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Zureick K, McCarron M, Dawson P, Davis JK, Barnes J, Wentworth D, Azziz‐Baumgartner E. Strengthening influenza surveillance capacity in the Eastern Mediterranean Region: Nearly two decades of direct support from the United States Centers for Disease Control and Prevention. Influenza Other Respir Viruses 2023; 17:e13220. [PMID: 37936576 PMCID: PMC10626284 DOI: 10.1111/irv.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023] Open
Abstract
Since 2004, the US Centers for Disease Control and Prevention (CDC) Influenza Division (ID) has supported seven countries in the Eastern Mediterranean region and the World Health Organization Regional Office for the Eastern Mediterranean to establish and strengthen influenza surveillance. The substantial growth of influenza surveillance capacities in the region demonstrates a commitment by governments to strengthen national programs and contribute to global surveillance. The full value of surveillance data is in its use to guide local public health decisions. CDC ID remains committed to supporting the region and supporting partners to translate surveillance data into policies and programs effectively.
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Affiliation(s)
- Kinda Zureick
- Influenza DivisionUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Margaret McCarron
- Influenza DivisionUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Patrick Dawson
- Influenza DivisionUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Jamie K. Davis
- Influenza DivisionUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - John Barnes
- Influenza DivisionUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - David Wentworth
- Influenza DivisionUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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Islam MA, Hassan MZ, Aleem MA, Akhtar Z, Chowdhury S, Rahman M, Rahman MZ, Ahmmed MK, Mah‐E‐Muneer S, Alamgir ASM, Anwar SNR, Alam AN, Shirin T, Rahman M, Davis WW, Mott JA, Azziz‐Baumgartner E, Chowdhury F. Lessons learned from identifying clusters of severe acute respiratory infections with influenza sentinel surveillance, Bangladesh, 2009-2020. Influenza Other Respir Viruses 2023; 17:e13201. [PMID: 37744992 PMCID: PMC10515138 DOI: 10.1111/irv.13201] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background We explored whether hospital-based surveillance is useful in detecting severe acute respiratory infection (SARI) clusters and how often these events result in outbreak investigation and community mitigation. Methods During May 2009-December 2020, physicians at 14 sentinel hospitals prospectively identified SARI clusters (i.e., ≥2 SARI cases who developed symptoms ≤10 days of each other and lived <30 min walk or <3 km from each other). Oropharyngeal and nasopharyngeal swabs were tested for influenza and other respiratory viruses by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). We describe the demographic of persons within clusters, laboratory results, and outbreak investigations. Results Field staff identified 464 clusters comprising 1427 SARI cases (range 0-13 clusters per month). Sixty percent of clusters had three, 23% had two, and 17% had ≥4 cases. Their median age was 2 years (inter-quartile range [IQR] 0.4-25) and 63% were male. Laboratory results were available for the 464 clusters with a median of 9 days (IQR = 6-13 days) after cluster identification. Less than one in five clusters had cases that tested positive for the same virus: respiratory syncytial virus (RSV) in 58 (13%), influenza viruses in 24 (5%), human metapneumovirus (HMPV) in five (1%), human parainfluenza virus (HPIV) in three (0.6%), adenovirus in two (0.4%). While 102/464 (22%) had poultry exposure, none tested positive for influenza A (H5N1) or A (H7N9). None of the 464 clusters led to field deployments for outbreak response. Conclusions For 11 years, none of the hundreds of identified clusters led to an emergency response. The value of this event-based surveillance might be improved by seeking larger clusters, with stronger epidemiologic ties or decedents.
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Affiliation(s)
| | - Md Zakiul Hassan
- Infectious Diseases Division, icddr,bDhakaBangladesh
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Mohammad Abdul Aleem
- Infectious Diseases Division, icddr,bDhakaBangladesh
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Zubair Akhtar
- Infectious Diseases Division, icddr,bDhakaBangladesh
- Biosecurity Program, Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | | | | | | | | | | | - A. S. M. Alamgir
- Institute of Epidemiology, Disease Control and Research (IEDCR)DhakaBangladesh
| | | | - Ahmed Nawsher Alam
- Institute of Epidemiology, Disease Control and Research (IEDCR)DhakaBangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR)DhakaBangladesh
| | | | - William W. Davis
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA
| | - Joshua A. Mott
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA
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Azziz‐Baumgartner E, Neyra J, Yau TS, Soto G, Owusu D, Zhang C, Romero C, Yoo YM, Gonzales M, Tinoco Y, Silva M, Bravo E, Serrano NR, Matos E, Chavez‐Perez V, Castro JC, Esther Castillo M, Porter R, Munayco C, Rodriguez A, Levine MZ, Prouty M, Thompson MG, Arriola CS. Healthcare personnel in 2016-2019 prospective cohort infrequently got vaccinated, worked while ill, and frequently used antibiotics rather than antivirals against viral influenza illnesses. Influenza Other Respir Viruses 2023; 17:e13189. [PMID: 37693773 PMCID: PMC10485305 DOI: 10.1111/irv.13189] [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: 02/23/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background Uncertainty about risk of illness and the value of influenza vaccines negatively affects vaccine uptake among persons targeted for influenza vaccination. Methods During 2016-2019, we followed a cohort of healthcare personnel (HCP) targeted for free-of-charge influenza vaccination in five Lima hospitals to quantify risk of influenza, workplace presenteeism (coming to work despite illness), and absenteeism (taking time off from work because of illness). The HCP who developed acute respiratory illnesses (ARI) (≥1 of acute cough, runny nose, body aches, or feverishness) were tested for influenza using reverse-transcription polymerase chain reaction (rt-PCR). Findings The cohort (2968 HCP) contributed 950,888 person-days. Only 36 (6%) of 605 HCP who participated every year were vaccinated. The HCP had 5750 ARI and 147 rt-PCR-confirmed influenza illnesses. The weighted incidence of laboratory-confirmed influenza was 10.0/100 person-years; 37% used antibiotics, and 0.7% used antivirals to treat these illnesses. The HCP with laboratory-confirmed influenza were present at work while ill for a cumulative 1187 hours. Interpretation HCP were frequently ill and often worked rather than stayed at home while ill. Our findings suggest the need for continuing medical education about the risk of influenza and benefits of vaccination and stay-at-home-while-ill policies.
