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Tippett A, Ess G, Hussaini L, Reese O, Salazar L, Kelly M, Taylor M, Ciric C, Keane A, Cheng A, Gibson T, Li W, Hsiao HM, Bristow L, Hellmeister K, Al-Husein Z, Hubler R, Begier E, Liu Q, Gessner B, Swerdlow DL, Kamidani S, Kao C, Yildirim I, Rouphael N, Rostad CA, Anderson EJ. Influenza Vaccine Effectiveness Pre-pandemic Among Adults Hospitalized With Congestive Heart Failure or Chronic Obstructive Pulmonary Disease and Older Adults. Clin Infect Dis 2024; 78:1065-1072. [PMID: 37946601 DOI: 10.1093/cid/ciad679] [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: 08/18/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Data are limited on influenza vaccine effectiveness (VE) in the prevention of influenza-related hospitalizations in older adults and those with underlying high-risk comorbidities. METHODS We conducted a prospective, test-negative, case-control study at 2 US hospitals from October 2018-March 2020 among adults aged ≥50 years hospitalized with acute respiratory illnesses (ARIs) and adults ≥18 years admitted with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) exacerbations. Adults were eligible if they resided in 1 of 8 counties in metropolitan Atlanta, Georgia. Nasopharyngeal and oropharyngeal swabs were tested using BioFire FilmArray (bioMérieux, Inc.) respiratory panel, and standard-of-care molecular results were included when available. Influenza vaccination history was determined from the Georgia vaccine registry and medical records. We used multivariable logistic regression to control for potential confounders and to determine 95% confidence intervals (CIs). RESULTS Among 3090 eligible adults, 1562 (50.6%) were enrolled. Of the 1515 with influenza vaccination history available, 701 (46.2%) had received vaccination during that season. Influenza was identified in 37 (5.3%) vaccinated versus 78 (9.6%) unvaccinated participants. After adjustment for age, race/ethnicity, immunosuppression, month, and season, pooled VE for any influenza-related hospitalization in the eligible study population was 63.1% (95% CI, 43.8-75.8%). Adjusted VE against influenza-related hospitalization for ARI in adults ≥50 years was 55.9% (29.9-72.3%) and adjusted VE against influenza-related CHF/COPD exacerbation in adults ≥18 years was 80.3% (36.3-93.9%). CONCLUSIONS Influenza vaccination was effective in preventing influenza-related hospitalizations in adults aged ≥50 years and those with CHF/COPD exacerbations during the 2018-2020 seasons.
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Affiliation(s)
- Ashley Tippett
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gabby Ess
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Olivia Reese
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis Salazar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Kelly
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Meg Taylor
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Caroline Ciric
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amy Keane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Cheng
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wensheng Li
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laurel Bristow
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kieffer Hellmeister
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zayna Al-Husein
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Qing Liu
- Pfizer, Inc,New York, New York, USA
| | | | | | - Satoshi Kamidani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Carol Kao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Inci Yildirim
- Department of Pediatrics (Infectious Diseases), Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Public Health, Yale Institute for Global Health, New Haven, Connecticut, USA
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nadine Rouphael
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
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Qousain Naqvi ST, Muhammad SA, Guo J, Zafar S, Ali A, Anderson LJ, Rostad CA, Bai B. Experimental trials of predicted CD4 + and CD8 + T-cell epitopes of respiratory syncytial virus. Front Immunol 2024; 15:1349749. [PMID: 38629077 PMCID: PMC11018974 DOI: 10.3389/fimmu.2024.1349749] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) is the most common cause of viral lower respiratory tract infections (LRTIs) in young children around the world and an important cause of LRTI in the elderly. The available treatments and FDA-approved vaccines for RSV only lessen the severity of the infection and are recommended for infants and elderly people. Methods We focused on developing a broad-spectrum vaccine that activates the immune system to directly combat RSV. The objective of this study is to identify CD4+ and CD8+ T-cell epitopes using an immunoinformatics approach to develop RSV vaccines. The efficacy of these peptides was validated through in-vitro and in-vivo studies involving healthy and diseased animal models. Results For each major histocompatibility complex (MHC) class-I and II, we found three epitopes of RSV proteins including F, G, and SH with an antigenic score of >0.5 and a projected SVM score of <5. Experimental validation of these peptides on female BALB/c mice was conducted before and after infection with the RSV A2 line 19f. We found that the 3RVMHCI (CD8+) epitope of the F protein showed significant results of white blood cells (19.72 × 103 cells/μl), neutrophils (6.01 × 103 cells/μl), lymphocytes (12.98 × 103 cells/μl), IgG antibodies (36.9 µg/ml), IFN-γ (86.96 ng/L), and granzyme B (691.35 pg/ml) compared to control at the second booster dose of 10 µg. Similarly, 4RVMHCII (CD4+) of the F protein substantially induced white blood cells (27.08 × 103 cells/μl), neutrophils (6.58 × 103 cells/μl), lymphocytes (16.64 × 103 cells/μl), IgG antibodies (46.13 µg/ml), IFN-γ (96.45 ng/L), and granzyme B (675.09 pg/ml). In-vitro studies showed that 4RVMHCII produced a significant level of antibodies in sera on day 45 comparable to mice infected with the virus. 4RVMHCII also induced high IFN-γ and IL-2 secretions on the fourth day of the challenge compared to the preinfectional stage. Conclusion In conclusion, epitopes of the F protein showed considerable immune response and are suitable for further validation.
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Affiliation(s)
| | - Syed Aun Muhammad
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, Pakistan
| | - Jinlei Guo
- School of Intelligent Medical Engineering, Sanquan College of Xinxiang Medical University, Xinxiang, Henan, China
| | - Sidra Zafar
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, Pakistan
| | - Amjad Ali
- Atta-ur-Rehman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Larry J. Anderson
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Christina A. Rostad
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Baogang Bai
- School of Information and Technology, Wenzhou Business College, Wenzhou, Zhejiang, China
- Engineering Research Center of Intelligent Medicine, Wenzhou, Zhejiang Province, China
- The First School of Medical, School of Information and Engineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Loy CJ, Servellita V, Sotomayor-Gonzalez A, Bliss A, Lenz J, Belcher E, Suslovic W, Nguyen J, Williams ME, Oseguera M, Gardiner MA, Choi JH, Hsiao HM, Wang H, Kim J, Shimizu C, Tremoulet A, Delaney M, DeBiasi RL, Rostad CA, Burns JC, Chiu CY, Vlaminck ID. Plasma Cell-free RNA Signatures of Inflammatory Syndromes in Children. medRxiv 2024:2024.03.06.24303645. [PMID: 38496479 PMCID: PMC10942512 DOI: 10.1101/2024.03.06.24303645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Inflammatory syndromes, including those caused by infection, are a major cause of hospital admissions among children and are often misdiagnosed because of a lack of advanced molecular diagnostic tools. In this study, we explored the utility of circulating cell-free RNA (cfRNA) in plasma as an analyte for the differential diagnosis and characterization of pediatric inflammatory syndromes. We profiled cfRNA in 370 plasma samples from pediatric patients with a range of inflammatory conditions, including Kawasaki disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C), viral infections and bacterial infections. We developed machine learning models based on these cfRNA profiles, which effectively differentiated KD from MIS-C - two conditions presenting with overlapping symptoms - with high performance (Test Area Under the Curve (AUC) = 0.97). We further extended this methodology into a multiclass machine learning framework that achieved 81% accuracy in distinguishing among KD, MIS-C, viral, and bacterial infections. We further demonstrated that cfRNA profiles can be used to quantify injury to specific tissues and organs, including the liver, heart, endothelium, nervous system, and the upper respiratory tract. Overall, this study identified cfRNA as a versatile analyte for the differential diagnosis and characterization of a wide range of pediatric inflammatory syndromes.
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Jackson LA, Stapleton JT, Walter EB, Chen WH, Rouphael NG, Anderson EJ, Neuzil KM, Winokur PL, Smith MJ, Schmader KE, Swamy GK, Thompson AB, Mulligan MJ, Rostad CA, Cross K, Tsong R, Wegel A, Roberts PC. Immunogenicity and safety of varying dosages of a fifth-wave influenza A/H7N9 inactivated vaccine given with and without AS03 adjuvant in healthy adults. Vaccine 2024; 42:295-309. [PMID: 38105137 PMCID: PMC10790638 DOI: 10.1016/j.vaccine.2023.12.001] [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: 09/19/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Human infections with the avian influenza A(H7N9) virus were first reported in China in 2013 and continued to occur in annual waves. In the 2016/2017 fifth wave, Yangtze River Delta (YRD) lineage viruses, which differed antigenically from those of earlier waves, predominated. METHODS In this phase 2 double-blinded trial we randomized 720 adults ≥ 19 years of age to receive two injections of a YRD lineage inactivated A/Hong Kong/125/2017 fifth-wave H7N9 vaccine, given 21 days apart, at doses of 3.75, 7.5, and 15 µg of hemagglutinin (HA) with AS03A adjuvant and at doses of 15 and 45 µg of HA without adjuvant. RESULTS Two doses of adjuvanted vaccine were required to induce HA inhibition (HI) antibody titers ≥ 40 in most participants. After two doses of the 15 µg H7N9 formulation, given with or without AS03 adjuvant, the proportion achieving a HI titer ≥ 40 against the vaccine strain at 21 days after the second vaccination was 65 % (95 % CI, 57 %-73 %) and 0 % (95 % CI, 0 %-4%), respectively. Among those who received two doses of the 15 µg adjuvanted formulation the proportion with HI titer ≥ 40 at 21 days after the second vaccination was 76 % (95 % CI, 66 %-84 %) in those 19-64 years of age and 49 % (95 % CI, 37 %-62 %) in those ≥ 65 years of age. Responses to the adjuvanted vaccine formulations did not vary by HA content. Antibody responses declined over time and responses against drifted H7N9 strains were diminished. Overall, the vaccines were well tolerated but, as expected, adjuvanted vaccines were associated with more frequent solicited systemic and local adverse events. CONCLUSIONS AS03 adjuvant improved the immune responses to an inactivated fifth-wave H7N9 influenza vaccine, particularly in younger adults, but invoked lower responses to drifted H7N9 strains. These findings may inform future influenza pandemic preparedness strategies.
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Affiliation(s)
- Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Jack T Stapleton
- Departments of Internal Medicine and Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | - Emmanuel B Walter
- Duke Human Vaccine Institute, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nadine G Rouphael
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patricia L Winokur
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael J Smith
- Duke Human Vaccine Institute, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine and GRECC, Durham VA Health Care System, Durham, NC, USA
| | - Geeta K Swamy
- Duke Human Vaccine Institute and Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Amelia B Thompson
- Duke Human Vaccine Institute, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Mark J Mulligan
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina A Rostad
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
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5
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Anderson LJ, Jadhao SJ, Hussaini L, Ha B, McCracken CE, Gibson T, Yildirim I, Yi J, Stephens K, Korski C, Kao C, Sun H, Lee CY, Jaunarajs A, Rostad CA, Anderson EJ. Development and comparison of immunologic assays to detect primary RSV infections in infants. Front Immunol 2024; 14:1332772. [PMID: 38283339 PMCID: PMC10811012 DOI: 10.3389/fimmu.2023.1332772] [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: 11/03/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Effective respiratory syncytial virus (RSV) vaccines have been developed and licensed for elderly adults and pregnant women but not yet for infants and young children. The RSV immune state of the young child, i.e., previously RSV infected or not, is important to the conduct and interpretation of epidemiology studies and vaccine clinical trials. To address the need for sensitive assays to detect immunologic evidence of past infection, we developed, characterized, and evaluated 7 assays including 4 IgG antibody enzyme immunoassays (EIAs), two neutralizing antibody assays, and an IFN-γ EliSpot (EliSpot) assay. The four IgG EIAs used a subgroup A plus subgroup B RSV-infected Hep-2 cell lysate antigen (Lysate), an expressed RSV F protein antigen (F), an expressed subgroup A G protein antigen (Ga), or an expressed subgroup B G protein (Gb) antigen. The two neutralizing antibody assays used either a subgroup A or a subgroup B RSV strain. The EliSpot assay used a sucrose cushion purified combination of subgroup A and subgroup B infected cell lysate. All seven assays had acceptable repeatability, signal against control antigen, lower limit of detection, and, for the antibody assays, effect of red cell lysis, lipemia and anticoagulation of sample on results. In 44 sera collected from children >6 months after an RSV positive illness, the lysate, F, Ga and Gb IgG EIAs, and the subgroup A and B neutralizing antibody assays, and the EliSpot assays were positive in 100%, 100%, 86%, 95%, 43%, and 57%, respectively. The Lysate and F EIAs were most sensitive for detecting RSV antibody in young children with a documented RSV infection. Unexpectedly, the EliSpot assay was positive in 9/15 (60%) of PBMC specimens from infants not exposed to an RSV season, possibly from maternal microchimerism. The Lysate and F EIAs provide good options to reliably detect RSV antibodies in young children for epidemiologic studies and vaccine trials.
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Affiliation(s)
- Larry J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Samadhan J Jadhao
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Laila Hussaini
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Binh Ha
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Courtney E McCracken
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Theda Gibson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Inci Yildirim
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Jumi Yi
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kathy Stephens
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Chelsea Korski
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Carol Kao
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Heying Sun
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Chun Yi Lee
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | - Christina A Rostad
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Evan J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
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6
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Shah AB, Abrams JY, Godfred-Cato S, Kunkel A, Hammett TA, Perez MA, Hsiao HM, Baida N, Rostad CA, Ballan W, Ede K, Laham FR, Kao CM, Oster ME, Belay ED. Treatments and Severe Outcomes for Patients Diagnosed With MIS-C at Four Children's Hospitals in the United States, March 16, 2020-March 10, 2021. Pediatr Infect Dis J 2023; 42:990-998. [PMID: 37862698 DOI: 10.1097/inf.0000000000004065] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Clinical management of multisystem inflammatory syndrome in children (MIS-C) has varied over time and by medical institution. METHODS Data on patients with MIS-C were collected from 4 children's hospitals between March 16, 2020 and March 10, 2021. Relationships between MIS-C treatments and patient demographics, clinical characteristics, and outcomes were described. Propensity score matching was utilized to assess the relative risk of outcomes dependent on early treatment with intravenous immunoglobulin (IVIG) or low-dose steroids, controlling for potential confounding variables. RESULTS Of 233 patients diagnosed with MIS-C, the most commonly administered treatments were steroids (88.4%), aspirin (81.1%), IVIG (77.7%) and anticoagulants (71.2%). Compared with those patients without respiratory features, patients with respiratory features were less likely to receive IVIG and steroids on the same day (combination treatment) (44.1%). Controlling for confounding variables, patients receiving IVIG within 1 day of hospitalization were less likely to have hospital length of stay ≥8 days (RR = 0.53, 95% CI: 0.31-0.88). Patients receiving low-dose steroids within 1 day of hospitalization were less likely to develop ventricular dysfunction (RR = 0.45, 95% CI: 0.26-0.77), have increasingly elevated troponin levels (RR = 0.55, 95% CI: 0.40-0.75) or have hospital length of stay ≥8 days (RR = 0.46, 95% CI: 0.29-0.74). CONCLUSION Treatments for MIS-C differed by hospital, patient characteristics and illness severity. When IVIG and low-dose steroids were administered in combination or low-dose steroids were administered alone within 1 day of hospitalization, the risk of subsequent severe outcomes was decreased.
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Affiliation(s)
- Ami B Shah
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Falls Church, Virginia
| | - Joseph Y Abrams
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shana Godfred-Cato
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amber Kunkel
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa A Hammett
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria A Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nadine Baida
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Kaleo Ede
- Phoenix Children's Hospital, Phoenix, Arizona
| | - Federico R Laham
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew E Oster
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ermias D Belay
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Hsiao HM, DiMaggio LS, Perez MA, Chen X, Stephens K, Gibson T, Anderson EJ, Rostad CA. SARS-CoV-2 Antibody Profiles in Maternal Serum and Breast Milk Following mRNA COVID-19 Vaccination: A Longitudinal Prospective Observational Cohort Study. Vaccines (Basel) 2023; 11:1643. [PMID: 38005975 PMCID: PMC10675665 DOI: 10.3390/vaccines11111643] [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: 09/10/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19 vaccination during pregnancy protects infants against symptomatic COVID-19. Vaccination of lactating mothers may offer additional protection, but our understanding of immune responses in breast milk is limited. We, therefore, performed a single-center prospective cohort study of lactating mothers who received a COVID-19 mRNA primary vaccine series to evaluate the durability, breadth, and neutralizing capacity of the antibody responses in breast milk. Spike IgG- and IgA-binding antibodies of ancestral SARS-CoV-2 in serum and breast milk were quantified over 9 months using Meso Scale Discovery (MSD) V-PLEX assays, and ancestral titers were compared to four variants of concern (Alpha, Beta, Delta, Gamma) at a single time point. Neutralizing antibodies against ancestral SARS-CoV-2 and Omicron BA.4/5 were compared before and after vaccination using a pseudovirus-neutralization assay. Eleven lactating mothers received either Pfizer BNT162b2 (7/11) or Moderna mRNA-1273 (4/11) vaccine primary series. IgG and IgA titers increased in serum and breast milk following each dose, peaking 1-4 weeks after series completion. Titers remained significantly elevated for 7-9 months, except for in breast milk IgA which returned to baseline within 1 month. Furthermore, binding antibodies against all included variants were detected in breast milk collected 1-3 weeks after series completion. However, while vaccination induced a strong neutralizing response against ancestral SARS-CoV-2 in serum and more modest response in breast milk, it did not induce neutralizing antibodies against Omicron BA.4/5 in either specimen type. This study demonstrates that maternal COVID-19 mRNA vaccination may enhance immune protection for infants through breast milk via increased IgG- and IgA-binding-and-neutralizing antibodies; although, variant-specific boosters may be required to optimize immune protection.
