring, MD 20993, USA; (H.J.K.); (W.T.); (M.K.); (H.X.)
| | - Weichun Tang
- Laboratory of Pediatric and Respiratory Viral Diseases, Office of Vaccines Research and Review, Center for Biologics Evaluation, Food and Drug Administration (FDA), Silver Spring, MD 20993, USA; (H.J.K.); (W.T.); (M.K.); (H.X.)
| | - Martina Kosikova
- Laboratory of Pediatric and Respiratory Viral Diseases, Office of Vaccines Research and Review, Center for Biologics Evaluation, Food and Drug Administration (FDA), Silver Spring, MD 20993, USA; (H.J.K.); (W.T.); (M.K.); (H.X.)
| | - Hang Xie
- Laboratory of Pediatric and Respiratory Viral Diseases, Office of Vaccines Research and Review, Center for Biologics Evaluation, Food and Drug Administration (FDA), Silver Spring, MD 20993, USA; (H.J.K.); (W.T.); (M.K.); (H.X.)
| | - Linhua Tian
- Biosystems and Biomaterials Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (J.R.I.); (A.K.G.); (L.T.); (E.B.E.); (E.J.K.)
| | - Elzafir B. Elsheikh
- Biosystems and Biomaterials Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (J.R.I.); (A.K.G.); (L.T.); (E.B.E.); (E.J.K.)
| | - Edward J. Kwee
- Biosystems and Biomaterials Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (J.R.I.); (A.K.G.); (L.T.); (E.B.E.); (E.J.K.)
| | - Troy Kemp
- Vaccine, Immunity and Cancer Directorate, Frederick National Laboratory for Cancer Research (FNLCR), Frederick, MD 21702, USA;
| | - Simon Jochum
- Roche Diagnostics GmbH, 82377 Penzberg, Germany;
| | - Natalie Thornburg
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (N.T.); (L.C.M.); (A.V.G.)
| | - L. Clifford McDonald
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (N.T.); (L.C.M.); (A.V.G.)
| | - Adi V. Gundlapalli
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (N.T.); (L.C.M.); (A.V.G.)
| | - Sheng Lin-Gibson
- Biosystems and Biomaterials Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD 20899, USA; (J.R.I.); (A.K.G.); (L.T.); (E.B.E.); (E.J.K.)
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7
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Gold JAW, Adjei S, Gundlapalli AV, Huang YLA, Chiller T, Benedict K, Toda M. Increased Hospitalizations Involving Fungal Infections during COVID-19 Pandemic, United States, January 2020-December 2021. Emerg Infect Dis 2023; 29:1433-1437. [PMID: 37347805 PMCID: PMC10310397 DOI: 10.3201/eid2907.221771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Hospitalizations involving fungal infections increased 8.5% each year in the United States during 2019-2021. During 2020-2021, patients hospitalized with COVID-19-associated fungal infections had higher (48.5%) in-hospital mortality rates than those with non-COVID-19-associated fungal infections (12.3%). Improved fungal disease surveillance is needed, particularly during respiratory virus pandemics.
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8
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Pollock ED, Clay PA, Keen A, Currie DW, Carter RJ, Quilter LAS, Gundlapalli AV, Mermin J, Spicknall IH. Potential for Recurrent Mpox Outbreaks Among Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:568-573. [PMID: 37227964 DOI: 10.15585/mmwr.mm7221a1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
More than 30,000 monkeypox (mpox) cases have been diagnosed in the United States since May 2022, primarily among gay, bisexual, and other men who have sex with men (MSM) (1,2). In recent months, diagnoses have declined to one case per day on average. However, mpox vaccination coverage varies regionally, suggesting variable potential risk for mpox outbreak recurrence (3). CDC simulated dynamic network models representing sexual behavior among MSM to estimate the risk for and potential size of recurrent mpox outbreaks at the jurisdiction level for 2023 and to evaluate the benefits of vaccination for preparedness against mpox reintroduction. The risk for outbreak recurrence after mpox reintroduction is linearly (inversely) related to the proportion of MSM who have some form of protective immunity: the higher the population prevalence of immunity (from vaccination or natural infection), the lower the likelihood of recurrence in that jurisdiction across all immunity levels modeled. In contrast, the size of a potential recurrent outbreak might have thresholds: very small recurrences are predicted for jurisdictions with mpox immunity of 50%-100%; exponentially increasing sizes of recurrences are predicted for jurisdictions with 25%-50% immunity; and linearly increasing sizes of recurrences are predicted for jurisdictions with <25% immunity. Among the 50 jurisdictions examined, 15 are predicted to be at minimal risk for recurrence because of their high levels of population immunity. This analysis underscores the ongoing need for accessible and sustained mpox vaccination to decrease the risk for and potential size of future mpox recurrences.
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9
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McQuiston JH, Braden CR, Bowen MD, McCollum AM, McDonald R, Carnes N, Carter RJ, Christie A, Doty JB, Ellington S, Fehrenbach SN, Gundlapalli AV, Hutson CL, Kachur RE, Maitland A, Pearson CM, Prejean J, Quilter LAS, Rao AK, Yu Y, Mermin J. The CDC Domestic Mpox Response - United States, 2022-2023. MMWR Morb Mortal Wkly Rep 2023; 72:547-552. [PMID: 37200231 DOI: 10.15585/mmwr.mm7220a2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.S. Public Health Emergency on August 4, 2022, by the U.S. Department of Health and Human Services.† A U.S. government response was initiated, and CDC coordinated activities with the White House, the U.S. Department of Health and Human Services, and many other federal, state, and local partners. CDC quickly adapted surveillance systems, diagnostic tests, vaccines, therapeutics, grants, and communication systems originally developed for U.S. smallpox preparedness and other infectious diseases to fit the unique needs of the outbreak. In 1 year, more than 30,000 U.S. mpox cases were reported, more than 140,000 specimens were tested, >1.2 million doses of vaccine were administered, and more than 6,900 patients were treated with tecovirimat, an antiviral medication with activity against orthopoxviruses such as Variola virus and Monkeypox virus. Non-Hispanic Black (Black) and Hispanic or Latino (Hispanic) persons represented 33% and 31% of mpox cases, respectively; 87% of 42 fatal cases occurred in Black persons. Sexual contact among gay, bisexual, and other men who have sex with men (MSM) was rapidly identified as the primary risk for infection, resulting in profound changes in our scientific understanding of mpox clinical presentation, pathogenesis, and transmission dynamics. This report provides an overview of the first year of the response to the U.S. mpox outbreak by CDC, reviews lessons learned to improve response and future readiness, and previews continued mpox response and prevention activities as local viral transmission continues in multiple U.S. jurisdictions (Figure).
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Drzymalla E, Moonesinghe R, Kolor K, Khoury MJ, Schieber L, Gundlapalli AV. Severity Outcomes among Adult Patients with Primary Immunodeficiency and COVID-19 Seen in Emergency Departments, United States, April 2020-August 2021. J Clin Med 2023; 12:jcm12103516. [PMID: 37240621 DOI: 10.3390/jcm12103516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/06/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Primary immunodeficiencies (PIs) are a group of diseases that increase susceptibility to infectious diseases. Few studies have examined the relationship between PI and COVID-19 outcomes. In this study, we used Premier Healthcare Database, which contains information on inpatient discharges, to analyze COVID-19 outcomes among 853 adult PI and 1,197,430 non-PI patients who visited the emergency department. Hospitalization, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and death had higher odds in PI patients than in non-PI patients (hospitalization aOR: 2.36, 95% CI: 1.87-2.98; ICU admission aOR: 1.53, 95% CI: 1.19-1.96; IMV aOR: 1.41, 95% CI: 1.15-1.72; death aOR: 1.37, 95% CI: 1.08-1.74), and PI patients spent on average 1.91 more days in the hospital than non-PI patients when adjusted for age, sex, race/ethnicity, and chronic conditions associated with severe COVID-19. Of the largest four PI groups, selective deficiency of the immunoglobulin G subclass had the highest hospitalization frequency (75.2%). This large study of United States PI patients provides real-world evidence that PI is a risk factor for adverse COVID-19 outcomes.
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Affiliation(s)
- Emily Drzymalla
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Katherine Kolor
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Muin J Khoury
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Lyna Schieber
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Adi V Gundlapalli
- The Center for Surveillance, Epidemiology, and Laboratory Services, Office of the Director, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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11
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Riser AP, Hanley A, Cima M, Lewis L, Saadeh K, Alarcón J, Finn L, Kim M, Adams J, Holt D, Feldpausch A, Pavlick J, English A, Smith M, Rehman T, Lubelchek R, Black S, Collins M, Mounsey L, Blythe D, Avalos MH, Lee EH, Samson O, Wong M, Stokich BD, Salehi E, Denny L, Waller K, Talley P, Schuman J, Fischer M, White S, Davis K, Caeser Cuyler A, Sabzwari R, Anderson RN, Byrd K, Gold JAW, Kindilien S, Lee JT, O’Connor S, O’Shea J, Salmon-Trejo LAT, Velazquez-Kronen R, Zelaya C, Bower W, Ellington S, Gundlapalli AV, McCollum AM, Zilversmit Pao L, Rao AK, Wong KK, Guagliardo SAJ. Epidemiologic and Clinical Features of Mpox-Associated Deaths - United States, May 10, 2022-March 7, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:404-410. [PMID: 37053126 PMCID: PMC10121256 DOI: 10.15585/mmwr.mm7215a5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
As of March 7, 2023, a total of 30,235 confirmed and probable monkeypox (mpox) cases were reported in the United States,† predominantly among cisgender men§ who reported recent sexual contact with another man (1). Although most mpox cases during the current outbreak have been self-limited, cases of severe illness and death have been reported (2-4). During May 10, 2022-March 7, 2023, 38 deaths among persons with probable or confirmed mpox¶ (1.3 per 1,000 mpox cases) were reported to CDC and classified as mpox-associated (i.e., mpox was listed as a contributing or causal factor). Among the 38 mpox-associated deaths, 94.7% occurred in cisgender men (median age = 34 years); 86.8% occurred in non-Hispanic Black or African American (Black) persons. The median interval from symptom onset to death was 68 days (IQR = 50-86 days). Among 33 decedents with available information, 93.9% were immunocompromised because of HIV. Public health actions to prevent mpox deaths include integrated testing, diagnosis, and early treatment for mpox and HIV, and ensuring equitable access to both mpox and HIV prevention and treatment, such as antiretroviral therapy (ART) (5).