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Affiliation(s)
| | - Joan Neyra
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - Tat S. Yau
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Giselle Soto
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - Daniel Owusu
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Chao Zhang
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Young M. Yoo
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Yeny Tinoco
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - María Silva
- US Naval Medical Research Unit No. 6BellavistaPeru
| | | | | | | | | | | | - Maria Esther Castillo
- Instituto Nacional de Salud del NiñoLimaPeru
- Medicine School from Universidad Peruana Cayetano HerediaLimaPeru
| | - Rachael Porter
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Angel Rodriguez
- Health Emergencies Department, Pan American Health Organization (PAHO/WHO)WashingtonDistrict of ColumbiaUSA
| | - Min Z. Levine
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Mark G. Thompson
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Duque J, Howe AS, Azziz‐Baumgartner E, Petousis‐Harris H. Multi-decade national cohort identifies adverse pregnancy and birth outcomes associated with acute respiratory illness hospitalisations during the influenza season. Influenza Other Respir Viruses 2022; 17:e13063. [PMID: 36308015 PMCID: PMC9835450 DOI: 10.1111/irv.13063] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Despite the World Health Organization (WHO) recommendation that pregnant women be prioritised for seasonal influenza vaccination, coverage in the Western Pacific Region remains low. Our goal was to provide additional data for the Western Pacific Region about the value of maternal influenza vaccination to pregnant women and their families. METHODS We conducted a 16-year retrospective cohort to evaluate risks associated with influenza-associated maternal acute respiratory infection (ARI) in New Zealand. ARI hospitalisations during the May to September influenza season were identified using select ICD-10-AM primary and secondary discharge codes from chapter J00-J99 (diseases of the respiratory system). Cox proportional hazards models were used to calculate crude and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS We identified 822,391 pregnancies among New Zealand residents between 2003 and 2018; 5095 (0.6%) had ≥1 associated ARI hospitalisation during the influenza season; these pregnancies were at greater risk of preterm birth (aHR 1.50, 95% CI 1.39-1.61) and low birthweight (aHR 1.64, 95% CI 1.51-1.79) than pregnancies without such hospitalisations. We did not find an association between maternal ARI hospitalisation and fetal death (aHR 0.96, 95% CI 0.69-1.34) during the influenza season. Maternal influenza vaccination was associated with reduced risk of preterm birth (aHR 0.79, 95% CI 0.77-0.82), low birthweight (aHR 0.87, 95% CI 0.83-0.90) and fetal death (aHR 0.50%, 95% CI 0.44-0.57). CONCLUSION In this population-based cohort, being hospitalised for an ARI during the influenza season while pregnant was a risk factor for delivering a preterm or a low birthweight infant and vaccination reduced this risk.