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Affiliation(s)
- Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Langdon S. DiMaggio
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Maria A. Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Xuemin Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Kathleen Stephens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
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8
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Rick AM, Laurens MB, Huang Y, Yu C, Martin TCS, Rodriguez CA, Rostad CA, Maboa RM, Baden LR, El Sahly HM, Grinsztejn B, Gray GE, Gay CL, Gilbert PB, Janes HE, Kublin JG, Huang Y, Leav B, Hirsch I, Struyf F, Dunkle LM, Neuzil KM, Corey L, Goepfert PA, Walsh SR, Follmann D, Kotloff KL. Risk of COVID-19 after natural infection or vaccination. EBioMedicine 2023; 96:104799. [PMID: 37738833 PMCID: PMC10518569 DOI: 10.1016/j.ebiom.2023.104799] [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: 04/20/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. METHODS In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7-15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. FINDINGS Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05-0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01-0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. INTERPRETATION Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. FUNDING National Institutes of Health.
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Affiliation(s)
- Anne-Marie Rick
- Department of Pediatrics, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Matthew B Laurens
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ying Huang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Chenchen Yu
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Thomas C S Martin
- Department of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Carina A Rodriguez
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christina A Rostad
- Department of Pediatrics, Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Glenda E Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Cynthia L Gay
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | | | - Yunda Huang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Ian Hirsch
- AstraZeneca BioPharmaceuticals, Cambridge, UK
| | | | | | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Paul A Goepfert
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Stephen R Walsh
- Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Dean Follmann
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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9
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Westbrook A, Wang T, Bhakta K, Sullivan J, Gonzalez MD, Lam W, Rostad CA. Respiratory Coinfections in Children With SARS-CoV-2. Pediatr Infect Dis J 2023; 42:774-780. [PMID: 37257127 PMCID: PMC10417240 DOI: 10.1097/inf.0000000000003981] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND As the transmission of endemic respiratory pathogens returns to prepandemic levels, understanding the epidemiology of respiratory coinfections in children with SARS-CoV-2 is of increasing importance. METHODS We performed a retrospective analysis of all pediatric patients 0-21 years of age who had a multiplexed BioFire Respiratory Panel 2.1 test performed at Children's Healthcare of Atlanta, Georgia, from January 1 to December 31, 2021. We determined the proportion of patients with and without SARS-CoV-2 who had respiratory coinfections and performed Poisson regression to determine the likelihood of coinfection and its association with patient age. RESULTS Of 19,199 respiratory panel tests performed, 1466 (7.64%) were positive for SARS-CoV-2, of which 348 (23.74%) also had coinfection with another pathogen. The most common coinfection was rhino/enterovirus (n = 230, 15.69%), followed by adenovirus (n = 62, 4.23%), and RSV (n = 45, 3.507%). Coinfections with SARS-CoV-2 were most commonly observed in the era of Delta (B.1.617.2) predominance (190, 54.60%), which coincided with periods of peak rhino/enterovirus and RSV transmission. Although coinfections were common among all respiratory pathogens, they were significantly less common with SARS-CoV-2 than other pathogens, with exception of influenza A and B. Children <2 years of age had the highest frequency of coinfection and of detection of any pathogen, including SARS-CoV-2. Among children with SARS-CoV-2, for every 1-year increase in age, the rate of coinfections decreased by 8% (95% CI, 6-9). CONCLUSIONS Respiratory coinfections were common in children with SARS-CoV-2. Factors associated with the specific pathogen, host, and time period influenced the likelihood of coinfection.
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Affiliation(s)
- Adrianna Westbrook
- From the Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Tingyu Wang
- From the Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kushmita Bhakta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Julie Sullivan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Mark D. Gonzalez
- Division of Pathology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Wilbur Lam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, Georgia
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10
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Lyke KE, Atmar RL, Dominguez Islas C, Posavad CM, Deming ME, Branche AR, Johnston C, El Sahly HM, Edupuganti S, Mulligan MJ, Jackson LA, Rupp RE, Rostad CA, Coler RN, Bäcker M, Kottkamp AC, Babu TM, Dobrzynski D, Martin JM, Brady RC, Frenck RW, Rajakumar K, Kotloff K, Rouphael N, Szydlo D, PaulChoudhury R, Archer JI, Crandon S, Ingersoll B, Eaton A, Brown ER, McElrath MJ, Neuzil KM, Stephens DS, Post DJ, Lin BC, Serebryannyy L, Beigel JH, Montefiori DC, Roberts PC. Immunogenicity of NVX-CoV2373 heterologous boost against SARS-CoV-2 variants. NPJ Vaccines 2023; 8:98. [PMID: 37433788 PMCID: PMC10336079 DOI: 10.1038/s41541-023-00693-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 03/09/2023] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
As part of a multicenter study evaluating homologous and heterologous COVID-19 booster vaccines, we assessed the magnitude, breadth, and short-term durability of binding and pseudovirus-neutralizing antibody (PsVNA) responses following a single booster dose of NVX-CoV2373 in adults primed with either Ad26.COV2.S, mRNA-1273, or BNT162b2 vaccines. NVX-CoV2373 as a heterologous booster was immunogenic and associated with no safety concerns through Day 91. Fold-rises in PsVNA titers from baseline (Day 1) to Day 29 were highest for prototypic D614G variant and lowest for more recent Omicron sub-lineages BQ.1.1 and XBB.1. Peak humoral responses against all SARS-CoV-2 variants were lower in those primed with Ad26.COV2.S than with mRNA vaccines. Prior SARS CoV-2 infection was associated with substantially higher baseline PsVNA titers, which remained elevated relative to previously uninfected participants through Day 91. These data support the use of heterologous protein-based booster vaccines as an acceptable alternative to mRNA or adenoviral-based COVID-19 booster vaccines. This trial was conducted under ClinicalTrials.gov: NCT04889209.
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Affiliation(s)
- Kirsten E Lyke
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert L Atmar
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA.
| | - Clara Dominguez Islas
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christine M Posavad
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Laboratory Medicine & Pathology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Meagan E Deming
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Angela R Branche
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, USA
| | - Christine Johnston
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Laboratory Medicine & Pathology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Hana M El Sahly
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Srilatha Edupuganti
- Department of Medicine, Emory University School of Medicine, Atlanta, USA
- Hope Clinic of Emory Vaccine Center, Atlanta, GA, USA
| | - Mark J Mulligan
- NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Richard E Rupp
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Christina A Rostad
- Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rhea N Coler
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Martín Bäcker
- NYU Langone Hospital-Long Island Vaccine Center Research Clinic and Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Angelica C Kottkamp
- NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Tara M Babu
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - David Dobrzynski
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, USA
| | - Judith M Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert W Frenck
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kumaravel Rajakumar
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University School of Medicine, Atlanta, USA
- Hope Clinic of Emory Vaccine Center, Atlanta, GA, USA
| | - Daniel Szydlo
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rahul PaulChoudhury
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Brian Ingersoll
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Amanda Eaton
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth R Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - M Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David S Stephens
- Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Diane J Post
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Bob C Lin
- Vaccine Immunology Program, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Leonid Serebryannyy
- Vaccine Immunology Program, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David C Montefiori
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA
| | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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11
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Loy CJ, Sotomayor-Gonzalez A, Servellita V, Nguyen J, Lenz J, Bhattacharya S, Williams ME, Cheng AP, Bliss A, Saldhi P, Brazer N, Streithorst J, Suslovic W, Hsieh CJ, Bahar B, Wood N, Foresythe A, Gliwa A, Bhakta K, Perez MA, Hussaini L, Anderson EJ, Chahroudi A, Delaney M, Butte AJ, DeBiasi RL, Rostad CA, De Vlaminck I, Chiu CY. Nucleic acid biomarkers of immune response and cell and tissue damage in children with COVID-19 and MIS-C. Cell Rep Med 2023; 4:101034. [PMID: 37279751 PMCID: PMC10121104 DOI: 10.1016/j.xcrm.2023.101034] [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: 07/15/2022] [Revised: 11/28/2022] [Accepted: 04/11/2023] [Indexed: 06/08/2023]
Abstract
Differential host responses in coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) remain poorly characterized. Here, we use next-generation sequencing to longitudinally analyze blood samples from pediatric patients with COVID-19 or MIS-C across three hospitals. Profiling of plasma cell-free nucleic acids uncovers distinct signatures of cell injury and death between COVID-19 and MIS-C, with increased multiorgan involvement in MIS-C encompassing diverse cell types, including endothelial and neuronal cells, and an enrichment of pyroptosis-related genes. Whole-blood RNA profiling reveals upregulation of similar pro-inflammatory pathways in COVID-19 and MIS-C but also MIS-C-specific downregulation of T cell-associated pathways. Profiling of plasma cell-free RNA and whole-blood RNA in paired samples yields different but complementary signatures for each disease state. Our work provides a systems-level view of immune responses and tissue damage in COVID-19 and MIS-C and informs future development of new disease biomarkers.
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Affiliation(s)
- Conor J Loy
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Alicia Sotomayor-Gonzalez
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Venice Servellita
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jenny Nguyen
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Joan Lenz
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Sanchita Bhattacharya
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | | | - Alexandre P Cheng
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Andrew Bliss
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Prachi Saldhi
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Noah Brazer
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jessica Streithorst
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | | | - Charlotte J Hsieh
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California San Francisco, Oakland, CA 94609
| | - Burak Bahar
- Children's National Hospital, Washington, DC 20010, USA
| | - Nathan Wood
- UCSF Benioff Children's Hospital, Oakland, CA 94609, USA
| | - Abiodun Foresythe
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Amelia Gliwa
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kushmita Bhakta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Maria A Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA; Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Meghan Delaney
- Children's National Hospital, Washington, DC 20010, USA; The George Washington University School of Medicine, Washington, DC 20052, USA
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Roberta L DeBiasi
- Children's National Hospital, Washington, DC 20010, USA; The George Washington University School of Medicine, Washington, DC 20052, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Iwijn De Vlaminck
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA.
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA; Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA.
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12
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Servellita V, Sotomayor Gonzalez A, Lamson DM, Foresythe A, Huh HJ, Bazinet AL, Bergman NH, Bull RL, Garcia KY, Goodrich JS, Lovett SP, Parker K, Radune D, Hatada A, Pan CY, Rizzo K, Bertumen JB, Morales C, Oluniyi PE, Nguyen J, Tan J, Stryke D, Jaber R, Leslie MT, Lyons Z, Hedman HD, Parashar U, Sullivan M, Wroblewski K, Oberste MS, Tate JE, Baker JM, Sugerman D, Potts C, Lu X, Chhabra P, Ingram LA, Shiau H, Britt W, Gutierrez Sanchez LH, Ciric C, Rostad CA, Vinjé J, Kirking HL, Wadford DA, Raborn RT, St George K, Chiu CY. Adeno-associated virus type 2 in US children with acute severe hepatitis. Nature 2023; 617:574-580. [PMID: 36996871 PMCID: PMC10170441 DOI: 10.1038/s41586-023-05949-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [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: 09/11/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023]
Abstract
As of August 2022, clusters of acute severe hepatitis of unknown aetiology in children have been reported from 35 countries, including the USA1,2. Previous studies have found human adenoviruses (HAdVs) in the blood from patients in Europe and the USA3-7, although it is unclear whether this virus is causative. Here we used PCR testing, viral enrichment-based sequencing and agnostic metagenomic sequencing to analyse samples from 16 HAdV-positive cases from 1 October 2021 to 22 May 2022, in parallel with 113 controls. In blood from 14 cases, adeno-associated virus type 2 (AAV2) sequences were detected in 93% (13 of 14), compared to 4 (3.5%) of 113 controls (P < 0.001) and to 0 of 30 patients with hepatitis of defined aetiology (P < 0.001). In controls, HAdV type 41 was detected in blood from 9 (39.1%) of the 23 patients with acute gastroenteritis (without hepatitis), including 8 of 9 patients with positive stool HAdV testing, but co-infection with AAV2 was observed in only 3 (13.0%) of these 23 patients versus 93% of cases (P < 0.001). Co-infections by Epstein-Barr virus, human herpesvirus 6 and/or enterovirus A71 were also detected in 12 (85.7%) of 14 cases, with higher herpesvirus detection in cases versus controls (P < 0.001). Our findings suggest that the severity of the disease is related to co-infections involving AAV2 and one or more helper viruses.
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Affiliation(s)
- Venice Servellita
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Daryl M Lamson
- Wadsworth Center, New York State Department of Health, David Axelrod Institute, Albany, NY, USA
| | - Abiodun Foresythe
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Hee Jae Huh
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Adam L Bazinet
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - Nicholas H Bergman
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - Robert L Bull
- Federal Bureau of Investigation Laboratory Division/Scientific Response and Analysis Unit, Quantico, VA, USA
| | - Karla Y Garcia
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - Jennifer S Goodrich
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - Sean P Lovett
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - Kisha Parker
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - Diana Radune
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - April Hatada
- California Department of Public Health, Richmond, CA, USA
| | - Chao-Yang Pan
- California Department of Public Health, Richmond, CA, USA
| | - Kyle Rizzo
- California Department of Public Health, Richmond, CA, USA
| | - J Bradford Bertumen
- California Department of Public Health, Richmond, CA, USA
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | | | - Paul E Oluniyi
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jenny Nguyen
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Tan
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Doug Stryke
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rayah Jaber
- Florida Department of Health, Tallahassee, FL, USA
| | | | - Zin Lyons
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Hayden D Hedman
- Centers for Disease Control and Prevention, Atlanta, CA, USA
- South Dakota Department of Health, Pierre, SD, USA
| | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | - Maureen Sullivan
- Association for Public Health Laboratories, Silver Spring, MD, USA
| | - Kelly Wroblewski
- Association for Public Health Laboratories, Silver Spring, MD, USA
| | | | | | - Julia M Baker
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | - David Sugerman
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | - Caelin Potts
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | - Xiaoyan Lu
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | - Preeti Chhabra
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | | | - Henry Shiau
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Britt
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Caroline Ciric
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jan Vinjé
- Centers for Disease Control and Prevention, Atlanta, CA, USA
| | | | | | - R Taylor Raborn
- National Biodefense Analysis and Countermeasures Center (NBACC), Frederick, MD, USA
| | - Kirsten St George
- Wadsworth Center, New York State Department of Health, David Axelrod Institute, Albany, NY, USA
- Department of Biomedical Science, University at Albany, SUNY, Albany, NY, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
- Chan-Zuckerberg Biohub, San Francisco, CA, USA.
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13
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Perez MA, Hsiao HM, Chen X, Kunkel A, Baida N, Hussaini L, Lu AT, Kao CM, Laham FR, Hunstad DA, Beltran Y, Hammett TA, Godfred-Cato S, Chahroudi A, Anderson EJ, Belay E, Rostad CA. Serologic responses to COVID-19 vaccination in children with history of multisystem inflammatory syndrome (MIS-C). Vaccine 2023; 41:2743-2748. [PMID: 36964000 PMCID: PMC10015103 DOI: 10.1016/j.vaccine.2023.03.021] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/31/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
Understanding the serological responses to COVID-19 vaccination in children with history of MIS-C could inform vaccination recommendations. We prospectively enrolled seven children hospitalized with MIS-C and measured SARS-CoV-2 binding IgG antibodies to spike protein variants longitudinally pre- and post-Pfizer-BioNTech BNT162b2 primary series COVID-19 vaccination. We found that SARS-CoV-2 variant cross-reactive IgG antibodies variably waned following acute MIS-C, but were significantly boosted with vaccination and maintained for up to 3 months. We then compared post-vaccination binding, pseudovirus neutralizing, and functional antibody-dependent cell-mediated cytotoxicity (ADCC) titers to the reference strain (Wuhan-hu-1) and Omicron variant (B.1.1.529) among previously healthy children (n = 16) and children with history of MIS-C (n = 7) or COVID-19 (n = 8). Despite the breadth of binding antibodies elicited by vaccination in all three groups, pseudovirus neutralizing and ADCC titers were significantly reduced to the Omicron variant.
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Affiliation(s)
- Maria A Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Xuemin Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Amber Kunkel
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nadine Baida
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Austin T Lu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130 USA
| | | | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130 USA
| | - Yajira Beltran
- Arnold Palmer Hospital for Children, Orlando, FL 32806 USA
| | | | | | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ermias Belay
- Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA.