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12
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Owens LE, Currie DW, Kramarow EA, Siddique S, Swanson M, Carter RJ, Kriss JL, Boersma PM, Lee FC, Spicknall I, Hurley E, Zlotorzynska M, Gundlapalli AV. JYNNEOS Vaccination Coverage Among Persons at Risk for Mpox - United States, May 22, 2022-January 31, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:342-347. [PMID: 36995962 PMCID: PMC10078841 DOI: 10.15585/mmwr.mm7213a4] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
From May 2022 through the end of January 2023, approximately 30,000 cases of monkeypox (mpox) have been reported in the United States and >86,000 cases reported internationally.* JYNNEOS (Modified Vaccinia Ankara vaccine, Bavarian Nordic) is recommended for subcutaneous administration to persons at increased risk for mpox (1,2) and has been demonstrated to provide protection against infection (3-5). To increase the total number of vaccine doses available, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) on August 9, 2022, recommending administration of the vaccine intradermally (0.1 mL per dose) for persons aged ≥18 years who are recommended to receive it (6); intradermal administration can generate an equivalent immune response to that achieved through subcutaneous injection using approximately one fifth the subcutaneous dose (7). CDC analyzed JYNNEOS vaccine administration data submitted to CDC from jurisdictional immunization information systems (IIS)† to assess the impact of the EUA and to estimate vaccination coverage among the population at risk for mpox. During May 22, 2022-January 31, 2023, a total of 1,189,651 JYNNEOS doses (734,510 first doses and 452,884 second doses)§ were administered. Through the week of August 20, 2022, the predominant route of administration was subcutaneous, after which intradermal administration became predominant, in accordance with FDA guidance. As of January 31, 2023, 1-dose and 2-dose (full vaccination) coverage among persons at risk for mpox is estimated to have reached 36.7% and 22.7%, respectively. Despite a steady decline in mpox cases from a 7-day daily average of more than 400 cases on August 1, 2022, to five cases on January 31, 2023, vaccination for persons at risk for mpox continues to be recommended (1). Targeted outreach and continued access to and availability of mpox vaccines to persons at risk are important to help prevent and minimize the impact of a resurgence of mpox.
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13
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Khan D, Park M, Burkholder J, Dumbuya S, Ritchey MD, Yoon P, Galante A, Duva JL, Freeman J, Duck W, Soroka S, Bottichio L, Wellman M, Lerma S, Lyons BC, Dee D, Haile S, Gaughan DM, Langer A, Gundlapalli AV, Suthar AB. Tracking COVID-19 in the United States With Surveillance of Aggregate Cases and Deaths. Public Health Rep 2023:333549231163531. [PMID: 36960828 PMCID: PMC10040484 DOI: 10.1177/00333549231163531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Early during the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) leveraged an existing surveillance system infrastructure to monitor COVID-19 cases and deaths in the United States. Given the time needed to report individual-level (also called line-level) COVID-19 case and death data containing detailed information from individual case reports, CDC designed and implemented a new aggregate case surveillance system to inform emergency response decisions more efficiently, with timelier indicators of emerging areas of concern. We describe the processes implemented by CDC to operationalize this novel, multifaceted aggregate surveillance system for collecting COVID-19 case and death data to track the spread and impact of the SARS-CoV-2 virus at national, state, and county levels. We also review the processes established to acquire, process, and validate the aggregate number of cases and deaths due to COVID-19 in the United States at the county and jurisdiction levels during the pandemic. These processes include time-saving tools and strategies implemented to collect and validate authoritative COVID-19 case and death data from jurisdictions, such as web scraping to automate data collection and algorithms to identify and correct data anomalies. This topical review highlights the need to prepare for future emergencies, such as novel disease outbreaks, by having an event-agnostic aggregate surveillance system infrastructure in place to supplement line-level case reporting for near-real-time situational awareness and timely data.
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Affiliation(s)
- Diba Khan
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meeyoung Park
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sorie Dumbuya
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew D Ritchey
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service, Rockville, MD, USA
| | - Paula Yoon
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Galante
- Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Joseph L Duva
- Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Jeffrey Freeman
- Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - William Duck
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Soroka
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lyndsay Bottichio
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Wellman
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samuel Lerma
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Casey Lyons
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah Dee
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service, Rockville, MD, USA
| | - Seghen Haile
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Denise M Gaughan
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam Langer
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adi V Gundlapalli
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amitabh B Suthar
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Gundlapalli AV, Beekmann SE, Jones JM, Thornburg NJ, Clarke KEN, Uyeki TM, Satheshkumar PS, Carroll DS, Plumb ID, Briggs-Hagen M, Santibañez S, David-Ferdon C, Polgreen PM, McDonald LC. Use of Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Tests by US Infectious Disease Physicians: Results of an Emerging Infections Network Survey, March 2022. Open Forum Infect Dis 2023; 10:ofad091. [PMID: 36949879 PMCID: PMC10026543 DOI: 10.1093/ofid/ofad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/16/2023] [Indexed: 02/20/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests have had limited recommended clinical application during the coronavirus disease 2019 (COVID-19) pandemic. To inform clinical practice, an understanding is needed of current perspectives of United States-based infectious disease (ID) physicians on the use, interpretation, and need for SARS-CoV-2 antibody tests. Methods In March 2022, members of the Emerging Infections Network (EIN), a national network of practicing ID physicians, were surveyed on types of SARS-CoV-2 antibody assays ordered, interpretation of test results, and clinical scenarios for which antibody tests were considered. Results Of 1867 active EIN members, 747 (40%) responded. Among the 583 who managed or consulted on COVID-19 patients, a majority (434/583 [75%]) had ordered SARS-CoV-2 antibody tests and were comfortable interpreting positive (452/578 [78%]) and negative (405/562 [72%]) results. Antibody tests were used for diagnosing post-COVID-19 conditions (61%), identifying prior SARS-CoV-2 infection (60%), and differentiating prior infection and response to COVID-19 vaccination (37%). Less than a third of respondents had used antibody tests to assess need for additional vaccines or risk stratification. Lack of sufficient evidence for use and nonstandardized assays were among the most common barriers for ordering tests. Respondents indicated that statements from professional societies and government agencies would influence their decision to order SARS-CoV-2 antibody tests for clinical decision making. Conclusions Practicing ID physicians are using SARS-CoV-2 antibody tests, and there is an unmet need for clarifying the appropriate use of these tests in clinical practice. Professional societies and US government agencies can support clinicians in the community through the creation of appropriate guidance.
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Affiliation(s)
- Adi V Gundlapalli
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan E Beekmann
- Infectious Diseases Society of America–Emerging Infections Network and Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jefferson M Jones
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kristie E N Clarke
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy M Uyeki
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Darin S Carroll
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian D Plumb
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Briggs-Hagen
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Santibañez
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Corinne David-Ferdon
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip M Polgreen
- Infectious Diseases Society of America–Emerging Infections Network and Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - L Clifford McDonald
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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De Almeida BI, Smith TL, Delic A, Esquibel L, Galli J, Millsap L, Paz Soldán MM, Cortez MM, Rose J, Greenlee JE, Gundlapalli AV, Hill HR, Wong KH, Clardy SL. Neurologic Manifestations of Common Variable Immunodeficiency: Impact on Quality of Life. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/3/e200088. [PMID: 36797058 PMCID: PMC9936420 DOI: 10.1212/nxi.0000000000200088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/01/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Common variable immunodeficiency is a systemic disease and not solely a disease of humoral immunity. Neurologic symptoms associated with common variable immunodeficiency are underrecognized and warrant further study. This work aimed to characterize the neurologic symptoms reported by people living with common variable immunodeficiency. METHODS We conducted a single academic medical center study of neurologic symptoms reported by adults previously diagnosed with common variable immunodeficiency. We used a survey of common neurologic symptoms to determine the prevalence of these symptoms in a population with common variable immunodeficiency and further assessed these patient-reported symptoms with validated questionnaires and compared symptom burden with other neurologic conditions. RESULTS A volunteer sample of adults (aged 18 years or older) previously diagnosed with common variable immunodeficiency at the University of Utah Clinical Immunology/Immune Deficiency Clinic who were able to read and comprehend English and willing and able to answer survey-based questions were recruited. Of 148 eligible participants identified, 80 responded and 78 completed the surveys. The mean age of respondents was 51.3 years (range 20-78 years); 73.1% female and 94.8% White. Patients with common variable immunodeficiency reported many common neurologic symptoms (mean 14.6, SD 5.9, range 1-25), with sleep issues, fatigue, and headache reported by more than 85%. Validated questionnaires addressing specific neurologic symptoms supported these results. T-scores on Neuro QoL questionnaires for sleep (mean 56.4, SD 10.4) and fatigue (mean 54.1, SD 11) were higher, indicating more dysfunction, than in the reference clinical population (p < 0.005). The Neuro QoL questionnaire for cognitive function showed a lower T-score (mean 44.8, SD 11.1) than that in the reference general population (p < 0.005), indicating worse function in this domain. DISCUSSION Among survey respondents, there is a marked burden of neurologic symptoms. Given the impact of neurologic symptoms on health-related quality-of-life measures, clinicians should screen patients with common variable immunodeficiency for the presence of these symptoms and offer referral to neurologists and/or symptomatic treatment when indicated. Frequently prescribed neurologic medications may also affect the immune system, and neurologists should consider screening patients for immune deficiency before prescribing them.
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Affiliation(s)
- Bruno Ivo De Almeida
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Tammy L Smith
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Alen Delic
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Lawanda Esquibel
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Jonathan Galli
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Leah Millsap
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - M Mateo Paz Soldán
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Melissa M Cortez
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - John Rose
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - John E Greenlee
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Adi V Gundlapalli
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Harry R Hill
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Ka-Ho Wong
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Stacey L Clardy
- From the Université de Bordeaux (B.I.D.A.), U de Biologie, France; Department of Neurology (B.I.D.A., T.L.S., A.D., L.E., J.G., M.M.P.S., M.M.C., J.R., J.E.G., K.-H.W., S.L.C.), University of Utah School of Medicine, Salt Lake City; George E. Wahlen Department of Veterans Affairs Medical Center (T.L.S., J.G., M.M.P.S., J.R., J.E.G., S.L.C.), Salt Lake City, UT; University of Utah School of Medicine (L.M.); Department of Internal Medicine, (A.V.G.), University of Utah School of Medicine; and Divisions of Immunology and Infectious Disease (H.R.H.), Departments of Pathology, Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City.
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16
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Kompaniyets L, Wiegand RE, Oyalowo AC, Bull-Otterson L, Egwuogu H, Thompson T, Kahihikolo K, Moore L, Jones-Jack N, El Kalach R, Srinivasan A, Messer A, Pilishvili T, Harris AM, Gundlapalli AV, Link-Gelles R, Boehmer TK. Relative effectiveness of COVID-19 vaccination and booster dose combinations among 18.9 million vaccinated adults during the early SARS-CoV-2 Omicron period - United States, January 1, 2022-March 31, 2022. Clin Infect Dis 2023; 76:1753-1760. [PMID: 36750643 DOI: 10.1093/cid/ciad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Small sample sizes have limited prior studies' ability to capture severe COVID-19 outcomes, especially among Ad26.COV2.S vaccine recipients. This study of 18.9 million adults aged ≥18 years assessed relative vaccine effectiveness (rVE) in three recipient cohorts: (1) primary Ad26.COV2.S vaccine and Ad26.COV2.S booster (two Ad26.COV2.S), (2) primary Ad26.COV2.S vaccine and mRNA booster (Ad26.COV2.S+mRNA), (3) two doses of primary mRNA vaccine and mRNA booster (three mRNA). The study analyzed two de-identified datasets linked using privacy-preserving record linkage (PPRL): medical and pharmacy insurance claims and COVID-19 vaccination data from retail pharmacies. It assessed the presence of COVID-19 during January 1-March 31, 2022 in: (1) any claim, (2) outpatient claim, (3) emergency department (ED) claim, (4) inpatient claim, and (5) inpatient claim with intensive care unit (ICU) admission. rVE for each outcome comparing three recipient cohorts (reference: two Ad26.COV2.S doses) was estimated from adjusted Cox proportional hazards models. Compared with two Ad26.COV2.S doses, Ad26.COV2.S+mRNA and three mRNA doses were more effective against all COVID-19 outcomes, including 57% (95% CI: 52-62) and 62% (95% CI: 58-65) rVE against an ED visit; 44% (95% CI: 34-52) and 54% (95% CI: 48-59) rVE against hospitalization; and 48% (95% CI: 22-66) and 66% (95% CI: 53-75) rVE against ICU admission, respectively. This study demonstrated that Ad26.COV2.S + mRNA doses were as good as three doses of mRNA, and better than two doses of Ad26.COV2.S. Vaccination continues to be an important preventive measure for reducing the public health impact of COVID-19.
