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Sobieszczyk ME, Mannheimer S, Paez CA, Yu C, Gamble T, Theodore DA, Chege W, Yacovone M, Hanscom B, Heptinstall J, Seaton KE, Zhang L, Miner MD, Eaton A, Weiner JA, Mayer K, Kalams S, Stephenson K, Julg B, Caskey M, Nussenzweig M, Gama L, Barouch DH, Ackerman ME, Tomaras GD, Huang Y, Montefiori D. Safety, tolerability, pharmacokinetics, and immunological activity of dual-combinations and triple-combinations of anti-HIV monoclonal antibodies PGT121, PGDM1400, 10-1074, and VRC07-523LS administered intravenously to HIV-uninfected adults: a phase 1 randomised trial. Lancet HIV 2023; 10:e653-e662. [PMID: 37802566 PMCID: PMC10629933 DOI: 10.1016/s2352-3018(23)00140-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Preclinical and clinical studies suggest that combinations of broadly neutralising antibodies (bnAbs) targeting different HIV envelope epitopes might be required for sufficient prevention of infection. We aimed to evaluate the dual and triple anti-HIV bnAb combinations of PGDM1400 (V2 Apex), PGT121 (V3 glycan), 10-1074 (V3 glycan), and VRC07-523LS (CD4 binding site). METHODS In this phase 1 trial (HVTN 130/HPTN 089), adults without HIV were randomly assigned (1:1:1) to three dual-bnAb treatment groups simultaneously, or the triple-bnAb group, receiving 20 mg/kg of each antibody administered intravenously at four centres in the USA. Participants received a single dose of PGT121 + VRC07-523LS (treatment one; n=6), PGDM1400 + VRC07-523LS (treatment two; n=6), or 10-1074 + VRC07-523LS (treatment three; n=6), and two doses of PGDM1400 + PGT121 + VRC07-523LS (treatment four; n=9). Primary outcomes were safety, pharmacokinetics, and neutralising activity. Safety was determined by monitoring for 60 min after infusions and throughout the study by collecting laboratory assessments (ie, blood count, chemistry, urinalysis, and HIV), and solicited and unsolicited adverse events (via case report forms and participant diaries). Serum concentrations of each bnAb were measured by binding antibody assays on days 0, 3, 6, 14, 28, 56, 112, 168, 224, 280, and 336, and by serum neutralisation titres against Env-pseudotyped viruses on days 0, 3, 28, 56, and 112. Pharmacokinetic parameters were estimated by use of two-compartment population pharmacokinetic models; combination bnAb neutralisation titres were directly measured and assessed with different interaction models. This trial is registered with ClinicalTrials.gov, NCT03928821, and has been completed. FINDINGS 27 participants were enrolled from July 31, to Dec 20, 2019. The median age was 26 years (range 19-50), 16 (58%) of 27 participants were assigned female sex at birth, and 24 (89%) participants were non-Hispanic White. Infusions were safe and well tolerated. There were no statistically significant differences in pharmacokinetic patterns between the dual and triple combinations of PGT121, PGDM1400, and VRC07-523LS. The median estimated elimination half-lives of PGT121, PGDM1400, 10-1074, and VRC07-523LS were 32·2, 25·4, 27·5, and 52·9 days, respectively. Neutralisation coverage against a panel of 12 viruses was greater in the triple-bnAb versus dual-bnAb groups: area under the magnitude-breadth curve at day 28 was 3·1, 2·9, 3·0, and 3·4 for treatments one to four, respectively. The Bliss-Hill multiplicative interaction model, which assumes complementary neutralisation with no antagonism or synergism among the bnAbs, best described combination bnAb titres in the dual-bnAb and triple-bnAb groups. INTERPRETATION No pharmacokinetic interactions among the bnAbs and no loss of complementary neutralisation were observed in the dual and triple combinations. This study lays the foundation for designing future combination bnAb HIV prevention efficacy trials. FUNDING US National Institute of Allergy and Infectious Diseases, US National Institute on Drug Abuse, US National Institute of Mental Health, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
| | - Sharon Mannheimer
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Carmen A Paez
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Chenchen Yu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | - Wairimu Chege
- National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Margaret Yacovone