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14
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Druzak S, Iffrig E, Roberts BR, Zhang T, Fibben KS, Sakurai Y, Verkerke HP, Rostad CA, Chahroudi A, Schneider F, Wong AKH, Roberts AM, Chandler JD, Kim SO, Mosunjac M, Mosunjac M, Geller R, Albizua I, Stowell SR, Arthur CM, Anderson EJ, Ivanova AA, Ahn J, Liu X, Maner-Smith K, Bowen T, Paiardini M, Bosinger SE, Roback JD, Kulpa DA, Silvestri G, Lam WA, Ortlund EA, Maier CL. Multiplatform analyses reveal distinct drivers of systemic pathogenesis in adult versus pediatric severe acute COVID-19. Nat Commun 2023; 14:1638. [PMID: 37015925 PMCID: PMC10073144 DOI: 10.1038/s41467-023-37269-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 10/29/2022] [Accepted: 03/08/2023] [Indexed: 04/06/2023] Open
Abstract
The pathogenesis of multi-organ dysfunction associated with severe acute SARS-CoV-2 infection remains poorly understood. Endothelial damage and microvascular thrombosis have been identified as drivers of COVID-19 severity, yet the mechanisms underlying these processes remain elusive. Here we show alterations in fluid shear stress-responsive pathways in critically ill COVID-19 adults as compared to non-COVID critically ill adults using a multiomics approach. Mechanistic in-vitro studies, using microvasculature-on-chip devices, reveal that plasma from critically ill COVID-19 adults induces fibrinogen-dependent red blood cell aggregation that mechanically damages the microvascular glycocalyx. This mechanism appears unique to COVID-19, as plasma from non-COVID sepsis patients demonstrates greater red blood cell membrane stiffness but induces less significant alterations in overall blood rheology. Multiomics analyses in pediatric patients with acute COVID-19 or the post-infectious multi-inflammatory syndrome in children (MIS-C) demonstrate little overlap in plasma cytokine and metabolite changes compared to adult COVID-19 patients. Instead, pediatric acute COVID-19 and MIS-C patients show alterations strongly associated with cytokine upregulation. These findings link high fibrinogen and red blood cell aggregation with endotheliopathy in adult COVID-19 patients and highlight differences in the key mediators of pathogenesis between adult and pediatric populations.
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Grants
- T32 GM142617 NIGMS NIH HHS
- P51 OD011132 NIH HHS
- R35 HL145000 NHLBI NIH HHS
- K99 HL150626 NHLBI NIH HHS
- T32 GM135060 NIGMS NIH HHS
- F31 DK126435 NIDDK NIH HHS
- R01 DK115213 NIDDK NIH HHS
- R38 AI140299 NIAID NIH HHS
- A F31 training fellowship from the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), F31DK126435, supported S.A.D during the duration of this work. Stimulating Access to Research in Residency of the National Institutes of Health under Award Number R38AI140299 supported E.I. R35HL145000 supported E.I, Y.S, K.S.F and W.A.L. National Institutes of Health National Heart, Lung, and Blood Institute (NIH/NHLBI) HL150658, awarded to J.D.C. A training grant supported by the Biochemistry and Cell Developmental Biology program (BCDB) at Emory university, T32GM135060-02S1, to S.O.K. NIH/NIDDK Grant R01-DK115213 and Winship Synergy Award to E.A.O. NIH/NHLBI K99 HL150626-01 awarded to C.L.M. The lipidomics and metabolomics experiments were supported by the Emory Integrated Metabolomics and Lipidomics Core, which is subsidized by the Emory University School of Medicine and is one of the Emory Integrated Core Facilities.
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Affiliation(s)
- Samuel Druzak
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Iffrig
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Blaine R Roberts
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Tiantian Zhang
- Emory Integrated Metabolomics and Lipidomics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Kirby S Fibben
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Yumiko Sakurai
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Hans P Verkerke
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Frank Schneider
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Kam Ho Wong
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Anne M Roberts
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua D Chandler
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Susan O Kim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Mario Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marina Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel Geller
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Bureau of Investigation, Decatur, GA, USA
| | - Igor Albizua
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean R Stowell
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Connie M Arthur
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Evan J Anderson
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anna A Ivanova
- Emory Integrated Metabolomics and Lipidomics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Jun Ahn
- Emory Integrated Metabolomics and Lipidomics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Xueyun Liu
- Emory Integrated Metabolomics and Lipidomics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristal Maner-Smith
- Emory Integrated Metabolomics and Lipidomics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas Bowen
- Emory Integrated Metabolomics and Lipidomics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Mirko Paiardini
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Steve E Bosinger
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, USA
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Deanna A Kulpa
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
- Center for AIDS Research, Emory University, Atlanta, GA, USA
| | - Guido Silvestri
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, USA
- Center for AIDS Research, Emory University, Atlanta, GA, USA
| | - Wilbur A Lam
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Eric A Ortlund
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Integrated Metabolomics and Lipidomics Core, Emory University School of Medicine, Atlanta, GA, USA.
| | - Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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15
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Chen X, Ciric C, Gibson T, Anderson LJ, Anderson EJ, Rostad CA. Longitudinal Neutralizing and Functional Antibody Responses to SARS-CoV-2 Variants following mRNA COVID-19 Vaccination. Open Forum Infect Dis 2023; 10:ofad167. [PMID: 37065985 PMCID: PMC10096895 DOI: 10.1093/ofid/ofad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
In this longitudinal prospective cohort of healthy U.S. adults, we found that COVID-19 mRNA primary series and booster vaccinations elicited high titers of broadly cross-reactive neutralizing and ADCC antibodies, which gradually waned over 6 months and particularly against SARS-CoV-2 variants. This data supports the indication for a subsequent booster vaccination.
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Affiliation(s)
- Xuemin Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Caroline Ciric
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Larry J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Correspondence: Christina A. Rostad, MD, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr NE, Atlanta, GA 30322 ()
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16
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Yousaf AR, Kunkel A, Abrams JY, Shah AB, Hammett TA, Arnold KE, Beltran YL, Laham FR, Kao CM, Hunstad DA, Hussaini L, Baida N, Salazar L, Perez MA, Rostad CA, Godfred-Cato S, Campbell AP, Belay ED. COVID-19 Vaccine Reactogenicity and Vaccine Attitudes Among Children and Parents/Guardians After Multisystem Inflammatory Syndrome in Children or COVID-19 Hospitalization: September 2021-May 2022. Pediatr Infect Dis J 2023; 42:252-259. [PMID: 36729032 PMCID: PMC9935230 DOI: 10.1097/inf.0000000000003803] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a multiorgan hyperinflammatory condition following SARS-CoV-2 infection. Data on COVID-19 vaccine adverse events and vaccine attitudes in children with prior MIS-C are limited. We described characteristics associated with COVID-19 vaccination, vaccine adverse events and vaccine attitudes in children with a history of MIS-C or COVID-19 and their parents/guardians. METHODS We enrolled children previously hospitalized for MIS-C or COVID-19 from 3 academic institutions. We abstracted charts and interviewed children and parents/guardians regarding vaccine adverse events and acceptability. RESULTS Of 163 vaccine-eligible children enrolled with a history of MIS-C and 70 with history of COVID-19, 51 (31%) and 34 (49%), respectively, received mRNA COVID-19 vaccine a median of 10 (Interquartile Range 6-13) months after hospital discharge. Among 20 children with MIS-C and parents/guardians who provided interviews, local injection site reaction of brief duration (mean 1.8 days) was most commonly reported; no children required medical care within 2 weeks postvaccination. Vaccine survey results of interviewed, vaccinated children and their parents/guardians: of 20 children with MIS-C and 15 children with COVID-19, 17 (85%) and 13 (87%), respectively, listed doctors in the top 3 most trusted sources for vaccine information; 13 (65%) and 9 (60%) discussed vaccination with their doctor. CONCLUSIONS COVID-19 vaccination was well tolerated in children with prior MIS-C or COVID-19 participating in our investigation. Parents/guardians regarded their children's doctors as a trusted source of information for COVID-19 vaccines, and most vaccinated children's parents/guardians had discussed COVID-19 vaccination for their child with their doctor.
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Affiliation(s)
| | - Amber Kunkel
- From the CDC COVID-19 Response Team
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Yajira L. Beltran
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Federico R. Laham
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Carol M. Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Nadine Baida
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Luis Salazar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Maria A. Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
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17
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Damhorst GL, Verkerke HP, Harrington KR, McLendon K, Lu A, Perez MA, Hussaini L, Anderson EJ, Stowell SR, Roback JD, Lam WA, Rostad CA. SARS-CoV-2 Antigenemia is Associated With Pneumonia in Children But Lacks Sensitivity to Diagnose Acute Infection. Pediatr Infect Dis J 2023; 42:130-135. [PMID: 36638399 PMCID: PMC9838602 DOI: 10.1097/inf.0000000000003779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nucleocapsid antigenemia in adults has demonstrated high sensitivity and specificity for acute infection, and antigen burden is associated with disease severity. Data regarding SARS-CoV-2 antigenemia in children are limited. METHODS We retrospectively analyzed blood plasma specimens from hospitalized children with COVID-19 or MIS-C. Nucleocapsid and spike were measured using ultrasensitive immunoassays. RESULTS We detected nucleocapsid antigenemia in 62% (50/81) and spike antigenemia in 27% (21/79) of children with acute COVID-19 but 0% (0/26) and 15% (4/26) with MIS-C from March 2020-March 2021. Higher nucleocapsid levels were associated with radiographic infiltrates and respiratory symptoms in children with COVID-19. CONCLUSIONS Antigenemia lacks the sensitivity to diagnose acute infection in children but is associated with signs and symptoms of lower respiratory tract involvement. Further study into the mechanism of antigenemia, its association with specific organ involvement, and the role of antigenemia in the pathogenesis of COVID-19 is warranted.
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Affiliation(s)
- Gregory L. Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA
| | - Hans P. Verkerke
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Kaleb McLendon
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Austin Lu
- Center for Childhood Infections and Vaccines, Department of Pediatrics at Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Maria A. Perez
- Center for Childhood Infections and Vaccines, Department of Pediatrics at Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Laila Hussaini
- Center for Childhood Infections and Vaccines, Department of Pediatrics at Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Evan J. Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Center for Childhood Infections and Vaccines, Department of Pediatrics at Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Sean R. Stowell
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - John D. Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Wilbur A. Lam
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta, Atlanta, GA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Christina A. Rostad
- Center for Childhood Infections and Vaccines, Department of Pediatrics at Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
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18
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Zerra PE, Stowell J, Verkerke H, McCoy J, Jones J, Graciaa S, Lu A, Hussaini L, Anderson EJ, Rostad CA, Stowell SR, Chonat S. Factor H autoantibodies contribute to complement dysregulation in multisystem inflammatory syndrome in children (MIS-C). Am J Hematol 2023; 98:E98-E101. [PMID: 36715424 PMCID: PMC10089943 DOI: 10.1002/ajh.26868] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Patricia E Zerra
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Jennifer Stowell
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Hans Verkerke
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University, Atlanta, Georgia, USA
| | - James McCoy
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University, Atlanta, Georgia, USA
| | - Jayre Jones
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Sara Graciaa
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Austin Lu
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Laila Hussaini
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sean R Stowell
- Joint Program in Transfusion Medicine, Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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19
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Goggin KP, Sun E, Yun EJ, Kamel M, Perez M, Hsiao HM, Anderson EJ, Shane AL, Liverman R, George R, Rostad CA. 584. Prospective Observational Cohort Study of Serological Responses to COVID-19 Vaccines in Pediatric Kidney Transplant Recipients at a Single Institution. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Pediatric kidney transplant recipients (PKTR) are at risk of poor outcomes from COVID-19. Data on serologic responses to COVID-19 vaccines in PKTR remain sparse. We characterized the magnitude, breadth, and longevity of SARS-CoV-2 spike protein binding antibody responses in PKTR.
Methods
This single institution, prospective observational study enrolled PKTR presenting to a transplant clinic for routine care who had received or were eligible to receive a COVID-19 vaccine. Demographic data, history of prior COVID-19, and vaccination details were collected. Plasma samples obtained from standard-of-care residual specimens were analyzed for SARS-CoV-2 spike variant IgG using the MesoScale Discovery V-PLEX platform, which quantitatively measures antibodies to SARS-CoV-2 full-length spike wild-type (Wuhan-hu-1), Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), Gamma (P.1), and Omicron (B.1.1.529; BA.1) variants. Vaccine time points with > 5 samples available were analyzed. Geometric mean titers (GMTs) were calculated and log-transformed titers were compared using one-way ANOVA with Tukey’s post-hoc comparisons test.
Results
61 PKTR enrolled (Table1); 47 (77%) received at least 1 dose of COVID-19 vaccine in transplant clinic. 47 (77%) PKTR had at least one sample available for analysis, but serial specimens were lacking for many. By 6 months post-dose 2 of COVID-19 mRNA vaccination, spike (Wuhan-hu-1) IgG titers had waned to pre-vaccination levels (GMT 24 vs 47 binding antibody units (BAU)/mL, P=0.988). Administration of a 3rd dose of mRNA vaccine significantly boosted IgG antibodies (GMT 492 BAU/mL, P=0.007), and titers were maintained at 3 months (GMT 656 BAU/mL, P=0.001) but gradually waned by 6 months (GMT 223 BAU/mL, P=0.070). Administration of a 4th dose elicited a non-significant increase in titers (GMT 905 BAU/mL, P=0.870). Binding IgG antibodies to SARS-CoV-2 variant spike proteins post-vaccination were not significantly different from Wuhan spike.
Conclusion
In this cohort of PKTR, a 3rd dose of COVID-19 mRNA vaccine significantly boosted broadly cross-reactive binding IgG antibodies to SARS-CoV-2 spike variants, including Omicron. Decreasing titers at 6 months post-dose 3 raise concern for waning protective immunity and support 4th dose vaccination.
Disclosures
Evan J. Anderson, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kentucky Bioprocessing, Inc: Data Safety Monitoring Board|MedImmune: Grant/Research Support|Medscape: Advisor/Consultant|Merck: Grant/Research Support|Micron: Grant/Research Support|NIH: Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines|PaxVax: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data Adjudication and Data Safety Monitoring Boards|WCG and ACI Clinical: Data Adjudication Board Andi L. Shane, MD, MPH, MSc, International Scientific Association for Probiotics and Prebiotics (ISAPP): Honoraria Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Merck, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur.: Grant/Research Support|Meissa Vaccines, Inc.: Co-inventor of RSV vaccine technology licensed to Meissa Vaccines, Inc.|NIH (Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines): Grant/Research Support.
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Affiliation(s)
- Kathryn P Goggin
- Emory University School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
| | - Elizabeth Sun
- Emory University School of Medicine , Atlanta , Georgia
| | - Emily J Yun
- Emory University School of Medicine , Atlanta , Georgia
| | - Margret Kamel
- Emory University School of Medicine , Atlanta , Georgia
| | - Maria Perez
- Emory University School of Medicine , Atlanta , Georgia
| | | | | | - Andi L Shane
- Emory School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
| | | | - Roshan George
- Emory University School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
| | - Christina A Rostad
- Emory University School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
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20
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Lamichhane P, Schmidt ME, Terhüja M, Varga SM, Snider TA, Rostad CA, Oomens AGP. A live single-cycle RSV vaccine expressing prefusion F protein. Virology 2022; 577:51-64. [PMID: 36306605 PMCID: PMC10104964 DOI: 10.1016/j.virol.2022.10.003] [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: 06/07/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
Live-attenuated Respiratory syncytial virus (RSV) vaccines given intranasally have potential to provide comprehensive protection, including lung-resident immunity. It has however proven challenging to impart both sufficient safety and efficacy in a vaccine. To achieve the latter, we used a trans-complementing approach to generate live single-cycle RSV vaccines expressing the prefusion form (preF) of the viral fusion protein (F), either membrane-anchored or secreted. Both viruses were tested for their ability to induce a protective immune response in mice after intranasal prime-boost vaccination. The secreted preF vaccine failed to induce a protective response. The anchored preF vaccine induced anti-preF antibodies and antiviral T cells, and protected mice from lung pathology and viral shedding after challenge. Neither vaccine induced anti-G antibodies, for reasons unknown. In spite of the latter and single-cycle replication, the membrane-anchored preF vaccine was protective and demonstrates potential for development of an efficacious live vaccine with a stable safety phenotype.
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Affiliation(s)
- Pramila Lamichhane
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Megan E Schmidt
- Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, 52242, USA
| | - Megolhubino Terhüja
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Steven M Varga
- Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, 52242, USA; Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, 52242, USA; Department of Pathology, University of Iowa, Iowa City, IA, 52242, USA
| | - Timothy A Snider
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30329, USA
| | - Antonius G P Oomens
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, 74078, USA.