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Affiliation(s)
- Lyudmyla Kompaniyets
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan E Wiegand
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adewole C Oyalowo
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Booz Allen Hamilton, McLean, VA, USA
| | - Lara Bull-Otterson
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heartley Egwuogu
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Metas Solutions, Atlanta, GA, USA
| | - Trevor Thompson
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Booz Allen Hamilton, McLean, VA, USA
| | - Kaʻimi Kahihikolo
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Booz Allen Hamilton, McLean, VA, USA
| | - Lori Moore
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nkenge Jones-Jack
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Roua El Kalach
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arunkumar Srinivasan
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Messer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Peraton, Herndon, VA, USA
| | - Tamara Pilishvili
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron M Harris
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adi V Gundlapalli
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Link-Gelles
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tegan K Boehmer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Stewart IJ, Ambardar S, Howard JT, Janak JC, Walker LE, Poltavskiy E, Alcover KC, Watrous J, V Gundlapalli A, B P Pettey W, Suo Y, Nelson RE. Long-Term Health Care Costs for Service Members Injured in Iraq and Afghanistan. Mil Med 2023; 188:usad008. [PMID: 36734126 DOI: 10.1093/milmed/usad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/09/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Over the last two decades, the conflicts in Iraq and Afghanistan have cost the United States significantly in terms of lives lost, disabling injuries, and budgetary expenditures. This manuscript calculates the differences in costs between veterans with combat injuries vs veterans without combat injuries. This work could be used to project future costs in subsequent studies. MATERIALS AND METHODS In this retrospective cohort study, we randomly selected 7,984 combat-injured veterans between February 1, 2002, and June 14, 2016, from Veterans Affairs Health System administrative data. We matched injured veterans 1:1 to noninjured veterans on year of birth (± 1 year), sex, and first service branch. We observed patients for a maximum of 10 years. This research protocol was reviewed and approved by the David Grant USAF Medical Center institutional review board (IRB), the University of Utah IRB, and the Research Review Committee of the VA Salt Lake City Health Care System in accordance with all applicable Federal regulations. RESULTS Patients were primarily male (98.1% in both groups) and White (76.4% for injured patients, 72.3% for noninjured patients), with a mean (SD) age of 26.8 (6.6) years for the injured group and 27.7 (7.0) years for noninjured subjects. Average total costs for combat-injured service members were higher for each year studied. The difference was highest in the first year ($16,050 compared to $4,135 for noninjured). These differences remained significant after adjustment. Although this difference was greatest in the first year (marginal effect $12,386, 95% confidence interval $9,736-$15,036; P < 0.001), total costs continued to be elevated in years 2-10, with marginal effects ranging from $1,766 to $2,597 (P < 0.001 for all years). More severe injuries tended to increase costs in all categories. CONCLUSIONS Combat injured patients have significantly higher long-term health care costs compared to their noninjured counterparts. If this random sample is extrapolated to the 53,251 total of combat wounded service members, it implies a total excess cost of $1.6 billion to date after adjustment for covariates and a median follow-up time of 10 years. These costs are likely to increase as injured veterans age and develop additional chronic conditions.
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Affiliation(s)
- Ian J Stewart
- Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Military Cardiovascular Outcomes Research (MiCOR), Bethesda, MD 20814, USA
| | - Shiva Ambardar
- Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Jeffrey T Howard
- Department of Public Health, University of Texas San Antonio, San Antonio, TX 78349, USA
| | - Jud C Janak
- Bexar Data Limited, San Antonio, TX 78210, USA
| | | | | | - Karl C Alcover
- Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | | | - Adi V Gundlapalli
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Warren B P Pettey
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Ying Suo
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Richard E Nelson
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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18
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Click ES, Malec D, Chevinsky JR, Tao G, Melgar M, Giovanni JE, Gundlapalli AV, Datta SD, Wong KK. Longitudinal Analysis of Electronic Health Information to Identify Possible COVID-19 Sequelae. Emerg Infect Dis 2023; 29:389-392. [PMID: 36564152 PMCID: PMC9881771 DOI: 10.3201/eid2902.220712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ongoing symptoms might follow acute COVID-19. Using electronic health information, we compared pre‒ and post‒COVID-19 diagnostic codes to identify symptoms that had higher encounter incidence in the post‒COVID-19 period as sequelae. This method can be used for hypothesis generation and ongoing monitoring of sequelae of COVID-19 and future emerging diseases.
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19
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Walker LE, Poltavskiy E, Howard JT, Janak JC, Watrous J, Alcover K, Pettey WBP, Ambardar S, Meyer E, Gundlapalli AV, Stewart IJ. Suicide attempts and mental health diagnoses in combat-injured service members: A retrospective cohort study. Suicide Life Threat Behav 2022; 53:227-240. [PMID: 36576267 DOI: 10.1111/sltb.12938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/19/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Examinations of risk factors for suicide attempt in United States service members at high risk of mental health diagnoses, such as those with combat injuries, are essential to guiding prevention and intervention efforts. METHODS Retrospective cohort study of 8727 combat-injured patients matched to deployed, non-injured patients utilizing Department of Defense and Veterans Affairs administrative records. RESULTS Combat injury was positively associated with suicide attempt in the univariate model (HR = 1.75, 95% CI 1.5-2.1), but lost significance after adjustment for mental health diagnoses. Utilizing Latent Transition Analysis in the combat-injured group, we identified five mental/behavioral health profiles: (1) Few mental health diagnoses, (2) PTSD and depressive disorders, (3) Adjustment disorder, (4) Multiple mental health comorbidities, and (5) Multiple mental health comorbidities with alcohol use disorder (AUD). Multiple mental health comorbidities with AUD had the highest suicide attempt rate throughout the study and more than four times that of Multiple mental health comorbidities in the first study year (23.4 vs. 5.1 per 1000 person years, respectively). CONCLUSION Findings indicate that (1) combat injury's impact on suicide attempt is attenuated by mental health and (2) AUD with multiple mental health comorbidities confers heightened suicide attempt risk in combat-injured service members.
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Affiliation(s)
- Lauren E Walker
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eduard Poltavskiy
- David Grant USAF Medical Center, Travis AFB, Fairfield, California, USA
| | | | | | - Jessica Watrous
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Leidos Inc., San Diego, California, USA
| | - Karl Alcover
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Warren B P Pettey
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shiva Ambardar
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Eric Meyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Adi V Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR), Bethesda, Maryland, USA
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20
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Zhang Y, Romieu-Hernandez A, Boehmer TK, Azziz-Baumgartner E, Carton TW, Gundlapalli AV, Fearrington J, Nagavedu K, Dea K, Moyneur E, Cowell LG, Kaushal R, Mayer KH, Puro J, Rasmussen SA, Thacker D, Weiner MG, Saydeh S, Block JP. Association between SARS-CoV-2 Infection and Select Symptoms and Conditions 31 to 150 Days After Testing among Children and Adults. medRxiv 2022:2022.12.18.22283646. [PMID: 36597540 PMCID: PMC9810226 DOI: 10.1101/2022.12.18.22283646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31 to 150 days following a SARS-CoV-2 test among adults (≥20 years) and children (<20 years) with positive and negative test results documented in the electronic health records (EHRs) of institutions participating in PCORnet, the National Patient-Centered Clinical Research Network. Methods and Findings This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test (nucleic acid amplification or rapid antigen) during March 1, 2020-May 31, 2021 documented in their EHR. We identified hospitalization status in the day prior through the 16 days following the SARS-CoV-2 test as a proxy for the severity of COVID-19. We used logistic regression to calculate the odds of receiving a diagnostic code for each symptom outcome and Cox proportional hazard models to calculate the risk of being newly diagnosed with each condition outcome, comparing those with a SARS-CoV-2 positive test to those with a negative test. After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11-1.23]; children: aOR, 1.18[95% CI, 1.08-1.28]) and shortness of breath (adults: aOR, 1.50[95% CI, 1.38-1.63]; children: aOR, 1.40[95% CI, 1.15-1.70]) 31-150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥3 symptoms (aOR, 1.16[95% CI, 1.08 - 1.26]) and fatigue (aOR, 1.12[95% CI, 1.05 - 1.18]) compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (aHR, 1.25[95% CI, 1.17-1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11-1.28]), and respiratory disease (aHR, 1.44[95% CI, 1.30-1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive SARS-CoV-2 test had higher odds of being diagnosed with fatigue (aOR, 1.11[95% CI, 1.05-1.16]) and shortness of breath (aOR, 1.22[95% CI, 1.15-1.29]), and had an increased risk (aHR, 1.12[95% CI, 1.02-1.23]) of being newly diagnosed with hematologic disorders (i.e., venous thromboembolism and pulmonary embolism) 31-150 days following SARS-CoV-2 test compared with those testing negative. The risk of being newly diagnosed with certain conditions, such as mental health conditions and neurological disorders, was lower among patients with a positive viral test relative to those with a negative viral test. Conclusions Patients with SARS-CoV-2 infection were at higher risk of being diagnosed with certain symptoms and conditions, particularly fatigue, respiratory symptoms, and hematological abnormalities, after acute infection. The risk was highest among adults hospitalized after SARS-CoV-2 infection.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States of America
| | - Alfonso Romieu-Hernandez
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tegan K. Boehmer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas W. Carton
- Louisiana Public Health Institute, New Orleans, Louisiana, United States of America
| | - Adi V. Gundlapalli
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julia Fearrington
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Lindsey G. Cowell
- Peter O-Donnell Jr. School of Public Health, Department of Immunology, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States of America
| | - Kenneth H. Mayer
- Fenway Institute, Fenway Health, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jon Puro
- OCHIN, Inc., Portland, Oregon, United States of America
| | - Sonja A. Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children’s Health, Wilmington, Delaware, United States of America
| | - Mark G. Weiner
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States of America
| | - Sharon Saydeh
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jason P. Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, United States of America
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Payne AB, Ray LC, Cole MM, Canning M, Houck K, Shah HJ, Farrar JL, Lewis NM, Fothergill A, White EB, Feldstein LR, Roper LE, Lee F, Kriss JL, Sims E, Spicknall IH, Nakazawa Y, Gundlapalli AV, Shimabukuro T, Cohen AL, Honein MA, Mermin J, Payne DC. Reduced Risk for Mpox After Receipt of 1 or 2 Doses of JYNNEOS Vaccine Compared with Risk Among Unvaccinated Persons - 43 U.S. Jurisdictions, July 31-October 1, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1560-1564. [PMID: 36480479 PMCID: PMC9762900 DOI: 10.15585/mmwr.mm7149a5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As of October 28, 2022, a total of 28,244* monkeypox (mpox) cases have been reported in the United States during an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic), administered subcutaneously as a 2-dose (0.5 mL per dose) series (with doses administered 4 weeks apart), was approved by the Food and Drug Administration (FDA) in 2019 to prevent smallpox and mpox disease (2); an FDA Emergency Use Authorization issued on August 9, 2022, authorized intradermal administration of 0.1 mL per dose, increasing the number of persons who could be vaccinated with the available vaccine supply† (3). A previous comparison of mpox incidence during July 31-September 3, 2022, among unvaccinated, but vaccine-eligible men aged 18-49 years and those who had received ≥1 JYNNEOS vaccine dose in 32 U.S. jurisdictions, found that incidence among unvaccinated persons was 14 times that among vaccinated persons (95% CI = 5.0-41.0) (4). During September 4-October 1, 2022, a total of 205,504 persons received JYNNEOS vaccine dose 2 in the United States.§ To further examine mpox incidence among persons who were unvaccinated and those who had received either 1 or 2 JYNNEOS doses, investigators analyzed data on 9,544 reported mpox cases among men¶ aged 18-49 years during July 31-October 1, 2022, from 43 U.S. jurisdictions,** by vaccination status. During this study period, mpox incidence (cases per 100,000 population at risk) among unvaccinated persons was 7.4 (95% CI = 6.0-9.1) times that among persons who received only 1 dose of JYNNEOS vaccine ≥14 days earlier and 9.6 (95% CI = 6.9-13.2) times that among persons who received dose 2 ≥14 days earlier. The observed distribution of subcutaneous and intradermal routes of administration of dose 1 among vaccinated persons with mpox was not different from the expected distribution. This report provides additional data suggesting JYNNEOS vaccine provides protection against mpox, irrespective of whether the vaccine is administered intradermally or subcutaneously. The degree and durability of such protection remains unclear. Persons eligible for mpox vaccination should receive the complete 2-dose series to optimize strength of protection†† (5).