- National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Brett Hanscom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | - Lily Zhang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Maurine D Miner
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Amanda Eaton
- Duke University School of Medicine, Durham, NC, USA
| | - Joshua A Weiner
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | - Spyros Kalams
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Boris Julg
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | | | | | - Lucio Gama
- Vaccine Research Center, National Institute of Health, Bethesda, MD, USA
| | - Dan H Barouch
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | | | | | - Yunda Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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2
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Theodore DA, Branche AR, Zhang L, Graciaa DS, Choudhary M, Hatlen TJ, Osman R, Babu TM, Robinson ST, Gilbert PB, Follmann D, Janes H, Kublin JG, Baden LR, Goepfert P, Gray GE, Grinsztejn B, Kotloff KL, Gay CL, Leav B, Miller J, Hirsch I, Sadoff J, Dunkle LM, Neuzil KM, Corey L, Falsey AR, El Sahly HM, Sobieszczyk ME, Huang Y. Clinical and Demographic Factors Associated With COVID-19, Severe COVID-19, and SARS-CoV-2 Infection in Adults: A Secondary Cross-Protocol Analysis of 4 Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2323349. [PMID: 37440227 PMCID: PMC10346130 DOI: 10.1001/jamanetworkopen.2023.23349] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/15/2023] [Indexed: 07/14/2023] Open
Abstract
Importance Current data identifying COVID-19 risk factors lack standardized outcomes and insufficiently control for confounders. Objective To identify risk factors associated with COVID-19, severe COVID-19, and SARS-CoV-2 infection. Design, Setting, and Participants This secondary cross-protocol analysis included 4 multicenter, international, randomized, blinded, placebo-controlled, COVID-19 vaccine efficacy trials with harmonized protocols established by the COVID-19 Prevention Network. Individual-level data from participants randomized to receive placebo within each trial were combined and analyzed. Enrollment began July 2020 and the last data cutoff was in July 2021. Participants included adults in stable health, at risk for SARS-CoV-2, and assigned to the placebo group within each vaccine trial. Data were analyzed from April 2022 to February 2023. Exposures Comorbid conditions, demographic factors, and SARS-CoV-2 exposure risk at the time of enrollment. Main Outcomes and Measures Coprimary outcomes were COVID-19 and severe COVID-19. Multivariate Cox proportional regression models estimated adjusted hazard ratios (aHRs) and 95% CIs for baseline covariates, accounting for trial, region, and calendar time. Secondary outcomes included severe COVID-19 among people with COVID-19, subclinical SARS-CoV-2 infection, and SARS-CoV-2 infection. Results A total of 57 692 participants (median [range] age, 51 [18-95] years; 11 720 participants [20.3%] aged ≥65 years; 31 058 participants [53.8%] assigned male at birth) were included. The analysis population included 3270 American Indian or Alaska Native participants (5.7%), 7849 Black or African American participants (13.6%), 17 678 Hispanic or Latino participants (30.6%), and 40 745 White participants (70.6%). Annualized incidence was 13.9% (95% CI, 13.3%-14.4%) for COVID-19 and 2.0% (95% CI, 1.8%-2.2%) for severe COVID-19. Factors associated with increased rates of COVID-19 included workplace exposure (high vs low: aHR, 1.35 [95% CI, 1.16-1.58]; medium vs low: aHR, 1.41 [95% CI, 1.21-1.65]; P < .001) and living condition risk (very high vs low risk: aHR, 1.41 [95% CI, 1.21-1.66]; medium vs low risk: aHR, 1.19 [95% CI, 1.08-1.32]; P < .001). Factors associated with decreased rates of COVID-19 included previous SARS-CoV-2 infection (aHR, 0.13 [95% CI, 0.09-0.19]; P < .001), age 65 years or older (aHR vs age <65 years, 0.57 [95% CI, 0.50-0.64]; P < .001) and Black or African American race (aHR vs White race, 0.78 [95% CI, 0.67-0.91]; P = .002). Factors associated with increased rates of severe COVID-19 included race (American Indian or Alaska Native vs White: aHR, 2.61 [95% CI, 1.85-3.69]; multiracial vs White: aHR, 2.19 [95% CI, 1.50-3.20]; P < .001), diabetes (aHR, 1.54 [95% CI, 1.14-2.08]; P = .005) and at least 2 comorbidities (aHR vs none, 1.39 [95% CI, 1.09-1.76]; P = .008). In analyses restricted to participants