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21
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Roe MK, Perez MA, Hsiao HM, Lapp SA, Sun HY, Jadhao S, Young AR, Batista YS, Reed RC, Taz A, Piantadosi A, Chen X, Liang B, Koval M, Snider TA, Moore ML, Anderson EJ, Anderson LJ, Stobart CC, Rostad CA. An RSV Live-Attenuated Vaccine Candidate Lacking G Protein Mucin Domains Is Attenuated, Immunogenic, and Effective in Preventing RSV in BALB/c Mice. J Infect Dis 2022; 227:50-60. [PMID: 36281651 PMCID: PMC9796166 DOI: 10.1093/infdis/jiac382] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/09/2022] [Accepted: 10/31/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading viral respiratory pathogen in infants. The objective of this study was to generate RSV live-attenuated vaccine (LAV) candidates by removing the G-protein mucin domains to attenuate viral replication while retaining immunogenicity through deshielding of surface epitopes. METHODS Two LAV candidates were generated from recombinant RSV A2-line19F by deletion of the G-protein mucin domains (A2-line19F-G155) or deletion of the G-protein mucin and transmembrane domains (A2-line19F-G155S). Vaccine attenuation was measured in BALB/c mouse lungs by fluorescent focus unit (FFU) assays and real-time polymerase chain reaction (RT-PCR). Immunogenicity was determined by measuring serum binding and neutralizing antibodies in mice following prime/boost on days 28 and 59. Efficacy was determined by measuring RSV lung viral loads on day 4 postchallenge. RESULTS Both LAVs were undetectable in mouse lungs by FFU assay and elicited similar neutralizing antibody titers compared to A2-line19F on days 28 and 59. Following RSV challenge, vaccinated mice showed no detectable RSV in the lungs by FFU assay and a significant reduction in RSV RNA in the lungs by RT-PCR of 560-fold for A2-line19F-G155 and 604-fold for A2-line19F-G155S compared to RSV-challenged, unvaccinated mice. CONCLUSIONS Removal of the G-protein mucin domains produced RSV LAV candidates that were highly attenuated with retained immunogenicity.
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Affiliation(s)
- Molly K Roe
- Department of Biological Sciences, Butler University, Indianapolis, Indiana, USA
| | - Maria A Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacey A Lapp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - He-Ying Sun
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samadhan Jadhao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Audrey R Young
- Department of Biological Sciences, Butler University, Indianapolis, Indiana, USA
| | - Yara S Batista
- Department of Biological Sciences, Butler University, Indianapolis, Indiana, USA
| | - Ryan C Reed
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Azmain Taz
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anne Piantadosi
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Xuemin Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bo Liang
- Department of Biochemistry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Koval
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Timothy A Snider
- Department of Veterinary Pathobiology, Oklahoma State University, Stillwater, Oklahoma, USA
| | | | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Larry J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Christina A Rostad
- Correspondence: Christina A. Rostad, MD, Emory Children's Center, 2015 Uppergate Drive NE, Atlanta, GA 30322 ()
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22
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Gombolay G, Anderson M, Xiang Y, Bai S, Rostad CA, Tyor W. Neurological Complications in Children Hospitalized With Seizures and Respiratory Infections: A Comparison Between SARS-CoV-2 and Other Respiratory Infections. Pediatr Neurol 2022; 135:52-55. [PMID: 35995010 PMCID: PMC9338832 DOI: 10.1016/j.pediatrneurol.2022.07.010] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can experience neurological symptoms, but limited data are available on neurological symptoms associated with other respiratory infections. We compared proportions of neurological symptoms in children hospitalized with seizures and respiratory infections, including SARS-CoV-2, influenza, and endemic coronaviruses. METHODS A retrospective cohort study was performed on children admitted for seizures who had positive respiratory polymerase chain reactions for SARS-CoV-2, coronavirus NL63, coronavirus OC34, influenza (A and B), adenovirus, Mycoplasma pneumoniae, or parainfluenza 3 or 4. Primary outcomes were rates of new neurological diagnoses and mortality. RESULTS A total of 883 children were included. Mortality rates ranged from 0% with M. pneumoniae to 4.9% with parainfluenza 4. Strokes were observed with all infections except for coronavirus OC43 and M. pneumoniae, with the highest rates in parainfluenza 4 (4.9%) and SARS-CoV-2 (5.9%). Compared with other infections, children with SARS-CoV-2 were older, had higher rates of stroke, and lower rates of intubation. The most common brain magnetic resonance imaging (MRI) abnormality was diffusion restriction. Abnormal MRI rates were lower in SARS-CoV-2, compared with patients with other coronavirus (OC). However, rates of stroke, encephalopathy, hypoxic-ischemic encephalopathy, and meningoencephalitis were similar between SARS-CoV-2 and influenza cohorts. CONCLUSIONS In children hospitalized with seizures, higher rates of stroke were observed in SARS-CoV-2 versus OC. Similar rates of neurological symptoms were observed in patients with SARS-CoV-2 and those with influenza. Strokes can occur in children with these viral infections, particularly SARS-CoV-2.
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Affiliation(s)
- Grace Gombolay
- Division of Neurology, Department of Pediatrics, Emory University School of Medicine, Atlanta Georgia; Division of Pediatric Neurology, Children's Healthcare of Atlanta, Atlanta Georgia.
| | - Monique Anderson
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Yijin Xiang
- Emory University School of Medicine, Pediatric Biostatistics Core, Atlanta, Georgia
| | - Shasha Bai
- Emory University School of Medicine, Pediatric Biostatistics Core, Atlanta, Georgia
| | - Christina A Rostad
- Division of Infectious Diseases, and Center for Childhood Infections and Vaccines, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - William Tyor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Atlanta VA Medical Center, Decatur, Georgia
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23
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Gupta SL, Mantus G, Manning KE, Ellis M, Patel M, Ciric CR, Lu A, Turner JS, O’Halloran JA, Presti RM, Joshi DJ, Ellebedy AH, Anderson EJ, Rostad CA, Suthar MS, Wrammert J. Loss of Pfizer (BNT162b2) Vaccine-Induced Antibody Responses against the SARS-CoV-2 Omicron Variant in Adolescents and Adults. J Virol 2022; 96:e0058222. [PMID: 35976000 PMCID: PMC9472620 DOI: 10.1128/jvi.00582-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 12/19/2022] Open
Abstract
Emerging variants, especially the recent Omicron variant, and gaps in vaccine coverage threaten mRNA vaccine mediated protection against SARS-CoV-2. While children have been relatively spared by the ongoing pandemic, increasing case numbers and hospitalizations are now evident among children. Thus, it is essential to better understand the magnitude and breadth of vaccine-induced immunity in children against circulating viral variant of concerns (VOCs). Here, we compared the magnitude and breadth of humoral immune responses in adolescents and adults 1 month after the two-dose Pfizer (BNT162b2) vaccination. We found that adolescents (aged 11 to 16) demonstrated more robust binding antibody and neutralization responses against the wild-type SARS-CoV-2 virus spike protein contained in the vaccine compared to adults (aged 27 to 55). The quality of the antibody responses against VOCs in adolescents were very similar to adults, with modest changes in binding and neutralization of Beta, Gamma, and Delta variants. In comparison, a significant reduction of binding titers and a striking lack of neutralization was observed against the newly emerging Omicron variant for both adolescents and adults. Overall, our data show that a two-dose BNT162b2 vaccine series may be insufficient to protect against the Omicron variant. IMPORTANCE While plasma binding and neutralizing antibody responses have been reported for cohorts of infected and vaccinated adults, much less is known about the vaccine-induced antibody responses to variants including Omicron in children. This illustrates the need to characterize vaccine efficacy in key vulnerable populations. A third (booster) dose of BNTb162b was approved for children 12 to 15 years of age by the Food and Drug Administration (FDA) on January 1, 2022, and pediatric clinical trials are under way to evaluate the safety, immunogenicity, and effectiveness of a third dose in younger children. Similarly, variant-specific booster doses and pan-coronavirus vaccines are areas of active research. Our data show adolescents mounted stronger humoral immune responses after vaccination than adults. It also highlights the need for future studies of antibody durability in adolescents and children as well as the need for future studies of booster vaccination and their efficacy against the Omicron variant.
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Affiliation(s)
- Sneh Lata Gupta
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Grace Mantus
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kelly E. Manning
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- National Primate Research Center, Atlanta, Georgia, USA
| | - Madison Ellis
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- National Primate Research Center, Atlanta, Georgia, USA
| | - Mit Patel
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- National Primate Research Center, Atlanta, Georgia, USA
| | - Caroline Rose Ciric
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Austin Lu
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jackson S. Turner
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jane A. O’Halloran
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel M. Presti
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Devyani Jaideep Joshi
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ali H. Ellebedy
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology & Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri, USA
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Evan J. Anderson
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A. Rostad
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Mehul S. Suthar
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA
- National Primate Research Center, Atlanta, Georgia, USA
| | - Jens Wrammert
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Centers for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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24
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Amin O, Rostad CA, Gonzalez M, Rostad BS, Caltharp S, Quincer E, Betke BA, Gottdenker NL, Wilson JJ, Shane AL, Elmontser M, Camacho-Gonzalez A, Senior T, Smith O, Anderson EJ, Yildirim I. CAT-SCRATCH DISEASE: 9 YEARS OF EXPERIENCE AT A PEDIATRIC CENTER. Open Forum Infect Dis 2022; 9:ofac426. [PMID: 36072697 PMCID: PMC9439574 DOI: 10.1093/ofid/ofac426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.
Methods
We conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010, and December 31, 2018 who had serology, PCR and/or cytopathological results consistent with a Bartonella henselae infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia (UGA) from 2018-2020 to ascertain the burden of bartonellosis in companion animals within the state.
Results
We identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41/304, 13.5%) and September (47/304, 15.5%). The median age of child cases was 8.1 years (interquartile range (IQR) 5.4-12.1]; 156 (51.3%) were female; 242/262 (92.4%) reported feline exposure, while 55/250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63/304, 20.7%). Among children with radiographic imaging, 20/55 (36.4%) had splenomegaly and 21/55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, Bartonella seroprevalence was 12/146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.
Conclusion
Distinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.
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Affiliation(s)
- Omayma Amin
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Mark Gonzalez
- Department of Clinical Microbiology, Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Bradley S Rostad
- Division of Pediatric Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine , Atlanta, GA , USA
| | - Shelley Caltharp
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Pathology, Emory University School of Medicine , Atlanta, GA , USA
| | - Elizabeth Quincer
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Briana A Betke
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Nicole L Gottdenker
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Jonathan J Wilson
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Mohnd Elmontser
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Tal Senior
- Department of Advanced Analytics, Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Oliver Smith
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA
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25
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Kamidani S, Rostad CA, Anderson EJ. Addressing the global burden of paediatric critical COVID-19 and mortality. The Lancet Regional Health - Americas 2022; 12:100301. [PMID: 35757023 PMCID: PMC9212755 DOI: 10.1016/j.lana.2022.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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26
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Verkerke HP, Damhorst GL, Graciaa DS, McLendon K, O'Sick W, Robichaux C, Cheedarla N, Potlapalli S, Wu SC, Harrington KRV, Webster A, Kraft C, Rostad CA, Waggoner JJ, Gandhi NR, Guarner J, Auld SC, Neish A, Roback JD, Lam WA, Shah NS, Stowell SR. Nucleocapsid Antigenemia Is a Marker of Acute SARS-CoV-2 Infection. J Infect Dis 2022; 226:1577-1587. [PMID: 35877413 PMCID: PMC9384592 DOI: 10.1093/infdis/jiac225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 01/07/2023] Open
Abstract
Detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is essential for diagnosis, treatment, and infection control. Polymerase chain reaction (PCR) fails to distinguish acute from resolved infections, as RNA is frequently detected after infectiousness. We hypothesized that nucleocapsid in blood marks acute infection with the potential to enhance isolation and treatment strategies. In a retrospective serosurvey of inpatient and outpatient encounters, we categorized samples along an infection timeline using timing of SARS-CoV-2 testing and symptomatology. Among 1860 specimens from 1607 patients, the highest levels and frequency of antigenemia were observed in samples from acute SARS-CoV-2 infection. Antigenemia was higher in seronegative individuals and in those with severe disease. In our analysis, antigenemia exhibited 85.8% sensitivity and 98.6% specificity as a biomarker for acute coronavirus disease 2019 (COVID-19). Thus, antigenemia sensitively and specifically marks acute SARS-CoV-2 infection. Further study is warranted to determine whether antigenemia may aid individualized assessment of active COVID-19.
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Affiliation(s)
- Hans P Verkerke
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA
| | - Daniel S Graciaa
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kaleb McLendon
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William O'Sick
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Narayanaiah Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sindhu Potlapalli
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shang Chuen Wu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin R V Harrington
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Andrew Webster
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Colleen Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jesse J Waggoner
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA.,Emory Healthcare, Atlanta, Georgia, USA.,Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Neel R Gandhi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sara C Auld
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wilbur A Lam
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA.,Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - N Sarita Shah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Sean R Stowell
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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27
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Lyke KE, Atmar RL, Islas CD, Posavad CM, Szydlo D, Paul Chourdhury R, Deming ME, Eaton A, Jackson LA, Branche AR, El Sahly HM, Rostad CA, Martin JM, Johnston C, Rupp RE, Mulligan MJ, Brady RC, Frenck RW, Bäcker M, Kottkamp AC, Babu TM, Rajakumar K, Edupuganti S, Dobrzynski D, Coler RN, Archer JI, Crandon S, Zemanek JA, Brown ER, Neuzil KM, Stephens DS, Post DJ, Nayak SU, Suthar MS, Roberts PC, Beigel JH, Montefiori DC. Rapid decline in vaccine-boosted neutralizing antibodies against SARS-CoV-2 Omicron variant. Cell Rep Med 2022; 3:100679. [PMID: 35798000 PMCID: PMC9212999 DOI: 10.1016/j.xcrm.2022.100679] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exhibits reduced susceptibility to vaccine-induced neutralizing antibodies, requiring a boost to generate protective immunity. We assess the magnitude and short-term durability of neutralizing antibodies after homologous and heterologous boosting with mRNA and Ad26.COV2.S vaccines. All prime-boost combinations substantially increase the neutralization titers to Omicron, although the boosted titers decline rapidly within 2 months from the peak response compared with boosted titers against the prototypic D614G variant. Boosted Omicron neutralization titers are substantially higher for homologous mRNA vaccine boosting, and for heterologous mRNA and Ad26.COV2.S vaccine boosting, compared with homologous Ad26.COV2.S boosting. Homologous mRNA vaccine boosting generates nearly equivalent neutralizing activity against Omicron sublineages BA.1, BA.2, and BA.3 but modestly reduced neutralizing activity against BA.2.12.1 and BA.4/BA.5 compared with BA.1. These results have implications for boosting requirements to protect against Omicron and future variants of SARS-CoV-2. This trial was conducted under ClincalTrials.gov: NCT04889209.
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Affiliation(s)
- Kirsten E Lyke
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert L Atmar
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA.
| | - Clara Dominguez Islas
- Vaccine and Infectious Disease Division, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christine M Posavad
- Vaccine and Infectious Disease Division, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Departments of Laboratory Medicine and Pathology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel Szydlo
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rahul Paul Chourdhury
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Meagan E Deming
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amanda Eaton
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Angela R Branche
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, USA
| | - Hana M El Sahly
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Christina A Rostad
- Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Judith M Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christine Johnston
- Vaccine and Infectious Disease Division, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Departments of Laboratory Medicine and Pathology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Richard E Rupp
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Mark J Mulligan
- NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert W Frenck
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martín Bäcker
- NYU Langone Hospital-Long Island Vaccine Center Research Clinic and Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Angelica C Kottkamp
- NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Tara M Babu
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kumaravel Rajakumar
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Srilatha Edupuganti
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Hope Clinic of Emory Vaccine Center, Atlanta, GA, USA
| | - David Dobrzynski
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, USA
| | - Rhea N Coler
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jillian A Zemanek
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elizabeth R Brown
- Vaccine and Infectious Disease Division, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David S Stephens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Diane J Post
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Seema U Nayak
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mehul S Suthar
- Emory Vaccine Center, Yerkes National Primate Research Center, Department of Pediatrics, Department of Microbiology and Immunology, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David C Montefiori
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA.