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Kriss JL, Boersma PM, Martin E, Reed K, Adjemian J, Smith N, Carter RJ, Tan KR, Srinivasan A, McGarvey S, McGehee J, Henderson D, Aleshire N, Gundlapalli AV. Receipt of First and Second Doses of JYNNEOS Vaccine for Prevention of Monkeypox - United States, May 22-October 10, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1374-1378. [PMID: 36301741 PMCID: PMC9620573 DOI: 10.15585/mmwr.mm7143e2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccination with JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) to prevent monkeypox commenced shortly after confirmation of the first monkeypox case in the current outbreak in the United States on May 17, 2022 (1). To date, more than 27,000 cases have been reported across all 50 states, the District of Columbia (DC), and Puerto Rico.* JYNNEOS vaccine is licensed by the Food and Drug Administration (FDA) as a 0.5-mL 2-dose series administered subcutaneously 28 days apart to prevent smallpox and monkeypox infections (2) and has been found to provide protection against monkeypox infection during the current outbreak (3). The U.S. Department of Health and Human Services (HHS) allocated 1.1 million vials of JYNNEOS vaccine from the Strategic National Stockpile, with doses allocated to jurisdictions based on case counts and estimated size of population at risk (4). However, initial vaccine supplies were severely constrained relative to vaccine demand during the expanding outbreak. Some jurisdictions with highest incidence responded by prioritizing first dose administration during May-July (5,6). The FDA emergency use authorization (EUA) of 0.1 mL dosing for intradermal administration of JYNNEOS for persons aged ≥18 years on August 9, 2022, substantially expanded available vaccine supply† (7). The U.S. vaccination strategy focuses primarily on persons with known or presumed exposures to monkeypox (8) or those at high risk for occupational exposure (9). Data on monkeypox vaccine doses administered and reported to CDC by U.S. jurisdictions were analyzed to assess vaccine administration and completion of the 2-dose series. A total of 931,155 doses of JYNNEOS vaccine were administered and reported to the CDC by 55 U.S. jurisdictions during May 22-October 10, 2022. Among persons who received ≥1 dose, 51.4% were non-Hispanic White (White), 22.5% were Hispanic or Latino (Hispanic), and 12.6% were non-Hispanic Black or African American (Black). The percentages of vaccine recipients who were Black (5.6%) and Hispanic (15.5%) during May 22-June 25 increased to 13.3% and 22.7%, respectively, during July 31-October 10. Among 496,888 persons who received a first dose and were eligible for a second dose during the study period, 57.6% received their second dose. Second dose receipt was highest among older adults, White persons, and those residing in the South U.S. Census Bureau Region. Tracking and addressing disparities in vaccination can reduce inequities, and equitable access to and acceptance of vaccine should be an essential factor in planning vaccination programs, events, and strategies. Receipt of both first and second doses is necessary for optimal protection against Monkeypox virus infection.
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Boehmer TK, Koumans EH, Skillen EL, Kappelman MD, Carton TW, Patel A, August EM, Bernstein R, Denson JL, Draper C, Gundlapalli AV, Paranjape A, Puro J, Rao P, Siegel DA, Trick WE, Walker CL, Block JP. Racial and Ethnic Disparities in Outpatient Treatment of COVID-19 - United States, January-July 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1359-1365. [PMID: 36301738 PMCID: PMC9620572 DOI: 10.15585/mmwr.mm7143a2] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Clarke KEN, Kim Y, Jones J, Lee A, Deng Y, Nycz E, Iachan R, Gundlapalli AV, MacNeil A, Hall A. Pediatric Infection-Induced SARS-CoV-2 Seroprevalence Increases and Seroprevalence by Type of Clinical CareSeptember 2021 to February 2022. J Infect Dis 2022; 227:364-370. [PMID: 36281757 PMCID: PMC9620360 DOI: 10.1093/infdis/jiac423] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Trends in estimates of US pediatric SARS-CoV-2 infection-induced seroprevalence from commercial laboratory specimens may overrepresent children with frequent health care needs. We examined seroprevalence trends and compared seroprevalence estimates by testing type and diagnostic coding. METHODS Cross-sectional convenience samples of residual sera September 2021-February 2022 from 52 US jurisdictions were assayed for infection-induced SARS-CoV-2 antibodies; monthly seroprevalence estimates were calculated by age group. Multivariate logistic analyses compared seroprevalence estimates for specimens associated with International Classification of Diseases-Tenth Revision (ICD-10) codes and laboratory orders indicating well-child care with estimates for other pediatric specimens. RESULTS Infection-induced SARS-CoV-2 seroprevalence increased in each age group, from 30 to 68 (14 years), 38 to 77 (511 years), and 40 to 74 (1217 years). On multivariate analysis, patients with well-child ICD-10 codes were seropositive more often than other patients aged 117 years (adjusted prevalence ratio [aPR] 1.04; 95 confidence interval [CI], 1.021.07); children aged 911 years receiving standard lipid screening were seropositive more often than those receiving other laboratory tests (aPR, 1.05; 95 CI, 1.021.08). CONCLUSIONS Infection-induced seroprevalence more than doubled among children younger than 12 years between September 2021 and February 2022, and increased 85 in adolescents. Differences in seroprevalence by care type did not substantially impact US pediatric seroprevalence estimates.
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Affiliation(s)
- Kristie E N Clarke
- Address Correspondence to: Kristie E N Clarke, CDC/CSELS/OD/PHIO, 2400 Century Center Mailstop V24-6, Atlanta, GA 30345, USA, [], (843) 209-0829
| | - Yun Kim
- ICF, Rockville, Maryland, USA
| | - Jefferson Jones
- Alternate Corresponding Author: Jefferson Jones, CDC/NCIRD/CORVD, 1600 Clifton Rd NE, Mailstop H24-8, Atlanta GA 30333, USA, [], (404) 718-5517
| | | | | | - Elise Nycz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Abt Associates, Rockville, Maryland, USA
| | | | | | - Adam MacNeil
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Payne AB, Ray LC, Kugeler KJ, Fothergill A, White EB, Canning M, Farrar JL, Feldstein LR, Gundlapalli AV, Houck K, Kriss JL, Lewis NM, Sims E, Smith DK, Spicknall IH, Nakazawa Y, Damon IK, Cohn AC, Payne DC. Incidence of Monkeypox Among Unvaccinated Persons Compared with Persons Receiving ≥1 JYNNEOS Vaccine Dose — 32 U.S. Jurisdictions, July 31–September 3, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1278-1282. [PMID: 36201401 PMCID: PMC9541026 DOI: 10.15585/mmwr.mm7140e3] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Adjei S, Hong K, Molinari NAM, Bull-Otterson L, Ajani UA, Gundlapalli AV, Harris AM, Hsu J, Kadri SS, Starnes J, Yeoman K, Boehmer TK. Mortality Risk Among Patients Hospitalized Primarily for COVID-19 During the Omicron and Delta Variant Pandemic Periods — United States, April 2020–June 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1182-1189. [PMID: 36107788 PMCID: PMC9484808 DOI: 10.15585/mmwr.mm7137a4] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spicknall IH, Pollock ED, Clay PA, Oster AM, Charniga K, Masters N, Nakazawa YJ, Rainisch G, Gundlapalli AV, Gift TL. Modeling the Impact of Sexual Networks in the Transmission of Monkeypox virus Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1131-1135. [PMID: 36048619 PMCID: PMC9472773 DOI: 10.15585/mmwr.mm7135e2] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kompaniyets L, Bull-Otterson L, Boehmer TK, Baca S, Alvarez P, Hong K, Hsu J, Harris AM, Gundlapalli AV, Saydah S. Post–COVID-19 Symptoms and Conditions Among Children and Adolescents — United States, March 1, 2020–January 31, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:993-999. [PMID: 35925799 PMCID: PMC9368731 DOI: 10.15585/mmwr.mm7131a3] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Miller MJ, Himschoot A, Fitch N, Jawalkar S, Freeman D, Hilton C, Berney K, Guy GP, Benoit TJ, Clarke KE, Busch MP, Opsomer JD, Stramer SL, Hall AJ, Gundlapalli AV, MacNeil A, McCord R, Sunshine G, Howard-Williams M, Dunphy C, Jones JM. Association of Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seroprevalence and State-Issued Nonpharmaceutical Interventions: United States, 1 August 2020 to 30 March 2021. Clin Infect Dis 2022; 75:S264-S270. [PMID: 35684974 PMCID: PMC9214164 DOI: 10.1093/cid/ciac469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We assess if state-issued nonpharmaceutical interventions (NPIs) are associated with reduced rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as measured through anti-nucleocapsid (anti-N) seroprevalence, a proxy for cumulative prior infection that distinguishes seropositivity from vaccination. METHODS Monthly anti-N seroprevalence during 1 August 2020 to 30 March 2021 was estimated using a nationwide blood donor serosurvey. Using multivariable logistic regression models, we measured the association of seropositivity and state-issued, county-specific NPIs for mask mandates, gathering bans, and bar closures. RESULTS Compared with individuals living in a county with all three NPIs in place, the odds of having anti-N antibodies were 2.2 (95% confidence interval [CI]: 2.0-2.3) times higher for people living in a county that did not have any of the 3 NPIs, 1.6 (95% CI: 1.5-1.7) times higher for people living in a county that only had a mask mandate and gathering ban policy, and 1.4 (95% CI: 1.3-1.5) times higher for people living in a county that had only a mask mandate. CONCLUSIONS Consistent with studies assessing NPIs relative to COVID-19 incidence and mortality, the presence of NPIs were associated with lower SARS-CoV-2 seroprevalence indicating lower rates of cumulative infections. Multiple NPIs are likely more effective than single NPIs.