who contracted COVID-19, increased severe COVID-19 rates were associated with age 65 years or older (aHR vs <65 years, 1.75 [95% CI, 1.32-2.31]; P < .001), race (American Indian or Alaska Native vs White: aHR, 1.98 [95% CI, 1.38-2.83]; Black or African American vs White: aHR, 1.49 [95% CI, 1.03-2.14]; multiracial: aHR, 1.81 [95% CI, 1.21-2.69]; overall P = .001), body mass index (aHR per 1-unit increase, 1.03 [95% CI, 1.01-1.04]; P = .001), and diabetes (aHR, 1.85 [95% CI, 1.37-2.49]; P < .001). Previous SARS-CoV-2 infection was associated with decreased severe COVID-19 rates (aHR, 0.04 [95% CI, 0.01-0.14]; P < .001). Conclusions and Relevance In this secondary cross-protocol analysis of 4 randomized clinical trials, exposure and demographic factors had the strongest associations with outcomes; results could inform mitigation strategies for SARS-CoV-2 and viruses with comparable epidemiological characteristics.
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Affiliation(s)
- Deborah A. Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Angela R. Branche
- Department of Medicine, Infectious Disease Division, University of Rochester, Rochester, New York
| | - Lily Zhang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Daniel S. Graciaa
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Madhu Choudhary
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Raadhiya Osman
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Tara M. Babu
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle
| | - Samuel T. Robinson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Peter B. Gilbert
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
| | - Dean Follmann
- Biostatistics Research Branch, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
| | - James G. Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Paul Goepfert
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Karen L. Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Cynthia L. Gay
- Department of Medicine, Division of Infectious Diseases, UNC HIV Cure Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | | | | | - Ian Hirsch
- AstraZeneca BioPharmaceuticals, Cambridge, United Kingdom
| | - Jerald Sadoff
- Janssen Vaccines and Prevention, Leiden, the Netherlands
| | | | - Kathleen M. Neuzil
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Ann R. Falsey
- Department of Medicine, Infectious Disease Division, University of Rochester, Rochester, New York
| | - Hana M. El Sahly
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yunda Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Global Health, University of Washington, Seattle
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Heck CJ, Theodore DA, Sovic B, Austin E, Yang C, Rotbert J, Greissman S, Zucker J, Autry A, Catallozzi M, Sobieszczyk ME, Castor D. Correlates of psychological distress among undergraduate women engaged in remote learning through a New York City college during the COVID-19 pandemic. J Am Coll Health 2023:1-10. [PMID: 36649543 PMCID: PMC10350472 DOI: 10.1080/07448481.2022.2156797] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/14/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The study's objective is to explore psychological distress (PD) among remote learners during COVID-19. PARTICIPANTS Female undergraduates matriculated at an NYC college in Winter 2020. METHODS Using the Kessler-6 scale, we defined PD as no/low (LPD), mild/moderate (MPD), and severe (SPD) and assessed if residing in/near NYC modified associations. RESULTS PD was common (MPD: 34.1%, SPD: 38.9%). Students identifying as Other/Multiracial had lower MPD odds (aOR = 0.39 [0.17-0.88]). SPD was associated with identifying as White (aOR = 2.02 [1.02-3.99]), unbalanced meals (aOR = 2.59 [1.06-6.30]), violence experience (aOR = 1.77 [1.06-2.94]), no social support (aOR = 3.24 [1.37-7.64]), and loneliness (aOR = 2.52 [1.29-4.95]). Among students in/near NYC, moderate/high drug use (aOR = 2.76 [1.15-6.61]), no social support (aOR = 3.62 [1.10-1.19]), and loneliness (aOR = 2.92 [1.11-7.63]) were SPD correlates. CONCLUSIONS PD was high and associated with food insecurity, violence experience, no social support, and loneliness. Living in/near NYC modified drug use, loneliness, and social support associations. Mental health initiatives should address modifiable risk factors to ameliorate pandemic-associated PD.