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28
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Branche AR, Rouphael NG, Diemert DJ, Falsey AR, Losada C, Baden LR, Frey SE, Whitaker JA, Little SJ, Anderson EJ, Walter EB, Novak RM, Rupp R, Jackson LA, Babu TM, Kottkamp AC, Luetkemeyer AF, Immergluck LC, Presti RM, Bäcker M, Winokur PL, Mahgoub SM, Goepfert PA, Fusco DN, Malkin E, Bethony JM, Walsh EE, Graciaa DS, Samaha H, Sherman AC, Walsh SR, Abate G, Oikonomopoulou Z, El Sahly HM, Martin TCS, Rostad CA, Smith MJ, Ladner BG, Porterfield L, Dunstan M, Wald A, Davis T, Atmar RL, Mulligan MJ, Lyke KE, Posavad CM, Meagher MA, Stephens DS, Neuzil KM, Abebe K, Hill H, Albert J, Lewis TC, Giebeig LA, Eaton A, Netzl A, Wilks SH, Türeli S, Makhene M, Crandon S, Lee M, Nayak SU, Montefiori DC, Makowski M, Smith DJ, Roberts PC, Beigel JH. SARS-CoV-2 Variant Vaccine Boosters Trial: Preliminary Analyses. medRxiv 2022:2022.07.12.22277336. [PMID: 35898343 PMCID: PMC9327623 DOI: 10.1101/2022.07.12.22277336] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Protection from SARS-CoV-2 vaccines wanes over time and is compounded by emerging variants including Omicron subvariants. This study evaluated safety and immunogenicity of SARS-CoV-2 variant vaccines. Methods This phase 2 open-label, randomized trial enrolled healthy adults previously vaccinated with a SARS-CoV-2 primary series and a single boost. Eligible participants were randomized to one of six Moderna COVID19 mRNA vaccine arms (50µg dose): Prototype (mRNA-1273), Omicron BA.1+Beta (1 or 2 doses), Omicron BA.1+Delta, Omicron BA.1 monovalent, and Omicron BA.1+Prototype. Neutralization antibody titers (ID 50 ) were assessed for D614G, Delta, Beta and Omicron BA.1 variants and Omicron BA.2.12.1 and BA.4/BA.5 subvariants 15 days after vaccination. Results From March 30 to May 6, 2022, 597 participants were randomized and vaccinated. Median age was 53 years, and 20% had a prior SARS-CoV-2 infection. All vaccines were safe and well-tolerated. Day 15 geometric mean titers (GMT) against D614G were similar across arms and ages, and higher with prior infection. For uninfected participants, Day 15 Omicron BA.1 GMTs were similar across Omicron-containing vaccine arms (3724-4561) and higher than Prototype (1,997 [95%CI:1,482-2,692]). The Omicron BA.1 monovalent and Omicron BA.1+Prototype vaccines induced a geometric mean ratio (GMR) to Prototype for Omicron BA.1 of 2.03 (97.5%CI:1.37-3.00) and 1.56 (97.5%CI:1.06-2.31), respectively. A subset of samples from uninfected participants in four arms were also tested in a different laboratory at Day 15 for neutralizing antibody titers to D614G and Omicron subvariants BA.1, BA.2.12.2 and BA.4/BA.5. Omicron BA.4/BA.5 GMTs were approximately one third BA.1 GMTs (Prototype 517 [95%CI:324-826] vs. 1503 [95%CI:949-2381]; Omicron BA.1+Beta 628 [95%CI:367-1,074] vs. 2125 [95%CI:1139-3965]; Omicron BA.1+Delta 765 [95%CI:443-1,322] vs. 2242 [95%CI:1218-4128] and Omicron BA.1+Prototype 635 [95%CI:447-903] vs. 1972 [95%CI:1337-2907). Conclusions Higher Omicron BA.1 titers were observed with Omicron-containing vaccines compared to Prototype vaccine and titers against Omicron BA.4/BA.5 were lower than against BA.1 for all candidate vaccines. Clinicaltrialsgov NCT05289037.
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29
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Fintzi J, Bonnett T, Tebas P, Marconi VC, Levine CB, El Sahly HM, McLellan SLF, Benson CA, Rostad CA, Ganesan A, Huprikar N, Frank MG, Mularski RA, Atmar RL, Park PK, Short WR, Beigel JH, Mehta AK, Sweeney DA. Unraveling the Treatment Effect of Baricitinib on Clinical Progression and Resource Utilization in Hospitalized COVID-19 Patients: Secondary Analysis of the Adaptive COVID-19 Treatment Randomized Trial-2. Open Forum Infect Dis 2022; 9:ofac219. [PMID: 35818363 PMCID: PMC9129131 DOI: 10.1093/ofid/ofac219] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background The Adaptive COVID Treatment Trial-2 (ACTT-2) found that baricitinib in combination with remdesivir therapy (BCT) sped recovery in hospitalized coronavirus disease 2019 (COVID-19) patients vs remdesivir monotherapy (RMT). We examined how BCT affected progression throughout hospitalization and utilization of intensive respiratory therapies. Methods We characterized the clinical trajectories of 891 ACTT-2 participants requiring supplemental oxygen or higher levels of respiratory support at enrollment. We estimated the effect of BCT on cumulative incidence of clinical improvement and deterioration using competing risks models. We developed multistate models to estimate the effect of BCT on clinical improvement and deterioration and on utilization of respiratory therapies. Results BCT resulted in more linear improvement and lower incidence of clinical deterioration compared with RMT (hazard ratio [HR], 0.74; 95% CI, 0.58 to 0.95). The benefit was pronounced among participants enrolled on high-flow oxygen or noninvasive positive-pressure ventilation. In this group, BCT sped clinical improvement (HR, 1.21; 95% CI, 0.99 to 1.51) while slowing clinical deterioration (HR, 0.71; 95% CI, 0.48 to 1.02), which reduced the expected days in ordinal score (OS) 6 per 100 patients by 74 days (95% CI, -8 to 154 days) and the expected days in OS 7 per 100 patients by 161 days (95% CI, 46 to 291 days) compared with RMT. BCT did not benefit participants who were mechanically ventilated at enrollment. Conclusions Compared with RMT, BCT reduces the clinical burden and utilization of intensive respiratory therapies for patients requiring low-flow oxygen or noninvasive positive-pressure ventilation compared with RMT and may thereby improve care for this patient population.
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Affiliation(s)
- Jonathan Fintzi
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
| | - Tyler Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Pablo Tebas
- Division of Infectious Diseases/Clinical Trials Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vincent C Marconi
- Emory University School of Medicine and Rollins School of Public Health, Emory Vaccine Center, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Corri B Levine
- Division of Infectious Disease, Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Susan L F McLellan
- Division of Infectious Disease, Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Constance A Benson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Christina A Rostad
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anuradha Ganesan
- Division of Infectious Disease, Walter Reed National Military Medical Center, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Nikhil Huprikar
- Division of Pulmonary/Critical Care Medicine, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Maria G Frank
- Department of Medicine, Denver Health Hospital Authority, Associate Professor of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard A Mularski
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Robert L Atmar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Pauline K Park
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
| | - Aneesh K Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
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30
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Rostad CA, Chen X, Sun HY, Hussaini L, Lu A, Perez MA, Hsiao HM, Anderson LJ, Anderson EJ. Functional antibody responses to SARS-CoV-2 variants in children with COVID-19, MIS-C, and after two doses of BNT162b2 vaccination. J Infect Dis 2022; 226:1237-1242. [PMID: 35639597 PMCID: PMC9213873 DOI: 10.1093/infdis/jiac215] [Citation(s) in RCA: 8] [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: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
Background Although neutralizing antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) correlate with protection against coronavirus disease 2019 (COVID-19), little is known about the neutralizing and antibody-dependent cell-mediated cytotoxicity (ADCC) responses to COVID-19, multisystem inflammatory syndrome in children (MIS-C), and COVID-19 vaccination in children. Methods We enrolled children 0–21 years of age with a history of COVID-19 (n = 13), MIS-C (n = 13), or 2 doses of BNT162b2 vaccination (n = 14) into a phlebotomy protocol. We measured pseudovirus neutralizing and functional ADCC antibodies to SARS-CoV-2 variants, including Omicron (B.1.1.529). Results The primary BNT162b2 vaccination series elicited higher neutralizing and ADCC responses with greater breadth to SARS-CoV-2 variants than COVID-19 or MIS-C, although these were diminished against Omicron. Conclusions Serologic responses were significantly reduced against variants, particularly Omicron.
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Affiliation(s)
- Christina A Rostad
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Xuemin Chen
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - He-Ying Sun
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Laila Hussaini
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Austin Lu
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Maria A Perez
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Hui-Mien Hsiao
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Larry J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Evan J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Infectious Diseases, University of Georgia, Athens, GA, United States
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31
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Sharma S, Agha B, Delgado C, Walson K, Woods C, Gonzalez MD, Jerris R, Sysyn G, Beiter J, Kamidani S, Rostad CA. Croup Associated With SARS-CoV-2: Pediatric Laryngotracheitis During the Omicron Surge. J Pediatric Infect Dis Soc 2022; 11:371-374. [PMID: 35512450 PMCID: PMC9426860 DOI: 10.1093/jpids/piac032] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 12/05/2022]
Abstract
In this retrospective analysis, we describe weekly croup and corresponding viral prevalence patterns in a pediatric quaternary care system in metropolitan Atlanta. We characterize a series of 24 patients with croup associated with SARS-CoV-2 infection and show that this clinical presentation increased substantially in frequency during the period of high Omicron vs Delta transmission.
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Affiliation(s)
- Sujit Sharma
- Corresponding Author: Sujit Sharma, MD, Division of Emergency Medicine, Children's Healthcare of Atlanta at Scottish Rite, 1001 Johnson Ferry Road, Atlanta, GA 30342, USA. E-mail:
| | - Beesan Agha
- Pediatric Emergency Medicine Associates (PEMA), LLC, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Division of Emergency Medicine, Atlanta, Georgia, USA
| | - Carlos Delgado
- Pediatric Emergency Medicine Associates (PEMA), LLC, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Division of Emergency Medicine, Atlanta, Georgia, USA
| | - Karen Walson
- Children’s Healthcare of Atlanta, Division of Critical Care Medicine, Atlanta, Georgia, USA
| | - Charles Woods
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
| | - Mark D Gonzalez
- Children’s Healthcare of Atlanta, Division of Pathology, Atlanta, Georgia, USA
| | - Robert Jerris
- Children’s Healthcare of Atlanta, Division of Pathology, Atlanta, Georgia, USA
| | - Gregory Sysyn
- Children’s Healthcare of Atlanta, Division of Critical Care Medicine, Atlanta, Georgia, USA
| | - James Beiter
- Pediatric Emergency Medicine Associates (PEMA), LLC, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Division of Emergency Medicine, Atlanta, Georgia, USA
| | - Satoshi Kamidani
- Children’s Healthcare of Atlanta, Division of Infectious Disease, Atlanta, Georgia, USA,Department of Pediatrics, Division of Pediatric Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Children’s Healthcare of Atlanta, Division of Infectious Disease, Atlanta, Georgia, USA,Department of Pediatrics, Division of Pediatric Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
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32
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Gupta SL, Anderson EJ, Rostad CA, Suthar MS, Wrammert J. Robust antibody responses in children after Pfizer vaccination. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.65.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
SARS-CoV-2 is a devastating global pandemic which has resulted in mass loss of life. It is essential to vaccinate children to achieve herd immunity and prevent community transmission. In addition, the importance of vaccinating children is further illustrated by increasing COVID-19 cases among this age group and the associated Multisystem Inflammatory Syndrome in Children (MIS-C). Children possess a relatively naïve immune system compared to adults. With reopening of schools, relaxation of mask mandates and new emerging viral variants, it is imperative to better understand the magnitude and quality of vaccine induced responses in children, especially in terms of breadth of immunity against emerging viral variants.
In the current study we have assessed the humoral response after vaccination in children 11–17 years of age. We found robust responses in children, with Spike and RBD specific antibody titers that were significantly higher than adult vaccinees. In addition, these titers were also much higher than those seen in both convalescent hospitalized pediatric COVID and MIS-C cases. Compared to adults, the pediatric vaccinees showed a similar breadth against current viral variants. Finally, using a live neutralization assay we similarly found that children exhibited higher neutralization titers than adults and that the neutralization titers positively correlated with their RBD binding titers. Overall, our data show that vaccination induces more potent antibody responses in children as compared to adults, with similar breadth against emerging viral variants.
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33
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Kumar D, Rostad CA, Jaggi P, Villacis Nunez DS, Prince C, Lu A, Hussaini L, Nguyen TH, Malik S, Ponder LA, Shenoy SPV, Anderson EJ, Briones M, Sanz I, Prahalad S, Chandrakasan S. Distinguishing immune activation and inflammatory signatures of multisystem inflammatory syndrome in children (MIS-C) versus hemophagocytic lymphohistiocytosis (HLH). J Allergy Clin Immunol 2022; 149:1592-1606.e16. [PMID: 35304157 PMCID: PMC8923010 DOI: 10.1016/j.jaci.2022.02.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening sequela of severe acute respiratory syndrome coronavirus 2 infection characterized by hyperinflammation and multiorgan dysfunction. Although hyperinflammation is a prominent manifestation of MIS-C, there is limited understanding of how the inflammatory state of MIS-C differs from that of well-characterized hyperinflammatory syndromes such as hemophagocytic lymphohistiocytosis (HLH). OBJECTIVES We sought to compare the qualitative and quantitative inflammatory profile differences between patients with MIS-C, coronavirus disease 2019, and HLH. METHODS Clinical data abstraction from patient charts, T-cell immunophenotyping, and multiplex cytokine and chemokine profiling were performed for patients with MIS-C, patients with coronavirus disease 2019, and patients with HLH. RESULTS We found that both patients with MIS-C and patients with HLH showed robust T-cell activation, markers of senescence, and exhaustion along with elevated TH1 and proinflammatory cytokines such as IFN-γ, C-X-C motif chemokine ligand 9, and C-X-C motif chemokine ligand 10. In comparison, the amplitude of T-cell activation and the levels of cytokines/chemokines were higher in patients with HLH when compared with patients with MIS-C. Distinguishing inflammatory features of MIS-C included elevation in TH2 inflammatory cytokines such as IL-4 and IL-13 and cytokine mediators of angiogenesis, vascular injury, and tissue repair such as vascular endothelial growth factor A and platelet-derived growth factor. Immune activation and hypercytokinemia in MIS-C resolved at follow-up. In addition, when these immune parameters were correlated with clinical parameters, CD8+ T-cell activation correlated with cardiac dysfunction parameters such as B-type natriuretic peptide and troponin and inversely correlated with platelet count. CONCLUSIONS Overall, this study characterizes unique and overlapping immunologic features that help to define the hyperinflammation associated with MIS-C versus HLH.
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Affiliation(s)
- Deepak Kumar
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Christina A Rostad
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Preeti Jaggi
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - D Sofia Villacis Nunez
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Chengyu Prince
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Austin Lu
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Laila Hussaini
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Thinh H Nguyen
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Sakshi Malik
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Ga; Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Ga
| | | | - Sreekala P V Shenoy
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Evan J Anderson
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Michael Briones
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Ignacio Sanz
- Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Lowance Center for Human Immunology, Emory University, Atlanta, Ga
| | - Sampath Prahalad
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Department of Human Genetics, Emory University School of Medicine, Atlanta, Ga
| | - Shanmuganathan Chandrakasan
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga.
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Godfred-Cato S, Abrams JY, Balachandran N, Jaggi P, Jones K, Rostad CA, Lu AT, Fan L, Jabbar A, Anderson EJ, Kao CM, Hunstad DA, Rosenberg RB, Zafferani MJ, Ede KC, Ballan W, Laham FR, Beltran Y, Bryant B, Meng L, Hammett TA, Oster ME, Bamrah Morris S, Belay ED. Distinguishing Multisystem Inflammatory Syndrome in Children From COVID-19, Kawasaki Disease and Toxic Shock Syndrome. Pediatr Infect Dis J 2022; 41:315-323. [PMID: 35093995 PMCID: PMC8919949 DOI: 10.1097/inf.0000000000003449] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Distinguishing multisystem inflammatory syndrome in children (MIS-C) from coronavirus disease 2019 (COVID-19), Kawasaki disease (KD), and toxic shock syndrome (TSS) can be challenging. Because clinical management of these conditions can vary, timely and accurate diagnosis is essential. METHODS Data were collected from patients <21 years of age hospitalized with MIS-C, COVID-19, KD, and TSS in 4 major health care institutions. Patient demographics and clinical and laboratory data were compared among the 4 conditions, and a diagnostic scoring tool was developed to assist in clinical diagnosis. RESULTS A total of 233 patients with MIS-C, 102 with COVID-19, 101 with KD, and 76 with TSS were included in the analysis. Patients with MIS-C had the highest prevalence of decreased cardiac function (38.6%), myocarditis (34.3%), pericardial effusion (38.2%), mitral regurgitation (31.8%) and pleural effusion (34.8%) compared with patients with the other conditions. Patients with MIS-C had increased peak levels of C-reactive protein and decreased platelets and lymphocyte nadir counts compared with patients with COVID-19 and KD and elevated levels of troponin, brain natriuretic peptide and pro-brain natriuretic peptide compared with COVID-19. Diagnostic scores utilizing clinical findings effectively distinguished MIS-C from COVID-19, KD, and TSS, with internal validation showing area under the curve ranging from 0.87 to 0.97. CONCLUSIONS Compared with COVID-19, KD, and TSS, patients with MIS-C had significantly higher prevalence of cardiac complications, elevated markers of inflammation and cardiac damage, thrombocytopenia, and lymphopenia. Diagnostic scores can be a useful tool for distinguishing MIS-C from COVID-19, KD, and TSS.