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Affiliation(s)
- Maureen J. Miller
- Corresponding author: Maureen J. Miller, MD MPH, CDC COVID-19 Response, 1600 Clifton Rd. NE, MS 10-1, Atlanta, GA 30329-4027 ()
| | | | - Natalie Fitch
- Georgia Tech Research Institute, Atlanta, Georgia, USA
| | | | - Dane Freeman
- Georgia Tech Research Institute, Atlanta, Georgia, USA
| | | | - Kevin Berney
- Geospatial Research, Analysis, and Services Program (GRASP), Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia, USA
| | - Gery P. Guy
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Tina J. Benoit
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Kristie E.N. Clarke
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | | | - Susan L. Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Aron J. Hall
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Adi V. Gundlapalli
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Adam MacNeil
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Russell McCord
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Gregory Sunshine
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mara Howard-Williams
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Christopher Dunphy
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Jefferson M. Jones
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Clarke KE, Jones JM, Deng Y, Nycz E, Lee A, Iachan R, Gundlapalli AV, Hall AJ, MacNeil A. Seroprevalence of Infection-Induced SARS-CoV-2 Antibodies - United States, September 2021-February 2022. MMWR Morb Mortal Wkly Rep 2022; 71:606-608. [PMID: 35482574 PMCID: PMC9098232 DOI: 10.15585/mmwr.mm7117e3] [Citation(s) in RCA: 167] [Impact Index Per Article: 83.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In December 2021, the B.1.1.529 (Omicron) variant of SARS-CoV-2, the virus that causes COVID-19, became predominant in the United States. Subsequently, national COVID-19 case rates peaked at their highest recorded levels.* Traditional methods of disease surveillance do not capture all COVID-19 cases because some are asymptomatic, not diagnosed, or not reported; therefore, the proportion of the population with SARS-CoV-2 antibodies (i.e., seroprevalence) can improve understanding of population-level incidence of COVID-19. This report uses data from CDC's national commercial laboratory seroprevalence study and the 2018 American Community Survey to examine U.S. trends in infection-induced SARS-CoV-2 seroprevalence during September 2021-February 2022, by age group.
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Block JP, Boehmer TK, Forrest CB, Carton TW, Lee GM, Ajani UA, Christakis DA, Cowell LG, Draper C, Ghildayal N, Harris AM, Kappelman MD, Ko JY, Mayer KH, Nagavedu K, Oster ME, Paranjape A, Puro J, Ritchey MD, Shay DK, Thacker D, Gundlapalli AV. Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination - PCORnet, United States, January 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:517-523. [PMID: 35389977 PMCID: PMC8989373 DOI: 10.15585/mmwr.mm7114e1] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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32
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Hernandez-Romieu AC, Carton TW, Saydah S, Azziz-Baumgartner E, Boehmer TK, Garret NY, Bailey LC, Cowell LG, Draper C, Mayer KH, Nagavedu K, Puro JE, Rasmussen SA, Trick WE, Wanga V, Chevinsky JR, Jackson BR, Goodman AB, Cope JR, Gundlapalli AV, Block JP. Prevalence of Select New Symptoms and Conditions Among Persons Aged Younger Than 20 Years and 20 Years or Older at 31 to 150 Days After Testing Positive or Negative for SARS-CoV-2. JAMA Netw Open 2022; 5:e2147053. [PMID: 35119459 PMCID: PMC8817203 DOI: 10.1001/jamanetworkopen.2021.47053] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE New symptoms and conditions can develop following SARS-CoV-2 infection. Whether they occur more frequently among persons with SARS-CoV-2 infection compared with those without is unclear. OBJECTIVE To compare the prevalence of new diagnoses of select symptoms and conditions between 31 and 150 days after testing among persons who tested positive vs negative for SARS-CoV-2. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed aggregated electronic health record data from 40 health care systems, including 338 024 persons younger than 20 years and 1 790 886 persons aged 20 years or older who were tested for SARS-CoV-2 during March to December 2020 and who had medical encounters between 31 and 150 days after testing. MAIN OUTCOMES AND MEASURES International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes were used to capture new symptoms and conditions that were recorded 31 to 150 days after a SARS-CoV-2 test but absent in the 18 months to 7 days prior to testing. The prevalence of new symptoms and conditions was compared between persons with positive and negative SARS-CoV-2 tests stratified by age (20 years or older and young than 20 years) and care setting (nonhospitalized, hospitalized, or hospitalized and ventilated). RESULTS A total of 168 701 persons aged 20 years or older and 26 665 younger than 20 years tested positive for SARS-CoV-2, and 1 622 185 persons aged 20 years or older and 311 359 younger than 20 years tested negative. Shortness of breath was more common among persons with a positive vs negative test result among hospitalized patients (≥20 years: prevalence ratio [PR], 1.89 [99% CI, 1.79-2.01]; <20 years: PR, 1.72 [99% CI, 1.17-2.51]). Shortness of breath was also more common among nonhospitalized patients aged 20 years or older with a positive vs negative test result (PR, 1.09 [99% CI, 1.05-1.13]). Among hospitalized persons aged 20 years or older, the prevalence of new fatigue (PR, 1.35 [99% CI, 1.27-1.44]) and type 2 diabetes (PR, 2.03 [99% CI, 1.87-2.19]) was higher among those with a positive vs a negative test result. Among hospitalized persons younger than 20 years, the prevalence of type 2 diabetes (PR, 2.14 [99% CI, 1.13-4.06]) was higher among those with a positive vs a negative test result; however, the prevalence difference was less than 1%. CONCLUSIONS AND RELEVANCE In this cohort study, among persons hospitalized after a positive SARS-CoV-2 test result, diagnoses of certain symptoms and conditions were higher than among those with a negative test result. Health care professionals should be aware of symptoms and conditions that may develop after SARS-CoV-2 infection, particularly among those hospitalized after diagnosis.
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Affiliation(s)
- Alfonso C Hernandez-Romieu
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sharon Saydah
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Tegan K Boehmer
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nedra Y Garret
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - L Charles Bailey
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lindsay G Cowell
- Department of Population and Data Sciences, Department of Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Christine Draper
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville
| | - William E Trick
- Health Research & Solutions, Cook County Health, Chicago, Illinois
| | - Valentine Wanga
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Chevinsky
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan R Jackson
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyson B Goodman
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Cope
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adi V Gundlapalli
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
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Lee P, Abernethy A, Shaywitz D, Gundlapalli AV, Weinstein J, Doraiswamy PM, Schulman K, Madhavan S. Digital Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. NAM Perspect 2022; 2022:202201c. [PMID: 35402858 PMCID: PMC8970223 DOI: 10.31478/202201c] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
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Barrett CE, Koyama AK, Alvarez P, Chow W, Lundeen EA, Perrine CG, Pavkov ME, Rolka DB, Wiltz JL, Bull-Otterson L, Gray S, Boehmer TK, Gundlapalli AV, Siegel DA, Kompaniyets L, Goodman AB, Mahon BE, Tauxe RV, Remley K, Saydah S. Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years - United States, March 1, 2020-June 28, 2021. MMWR Morb Mortal Wkly Rep 2022; 71:59-65. [PMID: 35025851 PMCID: PMC8757617 DOI: 10.15585/mmwr.mm7102e2] [Citation(s) in RCA: 161] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic has disproportionately affected people with diabetes, who are at increased risk of severe COVID-19.* Increases in the number of type 1 diabetes diagnoses (1,2) and increased frequency and severity of diabetic ketoacidosis (DKA) at the time of diabetes diagnosis (3) have been reported in European pediatric populations during the COVID-19 pandemic. In adults, diabetes might be a long-term consequence of SARS-CoV-2 infection (4-7). To evaluate the risk for any new diabetes diagnosis (type 1, type 2, or other diabetes) >30 days† after acute infection with SARS-CoV-2 (the virus that causes COVID-19), CDC estimated diabetes incidence among patients aged <18 years (patients) with diagnosed COVID-19 from retrospective cohorts constructed using IQVIA health care claims data from March 1, 2020, through February 26, 2021, and compared it with incidence among patients matched by age and sex 1) who did not receive a COVID-19 diagnosis during the pandemic, or 2) who received a prepandemic non-COVID-19 acute respiratory infection (ARI) diagnosis. Analyses were replicated using a second data source (HealthVerity; March 1, 2020-June 28, 2021) that included patients who had any health care encounter possibly related to COVID-19. Among these patients, diabetes incidence was significantly higher among those with COVID-19 than among those 1) without COVID-19 in both databases (IQVIA: hazard ratio [HR] = 2.66, 95% CI = 1.98-3.56; HealthVerity: HR = 1.31, 95% CI = 1.20-1.44) and 2) with non-COVID-19 ARI in the prepandemic period (IQVIA, HR = 2.16, 95% CI = 1.64-2.86). The observed increased risk for diabetes among persons aged <18 years who had COVID-19 highlights the importance of COVID-19 prevention strategies, including vaccination, for all eligible persons in this age group,§ in addition to chronic disease prevention and management. The mechanism of how SARS-CoV-2 might lead to incident diabetes is likely complex and could differ by type 1 and type 2 diabetes. Monitoring for long-term consequences, including signs of new diabetes, following SARS-CoV-2 infection is important in this age group.
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Yek C, Warner S, Wiltz JL, Sun J, Adjei S, Mancera A, Silk BJ, Gundlapalli AV, Harris AM, Boehmer TK, Kadri SS. Risk Factors for Severe COVID-19 Outcomes Among Persons Aged ≥18 Years Who Completed a Primary COVID-19 Vaccination Series - 465 Health Care Facilities, United States, December 2020-October 2021. MMWR Morb Mortal Wkly Rep 2022; 71:19-25. [PMID: 34990440 PMCID: PMC8735560 DOI: 10.15585/mmwr.mm7101a4] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Shrestha SS, Kompaniyets L, Grosse SD, Harris AM, Baggs J, Sircar K, Gundlapalli AV. Estimation of Coronavirus Disease 2019 Hospitalization Costs From a Large Electronic Administrative Discharge Database, March 2020-July 2021. Open Forum Infect Dis 2021; 8:ofab561. [PMID: 34938822 PMCID: PMC8686820 DOI: 10.1093/ofid/ofab561] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Information on the costs of inpatient care for patients with coronavirus disease 2019 (COVID-19) is very limited. This study estimates the per-patient cost of inpatient care for adult COVID-19 patients seen at >800 US hospitals. Methods Patients aged ≥18 years with ≥1 hospitalization during March 2020–July 2021 with a COVID-19 diagnosis code in a large electronic administrative discharge database were included. We used validated costs when reported; otherwise, costs were calculated using charges multiplied by cost-to-charge ratios. We estimated costs of inpatient care per patient overall and by severity indicator, age, sex, underlying medical conditions, and acute complications of COVID-19 using a generalized linear model with log link function and gamma distribution. Results The overall cost among 654673 patients hospitalized with COVID-19 was $16.2 billion. Estimated per-patient hospitalization cost was $24 826. Among surviving patients, estimated per-patient cost was $13 090 without intensive care unit (ICU) admission or invasive mechanical ventilation (IMV), $21 222 with ICU admission alone, and $59 742 with IMV. Estimated per-patient cost among patients who died was $27 017. Adjusted cost differential was higher among patients with certain underlying conditions (eg, chronic kidney disease [$12 391], liver disease [$8878], cerebrovascular disease [$7267], and obesity [$5933]) and acute complications (eg, acute respiratory distress syndrome [$43 912], pneumothorax [$25 240], and intracranial hemorrhage [$22 280]). Conclusions The cost of inpatient care for COVID-19 patients was substantial through the first 17 months of the pandemic. These estimates can be used to inform policy makers and planners and cost-effectiveness analysis of public health interventions to alleviate the burden of COVID-19.