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Affiliation(s)
- Craig J. Heck
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Deborah A. Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brit Sovic
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Eloise Austin
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | | | | | - Samantha Greissman
- Department of Medicine, NewYork-Presbyterian/Columbia University Medical Center, New York, NY
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | | | - Marina Catallozzi
- Barnard College, New York, NY
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Delivette Castor
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY
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4
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Theodore DA, Furuya EY, Austin E, Greendyke WG. Outcomes among patients with Staphylococcus aureus bacteremia enrolled in a postdischarge outpatient parenteral antibiotic therapy program at an academic medical center. Antimicrob Steward Healthc Epidemiol 2022; 2:e167. [PMID: 36483366 PMCID: PMC9726507 DOI: 10.1017/ash.2022.302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/17/2023]
Abstract
We compared patients with Staphylococcus aureus bacteremia enrolled in outpatient parenteral antibiotic therapy monitoring program (OPAT-MP) upon hospital discharge with patients not enrolled. OPAT-MP patients were more likely to attend infectious diseases follow-up appointments. OPAT-related emergency room visits and/or readmissions were more common among non-OPAT-MP patients, but differences were not statistically significant.
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Affiliation(s)
- Deborah A. Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - E. Yoko Furuya
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
| | - Eloise Austin
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - William G. Greendyke
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
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Rowe K, Theodore DA, Zucker J, Cohensedgh O, LaSota E, Carnevale C, Cohall A, Olender S, Gordon P, Sobieszczyk ME. Lost2PrEP: Understanding Reasons for Pre-Exposure Prophylaxis and Sexual Health Care Disengagement Among Men Who Have Sex with Men Attending a Sexual Health Clinic at a Large Urban Academic Medical Center in New York City. AIDS Patient Care STDS 2022; 36:153-158. [PMID: 35438522 PMCID: PMC9057871 DOI: 10.1089/apc.2022.0004] [Citation(s) in RCA: 2] [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: 12/31/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) prevents HIV, but low rates of retention in care limit its effectiveness. We conducted a prospective survey-based study to investigate reasons for PrEP disengagement among men who have sex with men attending a sexual health clinic at a large urban academic medical center in New York City who were lost to follow up; surveys asked about current PrEP status, reasons for disengagement, attitudes toward PrEP, substance use, sexual practices, and behavioral/social determinants of health. Outreach attempts were made to 634 patients; majority of eligible participants were unable to be contacted (59%). Among those who agreed to participate (n = 175), 21% asked to re-establish care. Among those who completed the questionnaire (n = 86), 36% were taking PrEP. The most common reasons for PrEP discontinuation were cost/lack of insurance coverage (31%), decreased HIV risk perception (29%), and side effects (16%). Among those with decreased perception of risk, 62% were less sexually active, 38% were no longer engaging in anal sex, and 31% were using condoms for prevention. Participants reported that free medication (60%), having a sexual partner recommend PrEP (13%), and being able to receive PrEP from a primary care provider (13%) would encourage restarting PrEP. Findings were limited by low response rate (12% of eligible subjects completed the survey) and lack of Spanish-language questionnaires. Understanding reasons for loss-to-PrEP follow-up is essential for HIV prevention. Many people lost to follow up still desired PrEP, underscoring the importance of outreach, benefits navigators, and expansion of PrEP into primary care settings.