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Affiliation(s)
| | | | | | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | | | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Austin T. Lu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Lucie Fan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Carol M. Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Robert B. Rosenberg
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
| | - Marc J. Zafferani
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
| | - Kaleo C. Ede
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
- Division of Pediatric Rheumatology, Phoenix Children’s Hospital, Phoenix, AZ
| | - Wassim Ballan
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
- Pediatric Infectious Diseases, Phoenix Children’s Hospital, Phoenix, AZ
| | - Federico R. Laham
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Yajira Beltran
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Bobbi Bryant
- CDC COVID-19 Response Team, Atlanta, GA
- Oak Ridge Institute for Science and Education
| | - Lu Meng
- CDC COVID-19 Response Team, Atlanta, GA
- General Dynamics Information Technology, Falls Church, VA
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35
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Atmar RL, Lyke KE, Deming ME, Jackson LA, Branche AR, El Sahly HM, Rostad CA, Martin JM, Johnston C, Rupp RE, Mulligan MJ, Brady RC, Frenck RW, Bäcker M, Kottkamp AC, Babu TM, Rajakumar K, Edupuganti S, Dobrzynski D, Coler RN, Posavad CM, Archer JI, Crandon S, Nayak SU, Szydlo D, Zemanek JA, Dominguez Islas CP, Brown ER, Suthar MS, McElrath MJ, McDermott AB, O'Connell SE, Montefiori DC, Eaton A, Neuzil KM, Stephens DS, Roberts PC, Beigel JH. Homologous and Heterologous Covid-19 Booster Vaccinations. N Engl J Med 2022; 386:1046-1057. [PMID: 35081293 PMCID: PMC8820244 DOI: 10.1056/nejmoa2116414] [Citation(s) in RCA: 325] [Impact Index Per Article: 162.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although the three vaccines against coronavirus disease 2019 (Covid-19) that have received emergency use authorization in the United States are highly effective, breakthrough infections are occurring. Data are needed on the serial use of homologous boosters (same as the primary vaccine) and heterologous boosters (different from the primary vaccine) in fully vaccinated recipients. METHODS In this phase 1-2, open-label clinical trial conducted at 10 sites in the United States, adults who had completed a Covid-19 vaccine regimen at least 12 weeks earlier and had no reported history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection received a booster injection with one of three vaccines: mRNA-1273 (Moderna) at a dose of 100 μg, Ad26.COV2.S (Johnson & Johnson-Janssen) at a dose of 5×1010 virus particles, or BNT162b2 (Pfizer-BioNTech) at a dose of 30 μg. The primary end points were safety, reactogenicity, and humoral immunogenicity on trial days 15 and 29. RESULTS Of the 458 participants who were enrolled in the trial, 154 received mRNA-1273, 150 received Ad26.COV2.S, and 153 received BNT162b2 as booster vaccines; 1 participant did not receive the assigned vaccine. Reactogenicity was similar to that reported for the primary series. More than half the recipients reported having injection-site pain, malaise, headache, or myalgia. For all combinations, antibody neutralizing titers against a SARS-CoV-2 D614G pseudovirus increased by a factor of 4 to 73, and binding titers increased by a factor of 5 to 55. Homologous boosters increased neutralizing antibody titers by a factor of 4 to 20, whereas heterologous boosters increased titers by a factor of 6 to 73. Spike-specific T-cell responses increased in all but the homologous Ad26.COV2.S-boosted subgroup. CD8+ T-cell levels were more durable in the Ad26.COV2.S-primed recipients, and heterologous boosting with the Ad26.COV2.S vaccine substantially increased spike-specific CD8+ T cells in the mRNA vaccine recipients. CONCLUSIONS Homologous and heterologous booster vaccines had an acceptable safety profile and were immunogenic in adults who had completed a primary Covid-19 vaccine regimen at least 12 weeks earlier. (Funded by the National Institute of Allergy and Infectious Diseases; DMID 21-0012 ClinicalTrials.gov number, NCT04889209.).
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Affiliation(s)
- Robert L Atmar
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Kirsten E Lyke
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Meagan E Deming
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Lisa A Jackson
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Angela R Branche
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Hana M El Sahly
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Christina A Rostad
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Judith M Martin
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Christine Johnston
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Richard E Rupp
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Mark J Mulligan
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Rebecca C Brady
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Robert W Frenck
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Martín Bäcker
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Angelica C Kottkamp
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Tara M Babu
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Kumaravel Rajakumar
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Srilatha Edupuganti
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - David Dobrzynski
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Rhea N Coler
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Christine M Posavad
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Janet I Archer
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Sonja Crandon
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Seema U Nayak
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Daniel Szydlo
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Jillian A Zemanek
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Clara P Dominguez Islas
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Elizabeth R Brown
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Mehul S Suthar
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - M Juliana McElrath
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Adrian B McDermott
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Sarah E O'Connell
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - David C Montefiori
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Amanda Eaton
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Kathleen M Neuzil
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - David S Stephens
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - Paul C Roberts
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
| | - John H Beigel
- From the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston (R.L.A., H.M.E.S.), and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston (R.E.R.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (K.E.L., M.E.D., K.M.N.), and the Division of Microbiology and Infectious Diseases (S.C., S.U.N., P.C.R., J.H.B.) and the Vaccine Research Center (A.B.M., S.E.O.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Kaiser Permanente Washington Health Research Institute (L.A.J.), the Departments of Medicine (C.J., T.M.B., M.J. McElrath) and Laboratory Medicine and Pathology (C.J., C.M.P.), University of Washington, the Vaccine and Infectious Disease Division (C.J., C.M.P., C.P.D.I., E.R.B., M.J. McElrath) and the Statistical Center for HIV/AIDS Research and Prevention (D.S., J.A.Z.), Fred Hutchinson Cancer Research Center, and Seattle Children's Research Institute (R.N.C.) and the Department of Pediatrics (R.N.C.), University of Washington School of Medicine, Seattle; the Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester (A.R.B., D.D.), NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York (M.J. Mulligan, A.C.K.), and NYU Langone Hospital-Long Island Vaccine Center Research Clinic and the Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola (M.B.) - all in New York; the Departments of Pediatrics (C.A.R.), Microbiology and Immunology (M.S.S.), and Medicine (S.E., D.S.S.), the Center for Childhood Infections and Vaccines (C.A.R.), Hope Clinic of Emory Vaccine Center (S.E.), Emory Vaccine Center, and Yerkes National Primate Research Center (M.S.S.), Emory University School of Medicine, Emory University, and Children's Healthcare of Atlanta (C.A.R.) - all in Atlanta; the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (J.M.M., K.R.); Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati (R.C.B., R.W.F.); and FHI 360 (formerly Family Health International) (J.I.A.) and Duke Human Vaccine Institute (D.C.M.) and the Department of Surgery (D.C.M., A.E.), Duke University Medical Center, Durham, NC
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Westbrook AL, Benedit LC, Frediani JK, Griffiths MA, Khan NY, Levy JM, Morris CR, Rostad CA, Stone CL, Sullivan J, Vos MB, Welsh J, Wood A, Martin GS, Lam W, Pollock NR. Predictive value of isolated symptoms for diagnosis of SARS-CoV-2 infection in children tested during peak circulation of the delta variant. Clin Infect Dis 2022; 75:1131-1139. [PMID: 35271694 PMCID: PMC8992302 DOI: 10.1093/cid/ciac112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 01/03/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) testing policies for symptomatic children attending US schools or daycare vary, and whether isolated symptoms should prompt testing is unclear. We evaluated children presenting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing to determine if the likelihood of having a positive SARS-CoV-2 test differed between participants with 1 symptom vs ≥2 symptoms, and to examine the predictive capability of isolated symptoms. Methods Participants aged <18 years presenting for clinical SARS-CoV-2 molecular testing in 6 sites in urban/suburban/rural Georgia (July–October, 2021; Delta variant predominant) were queried about individual symptoms. Participants were classified into 3 groups: asymptomatic, 1 symptom only, or ≥2 symptoms. SARS-CoV-2 test results and clinical characteristics of the 3 groups were compared. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) for isolated symptoms were calculated by fitting a saturated Poisson model. Results Of 602 participants, 21.8% tested positive and 48.7% had a known or suspected close contact. Children reporting 1 symptom (n = 82; odds ratio [OR], 6.00 [95% confidence interval {CI}, 2.70–13.33]) and children reporting ≥2 symptoms (n = 365; OR, 5.25 [95% CI, 2.66–10.38]) were significantly more likely to have a positive COVID-19 test than asymptomatic children (n = 155), but they were not significantly different from each other (OR, 0.88 [95% CI, .52–1.49]). Sensitivity and PPV were highest for isolated fever (33% and 57%, respectively), cough (25% and 32%), and sore throat (21% and 45%); headache had low sensitivity (8%) but higher PPV (33%). Sensitivity and PPV of isolated congestion/rhinorrhea were 8% and 9%, respectively. Conclusions With high Delta variant prevalence, children with isolated symptoms were as likely as those with multiple symptoms to test positive for COVID-19. Isolated fever, cough, sore throat, or headache, but not congestion/rhinorrhea, offered the highest predictive value.
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Affiliation(s)
- Adrianna L Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA USA
| | - Laura C Benedit
- Department of Clinical Research, Children's Healthcare of Atlanta, Atlanta, GA USA
| | | | - Mark A Griffiths
- Children's Healthcare of Atlanta, Atlanta, GA USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Nabeel Y Khan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Joshua M Levy
- Department of Otolaryngology-HNS, Emory University School of Medicine, Atlanta, GA USA
| | - Claudia R Morris
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA.,Division of Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Christina A Rostad
- Children's Healthcare of Atlanta, Atlanta, GA USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Cheryl L Stone
- Department of Clinical Research, Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Julie Sullivan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Miriam B Vos
- Children's Healthcare of Atlanta, Atlanta, GA USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Jean Welsh
- Children's Healthcare of Atlanta, Atlanta, GA USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Anna Wood
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA USA
| | - Greg S Martin
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Wilbur Lam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA.,Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA USA.,Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA USA
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA USA
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37
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Lapp SA, Abrams J, Lu AT, Hussaini L, Kao CM, Hunstad DA, Rosenberg RB, Zafferani MJ, Ede KC, Ballan W, Laham FR, Beltran Y, Hsiao HM, Sherry W, Jenkins E, Jones K, Horner A, Brooks A, Bryant B, Meng L, Hammett TA, Oster ME, Bamrah-Morris S, Godfred-Cato S, Belay E, Chahroudi A, Anderson EJ, Jaggi P, Rostad CA. Serologic and Cytokine Signatures in Children With Multisystem Inflammatory Syndrome and Coronavirus Disease 2019. Open Forum Infect Dis 2022; 9:ofac070. [PMID: 35237703 PMCID: PMC8883592 DOI: 10.1093/ofid/ofac070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background The serologic and cytokine responses of children hospitalized with multisystem inflammatory syndrome (MIS-C) vs coronavirus disease 2019 (COVID-19) are poorly understood. Methods We performed a prospective, multicenter, cross-sectional study of hospitalized children who met the Centers for Disease Control and Prevention case definition for MIS-C (n = 118), acute COVID-19 (n = 88), or contemporaneous healthy controls (n = 24). We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD) immunoglobulin G (IgG) titers and cytokine concentrations in patients and performed multivariable analysis to determine cytokine signatures associated with MIS-C. We also measured nucleocapsid IgG and convalescent RBD IgG in subsets of patients. Results Children with MIS-C had significantly higher SARS-CoV-2 RBD IgG than children with acute COVID-19 (median, 2783 vs 146; P < .001), and titers correlated with nucleocapsid IgG. For patients with MIS-C, RBD IgG titers declined in convalescence (median, 2783 vs 1135; P = .010) in contrast to patients with COVID-19 (median, 146 vs 4795; P < .001). MIS-C was characterized by transient acute proinflammatory hypercytokinemia, including elevated levels of interleukin (IL) 6, IL-10, IL-17A, and interferon gamma (IFN-γ). Elevation of at least 3 of these cytokines was associated with significantly increased prevalence of prolonged hospitalization ≥8 days (prevalence ratio, 3.29 [95% CI, 1.17–9.23]). Conclusions MIS-C was associated with high titers of SARS-CoV-2 RBD IgG antibodies and acute hypercytokinemia with IL-6, IL-10, IL-17A, and IFN-γ.
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Affiliation(s)
- Stacey A Lapp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Joseph Abrams
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Austin T Lu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert B Rosenberg
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
| | - Marc J Zafferani
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
| | - Kaleo C Ede
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
- Division of Pediatric Rheumatology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Wassim Ballan
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
- Pediatric Infectious Diseases, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | | | - Yajira Beltran
- Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Whitney Sherry
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Elan Jenkins
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kaitlin Jones
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anna Horner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Alyssa Brooks
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Bobbi Bryant
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Lu Meng
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Apex Systems affiliated with General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Teresa A Hammett
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sapna Bamrah-Morris
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ermias Belay
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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38
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Chen X, Sun HY, Lee CY, Rostad CA, Trost J, Abreu RB, Carlock MA, Wilson JR, Gansebom S, Ross TM, Steinhauer DA, Anderson EJ, Anderson LJ. Functional antibody-dependent cell mediated cytotoxicity (ADCC) responses to vaccine and circulating influenza strains following vaccination. Virology 2022; 569:44-55. [PMID: 35255298 PMCID: PMC9013517 DOI: 10.1016/j.virol.2022.02.004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
Abstract
Novel cell-based assays were developed to assess antibody-dependence cellular cytotoxicity (ADCC) antibodies against both vaccine and a representative circulation strain HA and NA proteins for the 2014-15 influenza season. The four assays using target cells stably expressing one of the four proteins worked well. In pre- and post-vaccine sera from 70 participants in a pre-season vaccine trial, we found ADCC antibodies and a rise in ADCC antibody titer against target cells expressing the 4 proteins but a much higher titer for the vaccine than the circulating HA in both pre-and post-vaccine sera. These differences in HA ADCC antibodies were not reflected in differences in HA binding antibodies. Our observations suggested that relatively minor changes on the subtype HA can result in large differences in ADCC activity.
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Affiliation(s)
- Xuemin Chen
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States; Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Atlanta, GA, USA
| | - He-Ying Sun
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Atlanta, GA, USA
| | - Chun Yi Lee
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Christina A Rostad
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Jessica Trost
- Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Atlanta, GA, USA; Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States; Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | - Rodrigo B Abreu
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, United States; Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Athens, GA, USA
| | - Michael A Carlock
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, United States; Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Athens, GA, USA
| | - Jason R Wilson
- Molecular Virology and Vaccine Team, Influenza and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Disease, OID, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Shane Gansebom
- Molecular Virology and Vaccine Team, Influenza and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Disease, OID, Centers for Disease Control and Prevention, Atlanta, GA, United States; (CDC/DDID/NCIRD/ID) GDIT, Federal Civilian Division, 2 Corporate Square; Ste 100, Atlanta, GA, 30329, USA
| | - Ted M Ross
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, United States; Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Athens, GA, USA; Department of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - David A Steinhauer
- Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Atlanta, GA, USA; Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States
| | - Evan J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Larry J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States; Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), Atlanta, GA, USA.
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39
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Singh V, Obregon-Perko V, Lapp SA, Horner AM, Brooks A, Macoy L, Hussaini L, Lu A, Gibson T, Silvestri G, Grifoni A, Weiskopf D, Sette A, Anderson EJ, Rostad CA, Chahroudi A. Limited induction of SARS-CoV-2-specific T cell responses in children with multisystem inflammatory syndrome compared to COVID-19. JCI Insight 2022; 7:155145. [PMID: 35044955 PMCID: PMC8876428 DOI: 10.1172/jci.insight.155145] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 09/20/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022] Open
Abstract
Why multisystem inflammatory syndrome in children (MIS-C) develops after SARS-CoV-2 infection in a subset of children is unknown. We hypothesized that aberrant virus–specific T cell responses contribute to MIS-C pathogenesis. We quantified SARS-CoV-2–reactive T cells, serologic responses against major viral proteins, and cytokine responses from plasma and peripheral blood mononuclear cells in children with convalescent COVID-19, in children with acute MIS-C, and in healthy controls. Children with MIS-C had significantly lower virus-specific CD4+ and CD8+ T cell responses to major SARS-CoV-2 antigens compared with children convalescing from COVID-19. Furthermore, T cell responses in participants with MIS-C were similar to or lower than those in healthy controls. Serologic responses against spike receptor binding domain (RBD), full-length spike, and nucleocapsid were similar among convalescent COVID-19 and MIS-C, suggesting functional B cell responses. Cytokine profiling demonstrated predominant Th1 polarization of CD4+ T cells from children with convalescent COVID-19 and MIS-C, although cytokine production was reduced in MIS-C. Our findings support a role for constrained induction of anti–SARS-CoV-2–specific T cells in the pathogenesis of MIS-C.