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Affiliation(s)
- Sundar S Shrestha
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron M Harris
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kanta Sircar
- Division of Environmental Health Science and Practice. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adi V Gundlapalli
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Jones JM, Stone M, Sulaeman H, Fink RV, Dave H, Levy ME, Di Germanio C, Green V, Notari E, Saa P, Biggerstaff BJ, Strauss D, Kessler D, Vassallo R, Reik R, Rossmann S, Destree M, Nguyen KA, Sayers M, Lough C, Bougie DW, Ritter M, Latoni G, Weales B, Sime S, Gorlin J, Brown NE, Gould CV, Berney K, Benoit TJ, Miller MJ, Freeman D, Kartik D, Fry AM, Azziz-Baumgartner E, Hall AJ, MacNeil A, Gundlapalli AV, Basavaraju SV, Gerber SI, Patton ME, Custer B, Williamson P, Simmons G, Thornburg NJ, Kleinman S, Stramer SL, Opsomer J, Busch MP. Estimated US Infection- and Vaccine-Induced SARS-CoV-2 Seroprevalence Based on Blood Donations, July 2020-May 2021. JAMA 2021; 326:1400-1409. [PMID: 34473201 PMCID: PMC8414359 DOI: 10.1001/jama.2021.15161] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE People who have been infected with or vaccinated against SARS-CoV-2 have reduced risk of subsequent infection, but the proportion of people in the US with SARS-CoV-2 antibodies from infection or vaccination is uncertain. OBJECTIVE To estimate trends in SARS-CoV-2 seroprevalence related to infection and vaccination in the US population. DESIGN, SETTING, AND PARTICIPANTS In a repeated cross-sectional study conducted each month during July 2020 through May 2021, 17 blood collection organizations with blood donations from all 50 US states; Washington, DC; and Puerto Rico were organized into 66 study-specific regions, representing a catchment of 74% of the US population. For each study region, specimens from a median of approximately 2000 blood donors were selected and tested each month; a total of 1 594 363 specimens were initially selected and tested. The final date of blood donation collection was May 31, 2021. EXPOSURE Calendar time. MAIN OUTCOMES AND MEASURES Proportion of persons with detectable SARS-CoV-2 spike and nucleocapsid antibodies. Seroprevalence was weighted for demographic differences between the blood donor sample and general population. Infection-induced seroprevalence was defined as the prevalence of the population with both spike and nucleocapsid antibodies. Combined infection- and vaccination-induced seroprevalence was defined as the prevalence of the population with spike antibodies. The seroprevalence estimates were compared with cumulative COVID-19 case report incidence rates. RESULTS Among 1 443 519 specimens included, 733 052 (50.8%) were from women, 174 842 (12.1%) were from persons aged 16 to 29 years, 292 258 (20.2%) were from persons aged 65 years and older, 36 654 (2.5%) were from non-Hispanic Black persons, and 88 773 (6.1%) were from Hispanic persons. The overall infection-induced SARS-CoV-2 seroprevalence estimate increased from 3.5% (95% CI, 3.2%-3.8%) in July 2020 to 20.2% (95% CI, 19.9%-20.6%) in May 2021; the combined infection- and vaccination-induced seroprevalence estimate in May 2021 was 83.3% (95% CI, 82.9%-83.7%). By May 2021, 2.1 SARS-CoV-2 infections (95% CI, 2.0-2.1) per reported COVID-19 case were estimated to have occurred. CONCLUSIONS AND RELEVANCE Based on a sample of blood donations in the US from July 2020 through May 2021, vaccine- and infection-induced SARS-CoV-2 seroprevalence increased over time and varied by age, race and ethnicity, and geographic region. Despite weighting to adjust for demographic differences, these findings from a national sample of blood donors may not be representative of the entire US population.
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Affiliation(s)
- Jefferson M. Jones
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California
| | | | | | - Honey Dave
- Vitalant Research Institute, San Francisco, California
| | | | | | | | - Edward Notari
- Scientific Affairs, American Red Cross, Rockville, Maryland
| | - Paula Saa
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | - Brad J. Biggerstaff
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | - Chris Lough
- LifeSouth Community Blood Centers, Gainesville, Florida
| | | | | | - Gerardo Latoni
- Banco de Sangre de Servicios Mutuos, San Juan, Puerto Rico
| | | | | | - Jed Gorlin
- Innovative Blood Resources, St Paul, Minnesota
| | - Nicole E. Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn V. Gould
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin Berney
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tina J. Benoit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen J. Miller
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Alicia M. Fry
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Aron J. Hall
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam MacNeil
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adi V. Gundlapalli
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sridhar V. Basavaraju
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I. Gerber
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica E. Patton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
| | | | | | - Natalie J. Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
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Boehmer TK, Kompaniyets L, Lavery AM, Hsu J, Ko JY, Yusuf H, Romano SD, Gundlapalli AV, Oster ME, Harris AM. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data - United States, March 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1228-1232. [PMID: 34473684 PMCID: PMC8422872 DOI: 10.15585/mmwr.mm7035e5] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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DeStefano CB, Shaw K, Gundlapalli AV, Chung KK, Poltavskiy E, Stewart IJ. Incidence of cancer among U.S. combat casualties: a DoD Trauma Registry study. Am J Hematol 2021; 96:E324-E327. [PMID: 34029400 PMCID: PMC8453831 DOI: 10.1002/ajh.26252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Christin B. DeStefano
- Department of Hematology and Oncology David Grant USAF Medical Center Fairfield California USA
- Department of Medicine Uniformed Services University of the Health Sciences Bethesda Maryland USA
| | - Krista Shaw
- Department of Internal Medicine Keesler Medical Center Biloxi Mississippi USA
| | - Adi V. Gundlapalli
- Department of Internal Medicine Veterans Affairs Salt Lake City Health Care System Salt Lake City Utah USA
- Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA
| | - Kevin K. Chung
- Department of Medicine Uniformed Services University of the Health Sciences Bethesda Maryland USA
| | - Eduard Poltavskiy
- Department of Hematology and Oncology David Grant USAF Medical Center Fairfield California USA
| | - Ian J. Stewart
- Department of Medicine Uniformed Services University of the Health Sciences Bethesda Maryland USA
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Kadri SS, Sun J, Lawandi A, Strich JR, Busch LM, Keller M, Babiker A, Yek C, Malik S, Krack J, Dekker JP, Spaulding AB, Ricotta E, Powers JH, Rhee C, Klompas M, Athale J, Boehmer TK, Gundlapalli AV, Bentley W, Datta SD, Danner RL, Demirkale CY, Warner S. Association Between Caseload Surge and COVID-19 Survival in 558 U.S. Hospitals, March to August 2020. Ann Intern Med 2021; 174:1240-1251. [PMID: 34224257 PMCID: PMC8276718 DOI: 10.7326/m21-1213] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Several U.S. hospitals had surges in COVID-19 caseload, but their effect on COVID-19 survival rates remains unclear, especially independent of temporal changes in survival. OBJECTIVE To determine the association between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk and identify effect modifiers of this relationship. DESIGN Retrospective cohort study. (ClinicalTrials.gov: NCT04688372). SETTING 558 U.S. hospitals in the Premier Healthcare Database. PARTICIPANTS Adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020. MEASUREMENTS Each hospital-month was stratified by percentile rank on a surge index (a severity-weighted measure of COVID-19 caseload relative to pre-COVID-19 bed capacity). The effect of surge index on risk-adjusted odds ratio (aOR) of in-hospital mortality or discharge to hospice was calculated using hierarchical modeling; interaction by surge attributes was assessed. RESULTS Of 144 116 inpatients with COVID-19 at 558 U.S. hospitals, 78 144 (54.2%) were admitted to hospitals in the top surge index decile. Overall, 25 344 (17.6%) died; crude COVID-19 mortality decreased over time across all surge index strata. However, compared with nonsurging (<50th surge index percentile) hospital-months, aORs in the 50th to 75th, 75th to 90th, 90th to 95th, 95th to 99th, and greater than 99th percentiles were 1.11 (95% CI, 1.01 to 1.23), 1.24 (CI, 1.12 to 1.38), 1.42 (CI, 1.27 to 1.60), 1.59 (CI, 1.41 to 1.80), and 2.00 (CI, 1.69 to 2.38), respectively. The surge index was associated with mortality across ward, intensive care unit, and intubated patients. The surge-mortality relationship was stronger in June to August than in March to May (slope difference, 0.10 [CI, 0.033 to 0.16]) despite greater corticosteroid use and more judicious intubation during later and higher-surging months. Nearly 1 in 4 COVID-19 deaths (5868 [CI, 3584 to 8171]; 23.2%) was potentially attributable to hospitals strained by surging caseload. LIMITATION Residual confounding. CONCLUSION Despite improvements in COVID-19 survival between March and August 2020, surges in hospital COVID-19 caseload remained detrimental to survival and potentially eroded benefits gained from emerging treatments. Bolstering preventive measures and supporting surging hospitals will save many lives. PRIMARY FUNDING SOURCE Intramural Research Program of the National Institutes of Health Clinical Center, the National Institute of Allergy and Infectious Diseases, and the National Cancer Institute.
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Affiliation(s)
- Sameer S Kadri
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Junfeng Sun
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Alexander Lawandi
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Jeffrey R Strich
- National Institutes of Health Clinical Center, Bethesda, Maryland, and U.S. Public Health Service, Rockville, Maryland (J.R.S.)
| | - Lindsay M Busch
- National Institutes of Health Clinical Center, Bethesda, Maryland, and Emory University School of Medicine, Atlanta, Georgia (L.M.B.)
| | - Michael Keller
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Ahmed Babiker
- Emory University School of Medicine, Atlanta, Georgia (A.B.)
| | - Christina Yek
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Seidu Malik
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Janell Krack
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - John P Dekker
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland (J.P.D., E.R.)
| | - Alicen B Spaulding
- Children's Minnesota Research Institute, Minneapolis, Minnesota (A.B.S.)
| | - Emily Ricotta
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland (J.P.D., E.R.)
| | - John H Powers
- Frederick National Laboratory for Cancer Research, Frederick, Maryland (J.H.P.)
| | - Chanu Rhee
- Brigham and Women's Hospital, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (C.R., M.K.)
| | - Michael Klompas
- Brigham and Women's Hospital, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (C.R., M.K.)
| | - Janhavi Athale
- National Institutes of Health Clinical Center, Bethesda, Maryland, and Mayo Clinic Arizona, Phoenix, Arizona (J.A.)
| | - Tegan K Boehmer
- U.S. Public Health Service, Rockville, Maryland, and Centers for Disease Control and Prevention, Atlanta, Georgia (T.K.B.)
| | - Adi V Gundlapalli
- Centers for Disease Control and Prevention, Atlanta, Georgia (A.V.G., S.D.D.)
| | - William Bentley
- Centers for Disease Control and Prevention, Atlanta, Georgia, and General Dynamics Information Technology, Falls Church, Virginia (W.B.)
| | - S Deblina Datta
- Centers for Disease Control and Prevention, Atlanta, Georgia (A.V.G., S.D.D.)
| | - Robert L Danner
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Cumhur Y Demirkale
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
| | - Sarah Warner
- National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.)