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Affiliation(s)
- Kelly Rowe
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Deborah A. Theodore
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason Zucker
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Omid Cohensedgh
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elijah LaSota
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Caroline Carnevale
- NYP HIV Prevention Program, New York-Presbyterian Hospital, New York, New York, USA
| | - Alwyn Cohall
- Mailman School of Public Health and Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Zucker J, Gomez-Simmonds A, Purpura LJ, Shoucri S, LaSota E, Morley NE, Sovic BW, Castellon MA, Theodore DA, Bartram LL, Miko BA, Scherer ML, Meyers KA, Turner WC, Kelly M, Pavlicova M, Basaraba CN, Baldwin MR, Brodie D, Burkart KM, Bathon J, Uhlemann AC, Yin MT, Castor D, Sobieszczyk ME. Supervised Machine Learning Approach to Identify Early Predictors of Poor Outcome in Patients with COVID-19 Presenting to a Large Quaternary Care Hospital in New York City. J Clin Med 2021; 10:jcm10163523. [PMID: 34441819 PMCID: PMC8397083 DOI: 10.3390/jcm10163523] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The progression of clinical manifestations in patients with coronavirus disease 2019 (COVID-19) highlights the need to account for symptom duration at the time of hospital presentation in decision-making algorithms. Methods: We performed a nested case–control analysis of 4103 adult patients with COVID-19 and at least 28 days of follow-up who presented to a New York City medical center. Multivariable logistic regression and classification and regression tree (CART) analysis were used to identify predictors of poor outcome. Results: Patients presenting to the hospital earlier in their disease course were older, had more comorbidities, and a greater proportion decompensated (<4 days, 41%; 4–8 days, 31%; >8 days, 26%). The first recorded oxygen delivery method was the most important predictor of decompensation overall in CART analysis. In patients with symptoms for <4, 4–8, and >8 days, requiring at least non-rebreather, age ≥ 63 years, and neutrophil/lymphocyte ratio ≥ 5.1; requiring at least non-rebreather, IL-6 ≥ 24.7 pg/mL, and D-dimer ≥ 2.4 µg/mL; and IL-6 ≥ 64.3 pg/mL, requiring non-rebreather, and CRP ≥ 152.5 mg/mL in predictive models were independently associated with poor outcome, respectively. Conclusion: Symptom duration in tandem with initial clinical and laboratory markers can be used to identify patients with COVID-19 at increased risk for poor outcomes.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
- Correspondence: ; Tel.: +1-201-723-6637
| | - Angela Gomez-Simmonds
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Lawrence J. Purpura
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Sherif Shoucri
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Elijah LaSota
- Tulane University School of Medicine, Tulane Medical Center, New Orleans, LA 70112, USA;
| | - Nicholas E. Morley
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Brit W. Sovic
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Marvin A. Castellon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Deborah A. Theodore
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Logan L. Bartram
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Benjamin A. Miko
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Matthew L. Scherer
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Kathrine A. Meyers
- Aaron Diamond AIDS Research Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, USA;
| | - William C. Turner
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Maureen Kelly
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Martina Pavlicova
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Cale N. Basaraba
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Matthew R. Baldwin
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Daniel Brodie
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Kristin M. Burkart
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Joan Bathon
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Michael T. Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
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7
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Theodore DA, Greendyke WG, Miko B, Whittier S, Green DA, Shoucri S, Verna EC, Zucker J, Sobieszczyk ME, Aaron JG, Scully BE, Saiman L, Pereira M, Furuya EY. Cycle Thresholds Among Solid Organ Transplant Recipients Testing Positive for SARS-CoV-2. Transplantation 2021; 105:1445-1448. [PMID: 33606483 PMCID: PMC8222146 DOI: 10.1097/tp.0000000000003695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND The optimal duration of transmission-based precautions among immunocompromised patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. METHODS Retrospective review of patients with solid organ transplant with positive SARS-CoV-2 polymerase chain reaction result from nasopharyngeal specimens admitted to the hospital between March 13, 2020 and May 15, 2020. RESULTS Twenty-one percent of solid organ transplant recipients with positive SARS-CoV-2 polymerase chain reaction detected ≥20 d after symptom onset (or after first positive test among asymptomatic individuals) had a low cycle threshold (ie, high viral load). The majority of these patients were asymptomatic or symptomatically improved. CONCLUSIONS Solid organ transplant recipients may have prolonged high viral burden of SARS-CoV-2. Further data are needed to understand whether cycle threshold data can help inform strategies for prevention of healthcare-associated transmission of SARS-CoV-2 and for appropriate discontinuation of transmission-based precautions.