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Affiliation(s)
- Vidisha Singh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Veronica Obregon-Perko
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Stacey A Lapp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Anna M Horner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Alyssa Brooks
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Lisa Macoy
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Laila Hussaini
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, United States of America
| | - Austin Lu
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, United States of America
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Guido Silvestri
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, United States of America
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, United States of America
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, United States of America
| | - Evan J Anderson
- Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, United States of America
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40
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Reese OD, Tippett A, Hussaini L, Salazar L, Taylor M, Ciric C, Bristow L, Patel V, Li W, Hsiao HM, Stephens K, Gibson T, Kay A, Cheng A, Swerdlow DL, Hubler R, Lopman B, Rostad CA, Anderson L, Rouphael N, Rouphael N, Anderson EJ. 1340. The Burden of Influenza and Rhinovirus Among Hospitalized Adults Post the COVID-19 Pandemic. Open Forum Infect Dis 2021. [PMCID: PMC8643874 DOI: 10.1093/ofid/ofab466.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Acute respiratory tract infections (ARIs) are a significant cause of morbidity in adults. Influenza is associated with about 490,600 hospitalizations and 34,200 deaths in the US in the 2018-2019 season. The burden of rhinovirus among adults hospitalized with ARI is less well known. We compared the burden of influenza and rhinovirus from 2 consecutive winter respiratory viral seasons in hospitalized adults and healthy controls pre-COVID-19 and one season mid-COVID-19 to determine the impact of rhinovirus as a pathogen. Methods From Oct 2018 to Apr 2021, prospective surveillance of adults ≥50 years old admitted with ARI or COPD/CHF exacerbations at any age was conducted at two Atlanta hospitals. Adults were eligible if they lived within an eight-county region around Atlanta and if their symptom duration was < 14 days. In the seasons from Oct 2018 to Mar 2020, asymptomatic adults ≥50 years old were enrolled as controls. Standard of care test results were included and those enrolled contributed nasopharyngeal swabs that were tested for respiratory pathogens using BioFire® FilmArray® Respiratory Viral Panel (RVP). Results During the first two seasons, 1566 hospitalized adults were enrolled. Rhinovirus was detected in 7.5% (118) and influenza was detected in 7.7% (121). Rhinovirus was also detected in 2.2% of 466 healthy adult controls while influenza was detected in 0%. During Season 3, the peak of the COVID-19 pandemic, influenza declined to 0% of ARI hospitalizations. Rhinovirus also declined (p=0.01) but still accounted for 5.1% of all ARIs screened (Figure 1). Rhinovirus was detected at a greater rate in Season 3 than in asymptomatic controls in the first 2 seasons (p=0.008). In the first two seasons, Influenza was detected in 8.6% (24/276) of those admitted to the ICU. Rhinovirus was detected in 6.1% (17/276) of those admitted to the ICU but declined to 3.1% (8/258) in Season 3. ![]()
Figure 1. Percent Positive Cases of Influenza and Rhinovirus between Season 1&2 (hospitalized and healthy controls) vs Season 3 (hospitalized) Conclusion Dramatic declines occurred in influenza in adults hospitalized with ARI, CHF, or COPD in Atlanta during the COVID-19 pandemic and with enhanced public health measures. Although rhinovirus declined during the COVID-19 pandemic, it continued to be identified at a rate higher than in historical controls. Additional data are needed to understand the role of rhinovirus in adult ARI, CHF, and COPD exacerbations. Disclosures David L. Swerdlow, MD, Pfizer Vaccines (Employee) Robin Hubler, MS, Pfizer Inc. (Employee) Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Janssen, Merck, Moderna, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur. (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Meissa Vaccines (Other Financial or Material Support, Co-inventor of patented RSV vaccine technology unrelated to this manuscript, which has been licensed to Meissa Vaccines, Inc.) Larry Anderson, MD, ADVI (Consultant)Bavarian Nordic (Consultant)Novavax (Consultant)Phizer (Grant/Research Support, Scientific Research Study Investigator)Sciogen (Research Grant or Support) Nadine Rouphael, MD, pfizer, sanofi, lily, quidel, merck (Grant/Research Support) Nadine Rouphael, MD, Lilly (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Merck (Individual(s) Involved: Self): Emory study PI, Grant/Research Support; Pfizer: I conduct as co-PI the RSV PFIZER study at Emory, Research Grant; Pfizer (Individual(s) Involved: Self): Grant/Research Support, I conduct as co-PI the RSV PFIZER study at Emory; Quidel (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Sanofi Pasteur (Individual(s) Involved: Self): Chair phase 3 COVID vaccine, Grant/Research Support Evan J. Anderson, MD, GSK (Scientific Research Study Investigator)Janssen (Consultant, Scientific Research Study Investigator, Advisor or Review Panel member)Kentucky Bioprocessing, Inc (Advisor or Review Panel member)MedImmune (Scientific Research Study Investigator)Medscape (Consultant)Merck (Scientific Research Study Investigator)Micron (Scientific Research Study Investigator)PaxVax (Scientific Research Study Investigator)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Scientific Research Study Investigator)
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Affiliation(s)
| | | | | | - Luis Salazar
- Emory University School of Medicine, Atlanta, Georgia
| | - Megan Taylor
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Vikash Patel
- Emory University School of Medicine, Atlanta, Georgia
| | - Wensheng Li
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Theda Gibson
- Emory University School of Medicine, Atlanta, Georgia
| | - Ariel Kay
- Emory University School of Medicine, Atlanta, Georgia
| | - Andrew Cheng
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Ben Lopman
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | | | | | - Evan J Anderson
- Emory University, Atlanta VA Medical Center, Atlanta, Georgia
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Salazar LW, Tippett A, Hussaini L, Taylor M, Reese O, Ciric C, Bristow L, Patel V, Li W, Hsiao HM, Stephens K, Gibson T, Cheng A, Kay A, Swerdlow DL, Hubler R, Lopman B, Anderson L, Rostad CA, Rouphael N, Rouphael N, Anderson EJ. 1329. Burden of Respiratory Syncytial Virus (RSV) Infection among Hospitalized Older Adults and Those with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF). Open Forum Infect Dis 2021. [PMCID: PMC8644080 DOI: 10.1093/ofid/ofab466.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The burden of Respiratory Syncytial Virus (RSV)-associated hospitalization in adults is incompletely understood. The COVID-19 pandemic has resulted in multiple public health measures (e.g., social distancing, handwashing, masking) to decrease SARS-CoV-2 transmission, which could impact RSV-associated hospitalizations. We sought to compare RSV-associated hospitalizations from 2 pre- and one mid-COVID-19 winter viral respiratory seasons. Methods We conducted an IRB-approved prospective surveillance at two Atlanta-area hospitals during the winter respiratory viral seasons from Oct 2018–Apr 2021 for adults ≥ 50 years of age admitted with acute respiratory infections (ARI) and adults of any age with COPD or CHF-related admissions. Adults were eligible if they were residents of an 8 county region surrounding Atlanta, Georgia. Those with symptoms > 14 days were excluded. Standard of care test results were included. Asymptomatic adults ≥ 50 years of age were enrolled as controls in Seasons 1 and 2. Nasopharyngeal swabs from cases and controls were tested for RSV using BioFire® FilmArray® Respiratory Viral Panel (RVP). We compared the demographic features and outcomes of RSV+ cases and controls. Results RSV was detected in 71/2,728 (2.6%) hospitalized adults with ARI, CHF, or COPD and 4/466 (0.9%) controls. In Season 1, RSV occurred in 5.9% (35/596 patients), in Season 2 3.6% (35/970 patients), but in only 0.09% (1/1,162 patients) in Season 3 (P < 0.001 for both seasons). RSV detection in Season 3 was similar to RSV detection among controls during Seasons 1 and 2 (P=0.6). Median age of cases and controls was 67 years (Table 1). Of cases with RSV 11% were admitted to the ICU and two required mechanical ventilation. The majority of hospitalized patients were discharged home (95.8%) with a median length of hospitalization of three days (IQR 2-7). Table 1. Demographic Features and Outcomes Among RSV-Positive Hospitalized Adults. ![]()
Conclusion Over 3 seasons, RSV was detected in 2.6% of adults admitted to the hospital with ARI, CHF or COPD. The rate of RSV dramatically declined during the 2020-21 winter respiratory viral season, likely due to public health measures implemented in response to COVID-19. Disclosures David L. Swerdlow, MD, Pfizer Vaccines (Employee) Robin Hubler, MS, Pfizer Inc. (Employee) Larry Anderson, MD, ADVI (Consultant)Bavarian Nordic (Consultant)Novavax (Consultant)Phizer (Grant/Research Support, Scientific Research Study Investigator)Sciogen (Research Grant or Support) Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Janssen, Merck, Moderna, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur. (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Meissa Vaccines (Other Financial or Material Support, Co-inventor of patented RSV vaccine technology unrelated to this manuscript, which has been licensed to Meissa Vaccines, Inc.) Nadine Rouphael, MD, pfizer, sanofi, lily, quidel, merck (Grant/Research Support) Nadine Rouphael, MD, Lilly (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Merck (Individual(s) Involved: Self): Emory study PI, Grant/Research Support; Pfizer: I conduct as co-PI the RSV PFIZER study at Emory, Research Grant; Pfizer (Individual(s) Involved: Self): Grant/Research Support, I conduct as co-PI the RSV PFIZER study at Emory; Quidel (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Sanofi Pasteur (Individual(s) Involved: Self): Chair phase 3 COVID vaccine, Grant/Research Support Evan J. Anderson, MD, GSK (Scientific Research Study Investigator)Janssen (Consultant, Scientific Research Study Investigator, Advisor or Review Panel member)Kentucky Bioprocessing, Inc (Advisor or Review Panel member)MedImmune (Scientific Research Study Investigator)Medscape (Consultant)Merck (Scientific Research Study Investigator)Micron (Scientific Research Study Investigator)PaxVax (Scientific Research Study Investigator)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Scientific Research Study Investigator)
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Affiliation(s)
| | | | | | - Megan Taylor
- Emory University School of Medicine, Atlanta, Georgia
| | - Olivia Reese
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Vikash Patel
- Emory University School of Medicine, Atlanta, Georgia
| | - Wensheng Li
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Theda Gibson
- Emory University School of Medicine, Atlanta, Georgia
| | - Andrew Cheng
- Emory University School of Medicine, Atlanta, Georgia
| | - Ariel Kay
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Ben Lopman
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | | | | | - Evan J Anderson
- Emory University, Atlanta VA Medical Center, Atlanta, Georgia
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Taylor M, Tippett A, Hussaini L, Salazar L, Ciric C, Reese O, Bristow L, Patel V, Li W, Hsiao HM, Stephens K, Gibson T, Kay A, Cheng A, Swerdlow DL, Hubler R, Lopman B, Rostad CA, Anderson L, Rouphael N, Rouphael N, Anderson EJ. 1334. Outcomes Among Influenza and SARS-CoV-2 Infection in Hospitalized Adults Age ≥ 50 Years and with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF). Open Forum Infect Dis 2021. [PMCID: PMC8643808 DOI: 10.1093/ofid/ofab466.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background A significant burden of disease exists for adults infected with influenza (flu) and SARS-CoV-2, which causes COVID-19. However, data are limited comparing outcomes between hospitalized adults infected with these viruses. Methods Over the course of 3 consecutive winter respiratory viral seasons, adults ≥ 50 years of age admitted with acute respiratory tract infections (ARI) and adults of any age with COPD or CHF-related admissions were enrolled from 2 Atlanta area hospitals. For the 2018-19 and 2019-20 seasons, participants were approached in the hospital. If the participant enrolled, nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected and tested using BioFire® FilmArray® respiratory panel. Due to the COVID-19 pandemic in 2020-21 and limitations involving participant contact, only NP standard of care (SOC) swabs were collected. A comprehensive medical chart review was completed for each subject which encompassed data on their hospitalization, past medical history, and vaccination history. Co-infected patients were excluded from the analyses. Results Of the eligible participants, 118 were flu positive (three RSV-influenza co-infections were excluded) and 527 were COVID-19 positive. Median age was lower for the flu cohort at 62 (IQR 56-71) than those with COVID-19 (67, IQR 59-77) (p < 0.0001). Length of stay (LOS) was shorter in flu-infected patients (median 3 d, IQR 2-6), but was longer for COVID-19 patients (median 5 d, IQR 3-10). ICU admission occurred in 20% of those with flu, and among those admitted to the ICU mechanical ventilation (MV) occurred in 12.5%. ICU admission and MV was significantly higher for those with COVID-19, with 28% of patients admitted to the ICU and 47% of those requiring MV. Among patients with COVID-19, 8.9% died. This was significantly higher than that of flu (3.4%) (p=0.008). Hospital discharge occurred more frequently to a nursing home or LTCF with COVID-19 (10.3%) than with flu (0%) (p< 0.0001). Table 1. Breakdown of age, hospitalization course, and discharge disposition for participants diagnosed with influenza or COVID-19 during hospitalization. ![]()
Conclusion COVID-19 resulted in a longer hospital admission, a greater chance of ICU admission and MV as compared to flu. Additionally, COVID-19 participants had a high rate of discharge to a nursing home/LTCF and a significantly higher risk of death. While the clinical course was not as severe as COVID-19, influenza contributed a significant burden. Disclosures David L. Swerdlow, MD, Pfizer Vaccines (Employee) Robin Hubler, MS, Pfizer Inc. (Employee) Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Janssen, Merck, Moderna, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur. (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Meissa Vaccines (Other Financial or Material Support, Co-inventor of patented RSV vaccine technology unrelated to this manuscript, which has been licensed to Meissa Vaccines, Inc.) Larry Anderson, MD, ADVI (Consultant)Bavarian Nordic (Consultant)Novavax (Consultant)Phizer (Grant/Research Support, Scientific Research Study Investigator)Sciogen (Research Grant or Support) Nadine Rouphael, MD, pfizer, sanofi, lily, quidel, merck (Grant/Research Support) Nadine Rouphael, MD, Lilly (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Merck (Individual(s) Involved: Self): Emory study PI, Grant/Research Support; Pfizer: I conduct as co-PI the RSV PFIZER study at Emory, Research Grant; Pfizer (Individual(s) Involved: Self): Grant/Research Support, I conduct as co-PI the RSV PFIZER study at Emory; Quidel (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Sanofi Pasteur (Individual(s) Involved: Self): Chair phase 3 COVID vaccine, Grant/Research Support Evan J. Anderson, MD, GSK (Scientific Research Study Investigator)Janssen (Consultant, Scientific Research Study Investigator, Advisor or Review Panel member)Kentucky Bioprocessing, Inc (Advisor or Review Panel member)MedImmune (Scientific Research Study Investigator)Medscape (Consultant)Merck (Scientific Research Study Investigator)Micron (Scientific Research Study Investigator)PaxVax (Scientific Research Study Investigator)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Scientific Research Study Investigator)
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Affiliation(s)
- Megan Taylor
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Luis Salazar
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Olivia Reese
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Vikash Patel
- Emory University School of Medicine, Atlanta, Georgia
| | - Wensheng Li
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Theda Gibson
- Emory University School of Medicine, Atlanta, Georgia
| | - Ariel Kay
- Emory University School of Medicine, Atlanta, Georgia
| | - Andrew Cheng
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Ben Lopman
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | | | | | - Evan J Anderson
- Emory University, Atlanta VA Medical Center, Atlanta, Georgia
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Yildirim I, Kao CM, Tippett A, Suntarattiwong P, Munye M, Yi J, Elmontser M, Quincer E, Focht C, Watson N, Bilen H, Baker JM, Lopman B, Hogenesch E, Rostad CA, Anderson EJ. A Retrospective Test-Negative Case-Control Study to Evaluate Influenza Vaccine Effectiveness in Preventing Hospitalizations in Children. Clin Infect Dis 2021; 73:1759-1767. [PMID: 34410341 PMCID: PMC8599178 DOI: 10.1093/cid/ciab709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/13/2022] Open
Abstract
BACKGROUND Vaccination is the primary strategy to reduce influenza burden. Influenza vaccine effectiveness (VE) can vary annually depending on circulating strains. METHODS We used a test-negative case-control study design to estimate influenza VE against laboratory-confirmed influenza-related hospitalizations among children (aged 6 months-17 years) across 5 influenza seasons in Atlanta, Georgia, from 2012-2013 to 2016-2017. Influenza-positive cases were randomly matched to test-negative controls based on age and influenza season in a 1:1 ratio. We used logistic regression models to compare odds ratios (ORs) of vaccination in cases to controls. We calculated VE as [100% × (1 - adjusted OR)] and computed 95% confidence intervals (CIs) around the estimates. RESULTS We identified 14 596 hospitalizations of children who were tested for influenza using the multiplex respiratory molecular panel; influenza infection was detected in 1017 (7.0%). After exclusions, we included 512 influenza-positive cases and 512 influenza-negative controls. The median age was 5.9 years (interquartile range, 2.7-10.3), 497 (48.5%) were female, 567 (55.4%) were non-Hispanic Black, and 654 (63.9%) children were unvaccinated. Influenza A accounted for 370 (72.3%) of 512 cases and predominated during all 5 seasons. The adjusted VE against influenza-related hospitalizations during 2012-2013 to 2016-2017 was 51.3% (95% CI, 34.8% to 63.6%) and varied by season. Influenza VE was 54.7% (95% CI, 37.4% to 67.3%) for influenza A and 37.1% (95% CI, 2.3% to 59.5%) for influenza B. CONCLUSIONS Influenza vaccination decreased the risk of influenza-related pediatric hospitalizations by >50% across 5 influenza seasons.