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41
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Handberry M, Bull-Otterson L, Dai M, Mann NC, Chaney E, Ratto J, Horiuchi K, Siza C, Kulkarni A, Gundlapalli AV, Boehmer TK. Changes in Emergency Medical Services Before and During the COVID-19 Pandemic in the United States, January 2018-December 2020. Clin Infect Dis 2021; 73:S84-S91. [PMID: 33956123 PMCID: PMC8135919 DOI: 10.1093/cid/ciab373] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background As a result of the continuing surge of COVID-19, many patients have delayed or missed routine screening and preventive services. Medical conditions, such as coronary heart disease, mental health issues, and substance use disorder, may be identified later, leading to increases in patient morbidity and mortality. Methods The National Emergency Medical Services Information System (NEMSIS) data were used to assess 911 Emergency Medical Services (EMS) activations during 2018–2020. For specific activation types, the percentage of total activations was calculated per week and joinpoint analysis was used to identify changes over time. Results Since March 2020, the number of 911 emergency medical services (EMS) activations has decreased, while the percentages of on-scene death, cardiac arrest, and opioid use/overdose EMS activations were higher than pre-pandemic levels. During the early pandemic period, percentages of total EMS activations increased for on-scene death (from 1.3% to 2.4% during weeks 11–15), cardiac arrest (from 1.3% to 2.2% during weeks 11–15), and opioid use/overdose (from 0.6% to 1.1% during weeks 8–18); the percentages then declined, but remained above pre-pandemic levels through calendar week 52. Conclusions The COVID-19 pandemic has indirect consequences, such as relative increases in EMS activations for cardiac events and opioid use/overdose, possibly linked to disruptions is healthcare access and health-seeking behaviors. Increasing telehealth visits or other opportunities for patient-provider touch points for chronic disease and substance use disorders that emphasize counseling, preventive care, and expanded access to medications can disrupt delayed care-seeking during the pandemic and potentially prevent premature death.
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Affiliation(s)
- Maya Handberry
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA
| | - Lara Bull-Otterson
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA.,CDC COVID-19 Emergency Response, CDC, Atlanta, Georgia, USA
| | - Mengtao Dai
- NEMSIS Technical Assistant Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - N Clay Mann
- NEMSIS Technical Assistant Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Eric Chaney
- National Highway Traffic Safety Administration, Washington, DC, USA
| | - Jeff Ratto
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA
| | | | - Charlene Siza
- CDC COVID-19 Emergency Response, CDC, Atlanta, Georgia, USA
| | | | - Adi V Gundlapalli
- CDC COVID-19 Emergency Response, CDC, Atlanta, Georgia, USA.,Public Health Informatics Office, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA
| | - Tegan K Boehmer
- National Highway Traffic Safety Administration, Washington, DC, USA.,Public Health Informatics Office, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA.,United States Public Health Service Commissioned Corps, Rockville, Maryland, USA
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Chevinsky JR, Tao G, Lavery AM, Kukielka EA, Click ES, Malec D, Kompaniyets L, Bruce BB, Yusuf H, Goodman AB, Dixon MG, Nakao JH, Datta SD, MacKenzie WR, Kadri SS, Saydah S, Giovanni JE, Gundlapalli AV. Late Conditions Diagnosed 1-4 Months Following an Initial Coronavirus Disease 2019 (COVID-19) Encounter: A Matched-Cohort Study Using Inpatient and Outpatient Administrative Data-United States, 1 March-30 June 2020. Clin Infect Dis 2021; 73:S5-S16. [PMID: 33909072 PMCID: PMC8135331 DOI: 10.1093/cid/ciab338] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Late sequelae of COVID-19 have been reported; however, few studies have investigated the time course or incidence of late new COVID-19-related health conditions (post-COVID conditions) after COVID-19 diagnosis. Studies distinguishing post-COVID conditions from late conditions caused by other etiologies are lacking. Using data from a large administrative all-payer database, we assessed type, association, and timing of post-COVID conditions following COVID-19 diagnosis. METHODS Using the Premier Healthcare Database Special COVID-19 Release (release date, 20 October 2020) data, during March-June 2020, 27 589 inpatients and 46 857 outpatients diagnosed with COVID-19 (case-patients) were 1:1 matched with patients without COVID-19 through the 4-month follow-up period (control-patients) by using propensity score matching. In this matched-cohort study, adjusted ORs were calculated to assess for late conditions that were more common in case-patients than control-patients. Incidence proportion was calculated for conditions that were more common in case-patients than control-patients during 31-120 days following a COVID-19 encounter. RESULTS During 31-120 days after an initial COVID-19 inpatient hospitalization, 7.0% of adults experienced ≥1 of 5 post-COVID conditions. Among adult outpatients with COVID-19, 7.7% experienced ≥1 of 10 post-COVID conditions. During 31-60 days after an initial outpatient encounter, adults with COVID-19 were 2.8 times as likely to experience acute pulmonary embolism as outpatient control-patients and also more likely to experience a range of conditions affecting multiple body systems (eg, nonspecific chest pain, fatigue, headache, and respiratory, nervous, circulatory, and gastrointestinal symptoms) than outpatient control-patients. CONCLUSIONS These findings add to the evidence of late health conditions possibly related to COVID-19 in adults following COVID-19 diagnosis and can inform healthcare practice and resource planning for follow-up COVID-19 care.
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Affiliation(s)
- Jennifer R Chevinsky
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Guoyu Tao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy M Lavery
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Esther A Kukielka
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eleanor S Click
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Donald Malec
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lyudmyla Kompaniyets
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Beau B Bruce
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hussain Yusuf
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alyson B Goodman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith G Dixon
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jolene H Nakao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Deblina Datta
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William R MacKenzie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sameer S Kadri
- Clinical Epidemiology Section, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Sharon Saydah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer E Giovanni
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adi V Gundlapalli
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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43
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Ko JY, DeSisto CL, Simeone RM, Ellington S, Galang RR, Oduyebo T, Gilboa SM, Lavery AM, Gundlapalli AV, Shapiro-Mendoza CK. Adverse Pregnancy Outcomes, Maternal Complications, and Severe Illness Among US Delivery Hospitalizations With and Without a Coronavirus Disease 2019 (COVID-19) Diagnosis. Clin Infect Dis 2021; 73:S24-S31. [PMID: 33977298 PMCID: PMC8136045 DOI: 10.1093/cid/ciab344] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Evidence on risk for adverse outcomes from COVID-19 among pregnant women is still emerging. We examined the association between COVID-19 at delivery and adverse pregnancy outcomes, maternal complications, and severe illness, whether these associations differ by race/ethnicity; and described discharge status by COVID-19 diagnosis and maternal complications. Methods Data from 703 hospitals in the Premier Healthcare Database during March–September 2020 were included. Adjusted risk ratios overall and stratified by race/ethnicity were estimated using Poisson regression with robust standard errors. Proportion not discharged home was calculated by maternal complications, stratified by COVID-19 diagnosis. Results Among 489,471 delivery hospitalizations, 6,550 (1.3%) had a COVID-19 diagnosis. In adjusted models, COVID-19 was associated with increased risk for: acute respiratory distress syndrome (adjusted risk ratio [aRR] = 34.4), death (aRR = 17.0), sepsis (aRR = 13.6), mechanical ventilation (aRR = 12.7), shock (aRR = 5.1), intensive care unit admission (aRR = 3.6), acute renal failure (aRR = 3.5), thromboembolic disease (aRR = 2.7), adverse cardiac event/outcome (aRR = 2.2) and preterm labor with preterm delivery (aRR = 1.2). Risk for any maternal complications or for any severe illness did not significantly differ by race/ethnicity. Discharge status did not differ by COVID-19; however, among women with concurrent maternal complications, a greater proportion of those with (versus without) COVID-19 were not discharged home. Conclusions These findings emphasize the importance of implementing recommended mitigation strategies to reduce risk for SARS-CoV-2 infection and further inform counseling and clinical care for pregnant women during the COVID-19 pandemic.
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Affiliation(s)
- Jean Y Ko
- CDC COVID-19 Response Team, Atlanta, Georgia, USA.,US Public Health Service, Commissioned Corps, Rockville, Maryland, USA
| | | | | | | | | | | | | | - Amy M Lavery
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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44
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Kompaniyets L, Pennington AF, Goodman AB, Rosenblum HG, Belay B, Ko JY, Chevinsky JR, Schieber LZ, Summers AD, Lavery AM, Preston LE, Danielson ML, Cui Z, Namulanda G, Yusuf H, Mac Kenzie WR, Wong KK, Baggs J, Boehmer TK, Gundlapalli AV. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021. Prev Chronic Dis 2021; 18:E66. [PMID: 34197283 PMCID: PMC8269743 DOI: 10.5888/pcd18.210123] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Severe COVID-19 illness in adults has been linked to underlying medical conditions. This study identified frequent underlying conditions and their attributable risk of severe COVID-19 illness. METHODS We used data from more than 800 US hospitals in the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to describe hospitalized patients aged 18 years or older with COVID-19 from March 2020 through March 2021. We used multivariable generalized linear models to estimate adjusted risk of intensive care unit admission, invasive mechanical ventilation, and death associated with frequent conditions and total number of conditions. RESULTS Among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition. Essential hypertension (50.4%), disorders of lipid metabolism (49.4%), and obesity (33.0%) were the most common. The strongest risk factors for death were obesity (adjusted risk ratio [aRR] = 1.30; 95% CI, 1.27-1.33), anxiety and fear-related disorders (aRR = 1.28; 95% CI, 1.25-1.31), and diabetes with complication (aRR = 1.26; 95% CI, 1.24-1.28), as well as the total number of conditions, with aRRs of death ranging from 1.53 (95% CI, 1.41-1.67) for patients with 1 condition to 3.82 (95% CI, 3.45-4.23) for patients with more than 10 conditions (compared with patients with no conditions). CONCLUSION Certain underlying conditions and the number of conditions were associated with severe COVID-19 illness. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, and anxiety disorders were the strongest risk factors for severe COVID-19 illness. Careful evaluation and management of underlying conditions among patients with COVID-19 can help stratify risk for severe illness.
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Affiliation(s)
- Lyudmyla Kompaniyets
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-5, Atlanta GA 30341.
| | - Audrey F Pennington
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyson B Goodman
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Hannah G Rosenblum
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brook Belay
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y Ko
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Jennifer R Chevinsky
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyna Z Schieber
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April D Summers
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy M Lavery
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leigh Ellyn Preston
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa L Danielson
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zhaohui Cui
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gonza Namulanda
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hussain Yusuf
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William R Mac Kenzie
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Karen K Wong
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,US Public Health Service Commissioned Corps, Rockville, Maryland
| | - James Baggs
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tegan K Boehmer
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Adi V Gundlapalli
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rose AN, Baggs J, Wolford H, Neuhauser MM, Srinivasan A, Gundlapalli AV, Reddy S, Kompaniyets L, Pennington AF, Grigg C, Kabbani S. Trends in Antibiotic Use in United States Hospitals During the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2021; 8:ofab236. [PMID: 34226869 PMCID: PMC8244661 DOI: 10.1093/ofid/ofab236] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
We described antibiotic use among inpatients with coronavirus disease 2019 (COVID-19). Most
COVID-19 inpatients received antibiotic therapy. We also described hospital-wide antibiotic use
during 2020 compared with 2019, stratified by hospital COVID-19 burden. Although total
antibiotic use decreased between years, certain antibiotic use increased with higher COVID-19
burden.