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Affiliation(s)
- Deborah A. Theodore
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - William G. Greendyke
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - Benjamin Miko
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - Susan Whittier
- Department of Pathology & Cell Biology, Columbia
University Irving Medical Center, New York, NY, USA
| | - Daniel A. Green
- Department of Pathology & Cell Biology, Columbia
University Irving Medical Center, New York, NY, USA
| | - Sherif Shoucri
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia
University Irving Medical Center, New York, NY, USA
| | - Jason Zucker
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
- Department of Pediatrics, Columbia University Irving
Medical Center, New York, NY, USA
| | | | - Justin G. Aaron
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - Brian E. Scully
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving
Medical Center, New York, NY, USA
- Department of Infection Prevention and Control,
NewYork-Presbyterian Hospital, New York, NY, USA
| | - Marcus Pereira
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - E. Yoko Furuya
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
- Department of Infection Prevention and Control,
NewYork-Presbyterian Hospital, New York, NY, USA
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8
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Shoucri SM, Purpura L, DeLaurentis C, Adan MA, Theodore DA, Irace AL, Robbins-Juarez SY, Khedagi AM, Letchford D, Harb AA, Zerihun LM, Lee KE, Gambina K, Lauring MC, Chen N, Sperring CP, Mehta SS, Myers EL, Shih H, Argenziano MG, Bruce SL, Slater CL, Tiao JR, Natarajan K, Hripcsak G, Chen R, Yin MT, Sobieszczyk ME, Castor D, Zucker JE. Characterising the long-term clinical outcomes of 1190 hospitalised patients with COVID-19 in New York City: a retrospective case series. BMJ Open 2021; 11:e049488. [PMID: 34083350 PMCID: PMC8182750 DOI: 10.1136/bmjopen-2021-049488] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To characterise the long-term outcomes of patients with COVID-19 admitted to a large New York City medical centre at 3 and 6 months after hospitalisation and describe their healthcare usage, symptoms, morbidity and mortality. DESIGN Retrospective cohort through manual chart review of the electronic medical record. SETTING NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical centre in New York City. PARTICIPANTS The first 1190 consecutive patients with symptoms of COVID-19 who presented to the hospital for care between 1 March and 8 April 2020 and tested positive for SARS-CoV-2 on reverse transcriptase PCR assay. MAIN OUTCOME MEASURES Type and frequency of follow-up encounters, self-reported symptoms, morbidity and mortality at 3 and 6 months after presentation, respectively; patient disposition information prior to admission, at discharge, and at 3 and 6 months after hospital presentation. RESULTS Of the 1190 reviewed patients, 929 survived their initial hospitalisation and 261 died. Among survivors, 570 had follow-up encounters (488 at 3 months and 364 at 6 months). An additional 33 patients died in the follow-up period. In the first 3 months after admission, most encounters were telehealth visits (59%). Cardiopulmonary symptoms (35.7% and 28%), especially dyspnoea (22.1% and 15.9%), were the most common reported symptoms at 3-month and 6-month encounters, respectively. Additionally, a large number of patients reported generalised (26.4%) or neuropsychiatric (24.2%) symptoms 6 months after hospitalisation. Patients with severe COVID-19 were more likely to have reduced mobility, reduced independence or a new dialysis requirement in the 6 months after hospitalisation. CONCLUSIONS Patients hospitalised with SARS-CoV-2 infection reported persistent symptoms up to 6 months after diagnosis. These results highlight the long-term morbidity of COVID-19 and its burden on patients and healthcare resources.