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Affiliation(s)
- Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carol M Kao
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ashley Tippett
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Piyarat Suntarattiwong
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mohamed Munye
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jumi Yi
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, University of San Francisco, San Francisco, California, USA
| | - Mohnd Elmontser
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Elizabeth Quincer
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Hande Bilen
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Julia M Baker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ben Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elena Hogenesch
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Ha B, Jadhao S, Hussaini L, Gibson T, Stephens K, Salazar L, Ciric C, Taylor M, Rouphael N, Edupuganti S, Rostad CA, Tompkins SM, Anderson EJ, Anderson LJ. Evaluation of a SARS-CoV-2 Capture IgM Antibody Assay in Convalescent Sera. Microbiol Spectr 2021; 9:e0045821. [PMID: 34494855 PMCID: PMC8557898 DOI: 10.1128/spectrum.00458-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/08/2021] [Indexed: 01/19/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for a global pandemic with over 152 million cases and 3.19 million deaths reported by early May 2021. Understanding the serological response to SARS-CoV-2 is critical to determining the burden of infection and disease (coronavirus disease 2019 [COVID-19]) and transmission dynamics. We developed a capture IgM assay because it should have better sensitivity and specificity than the commonly used indirect assay. Here, we report the development and performance of a capture IgM enzyme-linked immunosorbent assay (ELISA) and a companion indirect IgG ELISA for the spike (S) and nucleocapsid (N) proteins and the receptor-binding domain (RBD) of S. We found that among the IgM ELISAs, the S ELISA was positive in 76% of 55 serum samples from SARS-CoV-2 PCR-positive patients, the RBD ELISA was positive in 55% of samples, and the N ELISA was positive in 15% of samples. The companion indirect IgG ELISAs were positive for S in 89% of the 55 serum samples, RBD in 78%, and N in 85%. While the specificities for IgM RBD, S, and N ELISAs and IgG S and RBD ELISAs were 97% to 100%, the specificity of the N IgG ELISA was lower (89%). RBD-specific IgM antibodies became undetectable by 3 to 6 months, and S IgM reached low levels at 6 months. The corresponding IgG S, RBD, and N antibodies persisted with some decreases in levels over this time period. These capture IgM ELISAs and the companion indirect IgG ELISAs should enhance serologic studies of SARS-CoV-2 infections. IMPORTANCE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has inflicted tremendous loss of lives, overwhelmed health care systems, and disrupted all aspects of life worldwide since its emergence in Wuhan, China, in December 2019. Detecting current and past infection by PCR or serology is important to understanding and controlling SARS-CoV-2. With increasing prevalence of past infection or vaccination, IgG antibodies are less helpful in diagnosing a current infection. IgM antibodies indicate a more recent infection and can supplement PCR diagnosis. We report an alternative method, capture IgM, to detect serum IgM antibodies, which should be more sensitive and specific than most currently used methods. We describe this capture IgM assay and a companion indirect IgG assay for the SARS-CoV-2 spike (S), nucleocapsid (N), and receptor-binding domain (RBD) proteins. These assays can add value to diagnostic and serologic studies of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Binh Ha
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Samadhan Jadhao
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Laila Hussaini
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Theda Gibson
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Kathy Stephens
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Luis Salazar
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Caroline Ciric
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Meg Taylor
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - Nadine Rouphael
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Srilatha Edupuganti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A. Rostad
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
| | - S. Mark Tompkins
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, USA
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, Georgia, USA
| | - Evan J. Anderson
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Larry J. Anderson
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children’s Health Care of Atlanta, Atlanta, Georgia, USA
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Atmar RL, Lyke KE, Deming ME, Jackson LA, Branche AR, El Sahly HM, Rostad CA, Martin JM, Johnston C, Rupp RE, Mulligan MJ, Brady RC, Frenck RW, Bäcker M, Kottkamp AC, Babu TM, Rajakumar K, Edupuganti S, Dobryzynski D, Posavad CM, Archer JI, Crandon S, Nayak SU, Szydlo D, Zemanek J, Dominguez Islas CP, Brown ER, Suthar MS, McElrath MJ, McDermott AB, O’Connell SE, Montefiori DC, Eaton A, Neuzil KM, Stephens DS, Roberts PC, Beigel JH. Heterologous SARS-CoV-2 Booster Vaccinations - Preliminary Report. medRxiv 2021:2021.10.10.21264827. [PMID: 34671773 PMCID: PMC8528081 DOI: 10.1101/2021.10.10.21264827] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background While Coronavirus disease 2019 (Covid-19) vaccines are highly effective, breakthrough infections are occurring. Booster vaccinations have recently received emergency use authorization (EUA) for certain populations but are restricted to homologous mRNA vaccines. We evaluated homologous and heterologous booster vaccination in persons who had received an EUA Covid-19 vaccine regimen. Methods In this phase 1/2 open-label clinical trial conducted at ten U.S. sites, adults who received one of three EUA Covid-19 vaccines at least 12 weeks prior to enrollment and had no reported history of SARS-CoV-2 infection received a booster injection with one of three vaccines (Moderna mRNA-1273 100-μg, Janssen Ad26.COV2.S 5×1010 virus particles, or Pfizer-BioNTech BNT162b2 30-μg; nine combinations). The primary outcomes were safety, reactogenicity, and humoral immunogenicity on study days 15 and 29. Results 458 individuals were enrolled: 154 received mRNA-1273, 150 received Ad26.CoV2.S, and 153 received BNT162b2 booster vaccines. Reactogenicity was similar to that reported for the primary series. Injection site pain, malaise, headache, and myalgia occurred in more than half the participants. Booster vaccines increased the neutralizing activity against a D614G pseudovirus (4.2-76-fold) and binding antibody titers (4.6-56-fold) for all combinations; homologous boost increased neutralizing antibody titers 4.2-20-fold whereas heterologous boost increased titers 6.2-76-fold. Day 15 neutralizing and binding antibody titers varied by 28.7-fold and 20.9-fold, respectively, across the nine prime-boost combinations. Conclusion Homologous and heterologous booster vaccinations were well-tolerated and immunogenic in adults who completed a primary Covid-19 vaccine regimen at least 12 weeks earlier.
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Affiliation(s)
- Robert L. Atmar
- Departments of Medicine and Molecular Virology & MIcrobiology, Baylor College of Medicine, Houston, TX 77030
| | - Kirsten E. Lyke
- Center for Vaccine Development and Global Health collaborating with the Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Meagan E. Deming
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Lisa A. Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Angela R. Branche
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY 14642
| | - Hana M. El Sahly
- Departments of Molecular Virology & MIcrobiology and Medicine, Baylor College of Medicine, Houston, TX 77030
| | - Christina A. Rostad
- Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA 30322
| | - Judith M. Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Christine Johnston
- Departments of Medicine and Laboratory Medicine, University of Washington, Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98104
| | - Richard E. Rupp
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX 77555
| | - Mark J. Mulligan
- NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016
| | - Rebecca C. Brady
- Cincinnati Children’s Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039
| | - Robert W. Frenck
- Cincinnati Children’s Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039
| | - Martín Bäcker
- NYU Langone Hospital—Long Island Vaccine Center Research Clinic and Division of Infectious Disease, Department of Medicine, NYU Long Island School of Medicine, Mineola, NY 11501
| | - Angelica C. Kottkamp
- NYU Langone Vaccine Center Bellevue Hospital Research Clinic and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016
| | - Tara M. Babu
- Department of Medicine, University of Washington, Seattle, WA 98104
| | - Kumaravel Rajakumar
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Srilatha Edupuganti
- Division of Infectious Diseases, Department of Medicine, Hope Clinic of Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA 30030
| | - David Dobryzynski
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY 14642
| | - Christine M. Posavad
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Seema U. Nayak
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Daniel Szydlo
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA 98109
| | - Jillian Zemanek
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA 98109
| | - Clara P. Dominguez Islas
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
| | - Elizabeth R. Brown
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
| | - Mehul S. Suthar
- Emory Vaccine Center, Yerkes National Primate Research Center; Department of Pediatrics; Department of Microbiology and Immunology, Emory School of Medicine, Emory University, Atlanta, GA
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Department of Medicine and Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Adrian B. McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Sarah E. O’Connell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - David C. Montefiori
- Duke Human Vaccine Institute and Department of Surgery, Duke University Medical Center, Durham, NC
| | - Amanda Eaton
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Kathleen M. Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | | | - Paul C. Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - John H. Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Affiliation(s)
- Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Satoshi Kamidani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Reisner A, Blackwell LS, Sayeed I, Myers HE, Wali B, Heilman S, Figueroa J, Lu A, Hussaini L, Anderson EJ, Shane AL, Rostad CA. Osteopontin as a biomarker for COVID-19 severity and multisystem inflammatory syndrome in children: A pilot study. Exp Biol Med (Maywood) 2021; 247:145-151. [PMID: 34565198 DOI: 10.1177/15353702211046835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study sought to evaluate the candidacy of plasma osteopontin (OPN) as a biomarker of COVID-19 severity and multisystem inflammatory condition in children (MIS-C) in children. A retrospective analysis of 26 children (0-21 years of age) admitted to Children's Healthcare of Atlanta with a diagnosis of COVID-19 between March 17 and May 26, 2020 was undertaken. The patients were classified into three categories based on COVID-19 severity levels: asymptomatic or minimally symptomatic (control population, admitted for other non-COVID-19 conditions), mild/moderate, and severe COVID-19. A fourth category of children met the Centers for Disease Control and Prevention's case definition for MIS-C. Residual blood samples were analyzed for OPN, a marker of inflammation using commercial ELISA kits (R&D), and results were correlated with clinical data. This study demonstrates that OPN levels are significantly elevated in children hospitalized with moderate and severe COVID-19 and MIS-C compared to OPN levels in mild/asymptomatic children. Further, OPN differentiated among clinical levels of severity in COVID-19, while other inflammatory markers including maximum erythrocyte sedimentation rate, C-reactive protein and ferritin, minimum lymphocyte and platelet counts, soluble interleukin-2R, and interleukin-6 did not. We conclude OPN is a potential biomarker of COVID-19 severity and MIS-C in children that may have future clinical utility. The specificity and positive predictive value of this marker for COVID-19 and MIS-C are areas for future larger prospective research studies.
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Affiliation(s)
- Andrew Reisner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Laura S Blackwell
- Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Iqbal Sayeed
- Department of Emergency Medicine, Brain Research Laboratory, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Hannah E Myers
- Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Bushra Wali
- Department of Emergency Medicine, Brain Research Laboratory, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Stacy Heilman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Austin Lu
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Laila Hussaini
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Evan J Anderson
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Medicine, 12239Emory University School of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Andi L Shane
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Christina A Rostad
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
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48
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Pegu A, O’Connell SE, Schmidt SD, O’Dell S, Talana CA, Lai L, Albert J, Anderson E, Bennett H, Corbett KS, Flach B, Jackson L, Leav B, Ledgerwood JE, Luke CJ, Makowski M, Nason MC, Roberts PC, Roederer M, Rebolledo PA, Rostad CA, Rouphael NG, Shi W, Wang L, Widge AT, Yang ES, Beigel JH, Graham BS, Mascola JR, Suthar MS, McDermott AB, Doria-Rose NA. Durability of mRNA-1273 vaccine-induced antibodies against SARS-CoV-2 variants. Science 2021; 373:1372-1377. [PMID: 34385356 PMCID: PMC8691522 DOI: 10.1126/science.abj4176] [Citation(s) in RCA: 353] [Impact Index Per Article: 117.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations may diminish vaccine-induced protective immune responses, particularly as antibody titers wane over time. Here, we assess the effect of SARS-CoV-2 variants B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), B.1.429 (Epsilon), B.1.526 (Iota), and B.1.617.2 (Delta) on binding, neutralizing, and angiotensin-converting enzyme 2 (ACE2)–competing antibodies elicited by the messenger RNA (mRNA) vaccine mRNA-1273 over 7 months. Cross-reactive neutralizing responses were rare after a single dose. At the peak of response to the second vaccine dose, all individuals had responses to all variants. Binding and functional antibodies against variants persisted in most subjects, albeit at low levels, for 6 months after the primary series of the mRNA-1273 vaccine. Across all assays, B.1.351 had the lowest antibody recognition. These data complement ongoing studies to inform the potential need for additional boost vaccinations.
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Affiliation(s)
- Amarendra Pegu
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sarah E. O’Connell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Stephen D. Schmidt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sijy O’Dell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Chloe A. Talana
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lilin Lai
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Evan Anderson
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Kizzmekia S. Corbett
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Britta Flach
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | | | - Julie E. Ledgerwood
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Catherine J. Luke
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Martha C. Nason
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Paul C. Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mario Roederer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Paulina A. Rebolledo
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Decatur, GA 30030, USA
| | - Christina A. Rostad
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nadine G. Rouphael
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Decatur, GA 30030, USA
| | - Wei Shi
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lingshu Wang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alicia T. Widge
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eun Sung Yang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - The mRNA-1273 Study Group§
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
- Emmes Company, Rockville, MD 20850, USA
- Moderna, Inc., Cambridge, MA 02139, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Decatur, GA 30030, USA
| | - John H. Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Barney S. Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - John R. Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mehul S. Suthar
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Adrian B. McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicole A. Doria-Rose
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Roback JD, Tyburski EA, Alter D, Asakrah S, Chahroudi A, Esper A, Farmer S, Figueroa J, K Frediani J, D Gonzalez M, S Gottfried D, Guarner J, A Gupta N, S Heilman S, E Hill C, Jerris R, R Kempker R, Ingersoll J, Levy JM, Mavigner M, S Moreno C, R Morris C, J Nehl E, S Neish A, Peker D, Saakadze N, Rebolledo PA, A Rostad C, Schoof N, Suessmith A, Sullivan J, Wang YFW, Wood A, Vos MB, Brand O, Martin GS, Lam WA. The need for new test verification and regulatory support for innovative diagnostics. Nat Biotechnol 2021; 39:1060-1062. [PMID: 34404954 PMCID: PMC9007716 DOI: 10.1038/s41587-021-01047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Erika A Tyburski
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - David Alter
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Saja Asakrah
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Annette Esper
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Farmer
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - David S Gottfried
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitika A Gupta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stacy S Heilman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles E Hill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Russell R Kempker
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua M Levy
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA
| | - Maud Mavigner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlos S Moreno
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Claudia R Morris
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Eric J Nehl
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Andrew S Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Deniz Peker
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Natia Saakadze
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Paulina A Rebolledo
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Nils Schoof
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Allie Suessmith
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie Sullivan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Yun F Wayne Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Wood
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Miriam B Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Oliver Brand
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Greg S Martin
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Wilbur A Lam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA.
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA.
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50
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Lapp SA, Edara VV, Lu A, Lai L, Hussaini L, Chahroudi A, Anderson LJ, Suthar MS, Anderson EJ, Rostad CA. Original antigenic sin responses to Betacoronavirus spike proteins are observed in a mouse model, but are not apparent in children following SARS-CoV-2 infection. PLoS One 2021; 16:e0256482. [PMID: 34449792 PMCID: PMC8396729 DOI: 10.1371/journal.pone.0256482] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background The effects of pre-existing endemic human coronavirus (HCoV) immunity on SARS-CoV-2 serologic and clinical responses are incompletely understood. Objectives We sought to determine the effects of prior exposure to HCoV Betacoronavirus HKU1 spike protein on serologic responses to SARS-CoV-2 spike protein after intramuscular administration in mice. We also sought to understand the baseline seroprevalence of HKU1 spike antibodies in healthy children and to measure their correlation with SARS-CoV-2 binding and neutralizing antibodies in children hospitalized with acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome (MIS-C). Methods Groups of 5 mice were injected intramuscularly with two doses of alum-adjuvanted HKU1 spike followed by SARS-CoV-2 spike; or the reciprocal regimen of SARS-Cov-2 spike followed by HKU1 spike. Sera collected 21 days following each injection was analyzed for IgG antibodies to HKU1 spike, SARS-CoV-2 spike, and SARS-CoV-2 neutralization. Sera from children hospitalized with acute COVID-19, MIS-C or healthy controls (n = 14 per group) were analyzed for these same antibodies. Results Mice primed with SARS-CoV-2 spike and boosted with HKU1 spike developed high titers of SARS-CoV-2 binding and neutralizing antibodies; however, mice primed with HKU1 spike and boosted with SARS-CoV-2 spike were unable to mount neutralizing antibodies to SARS-CoV-2. HKU1 spike antibodies were detected in all children with acute COVID-19, MIS-C, and healthy controls. Although children with MIS-C had significantly higher HKU1 spike titers than healthy children (GMT 37239 vs. 7551, P = 0.012), these titers correlated positively with both SARS-CoV-2 binding (r = 0.7577, P<0.001) and neutralizing (r = 0.6201, P = 0.001) antibodies. Conclusions Prior murine exposure to HKU1 spike protein completely impeded the development of neutralizing antibodies to SARS-CoV-2, consistent with original antigenic sin. In contrast, the presence of HKU1 spike IgG antibodies in children with acute COVID-19 or MIS-C was not associated with diminished neutralizing antibody responses to SARS-CoV-2.
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Affiliation(s)
- Stacey A. Lapp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
| | - Venkata Viswanadh Edara
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
- Yerkes Primate Center, Emory University, Atlanta, GA, United States of America
| | - Austin Lu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
| | - Lilin Lai
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
- Yerkes Primate Center, Emory University, Atlanta, GA, United States of America
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
| | - Larry J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
| | - Mehul S. Suthar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
- Yerkes Primate Center, Emory University, Atlanta, GA, United States of America
| | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States of America
- * E-mail:
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