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Affiliation(s)
- Ashley N Rose
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hannah Wolford
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melinda M Neuhauser
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Arjun Srinivasan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adi V Gundlapalli
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sujan Reddy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lyudmyla Kompaniyets
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Audrey F Pennington
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheri Grigg
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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46
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Kertesz SG, deRussy AJ, Kim YI, Hoge AE, Austin EL, Gordon AJ, Gelberg L, Gabrielian SE, Riggs KR, Blosnich JR, Montgomery AE, Holmes SK, Varley AL, Pollio DE, Gundlapalli AV, Jones AL. Comparison of Patient Experience Between Primary Care Settings Tailored for Homeless Clientele and Mainstream Care Settings. Med Care 2021; 59:495-503. [PMID: 33827104 PMCID: PMC8567819 DOI: 10.1097/mlr.0000000000001548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 1 million Americans receive primary care from federal homeless health care programs yearly. Vulnerabilities that can make care challenging include pain, addiction, psychological distress, and a lack of shelter. Research on the effectiveness of tailoring services for this population is limited. OBJECTIVE The aim was to examine whether homeless-tailored primary care programs offer a superior patient experience compared with nontailored ("mainstream") programs overall, and for highly vulnerable patients. RESEARCH DESIGN National patient survey comparing 26 US Department of Veterans Affairs (VA) Medical Centers' homeless-tailored primary care ("H-PACT"s) to mainstream primary care ("mainstream PACT"s) at the same locations. PARTICIPANTS A total of 5766 homeless-experienced veterans. MEASURES Primary care experience on 4 scales: Patient-Clinician Relationship, Cooperation, Accessibility/Coordination, and Homeless-Specific Needs. Mean scores (range: 1-4) were calculated and dichotomized as unfavorable versus not. We counted key vulnerabilities (chronic pain, unsheltered homelessness, severe psychological distress, and history of overdose, 0-4), and categorized homeless-experienced veterans as having fewer (≤1) and more (≥2) vulnerabilities. RESULTS H-PACTs outscored mainstream PACTs on all scales (all P<0.001). Unfavorable care experiences were more common in mainstream PACTs compared with H-PACTs, with adjusted risk differences of 11.9% (95% CI=6.3-17.4), 12.6% (6.2-19.1), 11.7% (6.0-17.3), and 12.6% (6.2-19.1) for Relationship, Cooperation, Access/Coordination, and Homeless-Specific Needs, respectively. For the Relationship and Cooperation scales, H-PACTs were associated with a greater reduction in unfavorable experience for patients with ≥2 vulnerabilities versus ≤1 (interaction P<0.0001). CONCLUSIONS Organizations that offer primary care for persons experiencing homelessness can improve the primary care experience by tailoring the design and delivery of services.
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Affiliation(s)
- Stefan G. Kertesz
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
- University of Alabama at Birmingham School of Public Health, 1665 University Blvd, Birmingham, AL 35233
| | - Aerin J. deRussy
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
| | - Young-il Kim
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
| | - April E. Hoge
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
| | - Erika L. Austin
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Public Health, 1665 University Blvd, Birmingham, AL 35233
| | - Adam J. Gordon
- VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073
- University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Sonya E. Gabrielian
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073
- University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Kevin R. Riggs
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
| | - John R. Blosnich
- University of Southern California, Los Angeles CA 90089
- VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA 15219
| | - Ann Elizabeth Montgomery
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Public Health, 1665 University Blvd, Birmingham, AL 35233
| | - Sally K. Holmes
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
| | - Allyson L. Varley
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
| | - David E. Pollio
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham College of Arts and Sciences, 1720 2 Ave. S., Birmingham AL 35294
| | - Adi V. Gundlapalli
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Audrey L. Jones
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073
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47
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Kompaniyets L, Agathis NT, Nelson JM, Preston LE, Ko JY, Belay B, Pennington AF, Danielson ML, DeSisto CL, Chevinsky JR, Schieber LZ, Yusuf H, Baggs J, Mac Kenzie WR, Wong KK, Boehmer TK, Gundlapalli AV, Goodman AB. Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children. JAMA Netw Open 2021; 4:e2111182. [PMID: 34097050 PMCID: PMC8185607 DOI: 10.1001/jamanetworkopen.2021.11182] [Citation(s) in RCA: 215] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Information on underlying conditions and severe COVID-19 illness among children is limited. OBJECTIVE To examine the risk of severe COVID-19 illness among children associated with underlying medical conditions and medical complexity. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included patients aged 18 years and younger with International Statistical Classification of Diseases, Tenth Revision, Clinical Modification code U07.1 (COVID-19) or B97.29 (other coronavirus) during an emergency department or inpatient encounter from March 2020 through January 2021. Data were collected from the Premier Healthcare Database Special COVID-19 Release, which included data from more than 800 US hospitals. Multivariable generalized linear models, controlling for patient and hospital characteristics, were used to estimate adjusted risk of severe COVID-19 illness associated with underlying medical conditions and medical complexity. EXPOSURES Underlying medical conditions and medical complexity (ie, presence of complex or noncomplex chronic disease). MAIN OUTCOMES AND MEASURES Hospitalization and severe illness when hospitalized (ie, combined outcome of intensive care unit admission, invasive mechanical ventilation, or death). RESULTS Among 43 465 patients with COVID-19 aged 18 years or younger, the median (interquartile range) age was 12 (4-16) years, 22 943 (52.8%) were female patients, and 12 491 (28.7%) had underlying medical conditions. The most common diagnosed conditions were asthma (4416 [10.2%]), neurodevelopmental disorders (1690 [3.9%]), anxiety and fear-related disorders (1374 [3.2%]), depressive disorders (1209 [2.8%]), and obesity (1071 [2.5%]). The strongest risk factors for hospitalization were type 1 diabetes (adjusted risk ratio [aRR], 4.60; 95% CI, 3.91-5.42) and obesity (aRR, 3.07; 95% CI, 2.66-3.54), and the strongest risk factors for severe COVID-19 illness were type 1 diabetes (aRR, 2.38; 95% CI, 2.06-2.76) and cardiac and circulatory congenital anomalies (aRR, 1.72; 95% CI, 1.48-1.99). Prematurity was a risk factor for severe COVID-19 illness among children younger than 2 years (aRR, 1.83; 95% CI, 1.47-2.29). Chronic and complex chronic disease were risk factors for hospitalization, with aRRs of 2.91 (95% CI, 2.63-3.23) and 7.86 (95% CI, 6.91-8.95), respectively, as well as for severe COVID-19 illness, with aRRs of 1.95 (95% CI, 1.69-2.26) and 2.86 (95% CI, 2.47-3.32), respectively. CONCLUSIONS AND RELEVANCE This cross-sectional study found a higher risk of severe COVID-19 illness among children with medical complexity and certain underlying conditions, such as type 1 diabetes, cardiac and circulatory congenital anomalies, and obesity. Health care practitioners could consider the potential need for close observation and cautious clinical management of children with these conditions and COVID-19.
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Affiliation(s)
- Lyudmyla Kompaniyets
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nickolas T. Agathis
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M. Nelson
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Leigh Ellyn Preston
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y. Ko
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Brook Belay
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Audrey F. Pennington
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa L. Danielson
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carla L. DeSisto
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R. Chevinsky
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyna Z. Schieber
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hussain Yusuf
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Baggs
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William R. Mac Kenzie
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Karen K. Wong
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Tegan K. Boehmer
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Adi V. Gundlapalli
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyson B. Goodman
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
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48
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Gundlapalli AV, Lavery AM, Boehmer TK, Beach MJ, Walke HT, Sutton PD, Anderson RN. Death Certificate-Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance - United States, January-December 2020. MMWR Morb Mortal Wkly Rep 2021; 70:523-527. [PMID: 33830982 PMCID: PMC8030983 DOI: 10.15585/mmwr.mm7014e2] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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49
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Bajema KL, Wiegand RE, Cuffe K, Patel SV, Iachan R, Lim T, Lee A, Moyse D, Havers FP, Harding L, Fry AM, Hall AJ, Martin K, Biel M, Deng Y, Meyer WA, Mathur M, Kyle T, Gundlapalli AV, Thornburg NJ, Petersen LR, Edens C. Estimated SARS-CoV-2 Seroprevalence in the US as of September 2020. JAMA Intern Med 2021; 181:450-460. [PMID: 33231628 PMCID: PMC7686880 DOI: 10.1001/jamainternmed.2020.7976] [Citation(s) in RCA: 203] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Case-based surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely underestimates the true prevalence of infections. Large-scale seroprevalence surveys can better estimate infection across many geographic regions. OBJECTIVE To estimate the prevalence of persons with SARS-CoV-2 antibodies using residual sera from commercial laboratories across the US and assess changes over time. DESIGN, SETTING, AND PARTICIPANTS This repeated, cross-sectional study conducted across all 50 states, the District of Columbia, and Puerto Rico used a convenience sample of residual serum specimens provided by persons of all ages that were originally submitted for routine screening or clinical management from 2 private clinical commercial laboratories. Samples were obtained during 4 collection periods: July 27 to August 13, August 10 to August 27, August 24 to September 10, and September 7 to September 24, 2020. EXPOSURES Infection with SARS-CoV-2. MAIN OUTCOMES AND MEASURES The proportion of persons previously infected with SARS-CoV-2 as measured by the presence of antibodies to SARS-CoV-2 by 1 of 3 chemiluminescent immunoassays. Iterative poststratification was used to adjust seroprevalence estimates to the demographic profile and urbanicity of each jurisdiction. Seroprevalence was estimated by jurisdiction, sex, age group (0-17, 18-49, 50-64, and ≥65 years), and metropolitan/nonmetropolitan status. RESULTS Of 177 919 serum samples tested, 103 771 (58.3%) were from women, 26 716 (15.0%) from persons 17 years or younger, 47 513 (26.7%) from persons 65 years or older, and 26 290 (14.8%) from individuals living in nonmetropolitan areas. Jurisdiction-level seroprevalence over 4 collection periods ranged from less than 1% to 23%. In 42 of 49 jurisdictions with sufficient samples to estimate seroprevalence across all periods, fewer than 10% of people had detectable SARS-CoV-2 antibodies. Seroprevalence estimates varied between sexes, across age groups, and between metropolitan/nonmetropolitan areas. Changes from period 1 to 4 were less than 7 percentage points in all jurisdictions and varied across sites. CONCLUSIONS AND RELEVANCE This cross-sectional study found that as of September 2020, most persons in the US did not have serologic evidence of previous SARS-CoV-2 infection, although prevalence varied widely by jurisdiction. Biweekly nationwide testing of commercial clinical laboratory sera can play an important role in helping track the spread of SARS-CoV-2 in the US.
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Affiliation(s)
- Kristina L Bajema
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan E Wiegand
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kendra Cuffe
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sadhna V Patel
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Travis Lim
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Fiona P Havers
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Alicia M Fry
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aron J Hall
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Mohit Mathur
- BioReference Laboratories, Elmwood Park, New Jersey
| | | | - Adi V Gundlapalli
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natalie J Thornburg
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyle R Petersen
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chris Edens
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
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50
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Kompaniyets L, Goodman AB, Belay B, Freedman DS, Sucosky MS, Lange SJ, Gundlapalli AV, Boehmer TK, Blanck HM. Body Mass Index and Risk for COVID-19-Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death - United States, March-December 2020. MMWR Morb Mortal Wkly Rep 2021; 70:355-361. [PMID: 33705371 PMCID: PMC7951819 DOI: 10.15585/mmwr.mm7010e4] [Citation(s) in RCA: 254] [Impact Index Per Article: 84.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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