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Affiliation(s)
- Sherif M Shoucri
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Lawrence Purpura
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Clare DeLaurentis
- Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Matthew A Adan
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Deborah A Theodore
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Alexandria Lauren Irace
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | | | - Apurva M Khedagi
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Daniel Letchford
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Amro A Harb
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Lillian M Zerihun
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Kate E Lee
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Karen Gambina
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Max C Lauring
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Noah Chen
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Colin P Sperring
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Sanket S Mehta
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Ellen L Myers
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Hueyjong Shih
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Michael G Argenziano
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Samuel L Bruce
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Cody L Slater
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Jonathan R Tiao
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Karthik Natarajan
- Biomedical Informatics, Columbia University Irving Medical Center, New York City, New York, USA
| | - George Hripcsak
- Biomedical Informatics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Ruijun Chen
- Biomedical Informatics, Columbia University Irving Medical Center, New York City, New York, USA
- Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania, USA
| | - Michael T Yin
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Magdalena E Sobieszczyk
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Delivette Castor
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Jason E Zucker
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
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9
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Chernyak E, Shi H, Theodore DA, Thakur KT. An Atypical Case of Neurosyphilis in a Patient With HIV: A Case Report. Neurohospitalist 2021; 11:255-258. [PMID: 34163553 DOI: 10.1177/1941874420985984] [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] [Indexed: 11/17/2022] Open
Abstract
Epidemiological trends have demonstrated re-emergence of neurosyphilis in the twenty-first century. As prevalence rises in clinical practice, neurosyphilis must be considered in the differential diagnosis even if initial diagnostic workup is unrevealing, especially in patients with human immunodeficiency virus (HIV). Co-infection of neurosyphilis and HIV can result in atypical presentations. In this report, we discuss a challenging diagnosis of neurosyphilis in a man with HIV who presented with atypical imaging findings and initially negative cerebrospinal fluid (CSF) nontreponemal testing. Our patient underwent repeated CSF evaluation and a comprehensive diagnostic workup, including brain biopsy, to arrive at the appropriate diagnosis. He received antibiotic treatment with excellent outcome. We review typical imaging features of neurosyphilis and highlight other neurological diseases that may mimic these radiographic findings. We discuss CSF testing and interpretation in this high-risk patient population.
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Affiliation(s)
| | - Hang Shi
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Deborah A Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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10
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Theodore DA, Goodwin RD, Zhang YV, Schneider N, Gordon RJ. History of Depression and Increased Risk of Sternal Wound Infection After Cardiothoracic Surgery: A Novel and Potentially Modifiable Risk Factor. Open Forum Infect Dis 2019; 6:ofz083. [PMID: 30949529 PMCID: PMC6440688 DOI: 10.1093/ofid/ofz083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Sternal wound infection (SWI) is a leading cause of postoperative disease and death; the risk factors for SWI remain incompletely understood. The goal of the current study was to investigate the relationship between a preoperative history of depression and the risk of SWI after cardiothoracic surgery. Methods Among patients undergoing cardiothoracic surgery in a major academic medical center between 2007 and 2012, those in whom SWI developed (n = 129) were matched, by date of surgery, with those in whom it did not (n = 258). Multivariable logistic regression was used to examine the strength of relationships between risk factors and development of infection. History of depression was defined as a composite variable to increase the sensitivity of detection. Results History of depression as defined by our composite variable was associated with increased risk of SWI (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–4.7; P = .01). Staphylococcus aureus was the most common organism isolated. Conclusions History of depression was associated with increased risk of SWI. Future prospective studies are warranted to further investigate this relationship. Depression is highly treatable, and increased efforts to identify and treat depression preoperatively may be a critical step toward preventing infection-related disease and death.
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Affiliation(s)
- Deborah A Theodore
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Renee D Goodwin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Yuan Vivian Zhang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Nancy Schneider
- Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York
| | - Rachel J Gordon
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
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