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Affiliation(s)
- Jazmin Duque
- Department of General Practice and Primary Health Care, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand,Abt Associates IncAtlantaGeorgiaUSA
| | - Anna S. Howe
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand,School of Health SciencesUniversity of CanterburyChristchurchNew Zealand
| | - Eduardo Azziz‐Baumgartner
- National Center for Immunization and Respiratory DiseasesU.S. Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Helen Petousis‐Harris
- Department of General Practice and Primary Health Care, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
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Neelam V, Reeves EL, Woodworth KR, O'Malley Olsen E, Reynolds MR, Rende J, Wingate H, Manning SE, Romitti P, Ojo KD, Silcox K, Barton J, Mobley E, Longcore ND, Sokale A, Lush M, Delgado‐Lopez C, Diedhiou A, Mbotha D, Simon W, Reynolds B, Hamdan TS, Beauregard S, Ellis EM, Seo JY, Bennett A, Ellington S, Hall AJ, Azziz‐Baumgartner E, Tong VT, Gilboa SM. Pregnancy and infant outcomes by trimester of SARS-CoV-2 infection in pregnancy-SET-NET, 22 jurisdictions, January 25, 2020-December 31, 2020. Birth Defects Res 2022; 115:145-159. [PMID: 36065896 PMCID: PMC9537929 DOI: 10.1002/bdr2.2081] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/04/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We describe clinical characteristics, pregnancy, and infant outcomes in pregnant people with laboratory-confirmed SARS-CoV-2 infection by trimester of infection. STUDY DESIGN We analyzed data from the Surveillance for Emerging Threats to Mothers and Babies Network and included people with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection. Pregnancy outcomes included live birth and pregnancy loss (<20 weeks and ≥20 weeks gestation). Infant outcomes included preterm birth (<37 weeks gestation), small for gestational age, birth defects, and neonatal intensive care unit admission. Adjusted prevalence ratios (aPR) were calculated for pregnancy and selected infant outcomes by trimester of infection, controlling for demographics. RESULTS Of 35,200 people included in this analysis, 50.8% of pregnant people had infection in the third trimester, 30.8% in the second, and 18.3% in the first. Third trimester infection was associated with a higher frequency of preterm birth compared to first or second trimester infection combined (17.8% vs. 11.8%; aPR 1.44 95% CI: 1.35-1.54). Prevalence of birth defects was 553.4/10,000 live births, with no difference by trimester of infection. CONCLUSIONS There were no signals for increased birth defects among infants in this population relative to national baseline estimates, regardless of timing of infection. However, the prevalence of preterm birth in people with SARS-CoV-2 infection in pregnancy in our analysis was higher relative to national baseline data (10.0-10.2%), particularly among people with third trimester infection. Consequences of COVID-19 during pregnancy support recommended COVID-19 prevention strategies, including vaccination.
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Affiliation(s)
- Varsha Neelam
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Emily L. Reeves
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA,Eagle Global Scientific, LLCAtlantaGeorgiaUSA
| | - Kate R. Woodworth
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Emily O'Malley Olsen
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Megan R. Reynolds
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Joy Rende
- New Jersey Department of HealthTrentonNew JerseyUSA
| | | | - Susan E. Manning
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA,Massachusetts Department of Public HealthBostonMassachusettsUSA
| | - Paul Romitti
- University of Iowa College of Public HealthIowa CityIowaUSA
| | | | | | | | - Evan Mobley
- Missouri Department of Health and Senior ServicesJefferson CityMissouriUSA
| | | | - Ayomide Sokale
- Philadelphia Department of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Mamie Lush
- Nebraska Department of Health and Human ServicesLincolnNebraskaUSA
| | | | - Abdoulaye Diedhiou
- South Carolina Department of Health and Environmental ControlColumbiaSouth CarolinaUSA
| | - Deborah Mbotha
- Washington State Department of HealthShorelineWashingtonUSA
| | - Wanda Simon
- Arkansas Department of HealthLittle RockArkansasUSA
| | | | | | - Suzann Beauregard
- New Hampshire Department of Health and Human ServicesConcordNew HampshireUSA
| | - Esther M. Ellis
- U.S. Virgin Islands Department of HealthChristianstedVirgin IslandsUSA
| | | | - Amanda Bennett
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA,Illinois Department of Public HealthChicagoIllinoisUSA
| | - Sascha Ellington
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Aron J. Hall
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Eduardo Azziz‐Baumgartner
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Van T. Tong
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
| | - Suzanne M. Gilboa
- Centers for Disease Control and Prevention COVID‐19 Response, Epidemiology Task ForceAtlantaGeorgiaUSA
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Kittikraisak W, Hunsawong T, Punjasamanvong S, Wongrapee T, Suttha P, Piyaraj P, Leepiyasakulchai C, Tanathitikorn C, Yoocharoen P, Jones AR, Mongkolsirichaikul D, Westercamp M, Azziz‐Baumgartner E, Mott JA, Chottanapund S. Anti-SARS-CoV-2 IgG antibody levels among Thai healthcare providers receiving homologous and heterologous COVID-19 vaccination regimens. Influenza Other Respir Viruses 2022; 16:662-672. [PMID: 35199966 PMCID: PMC9111827 DOI: 10.1111/irv.12975] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We examined SARS-CoV-2 anti-spike 1 IgG antibody levels following COVID-19 vaccination (AstraZeneca [AZ], Sinovac [SV], Pfizer-BioNTech [PZ]) among Thai healthcare providers. METHODS Blood specimens were tested using enzyme-linked immunosorbent assay. We analyzed seven vaccination regimens: (1) one dose of AZ or SV, (2) two doses of homologous (2AZ, 2SV) or heterologous (1AZ + 1PZ) vaccines, and (3) three doses of heterologous vaccines (2SV + 1AZ, 2SV + 1PZ). Differences in antibody levels were assessed using Kruskal-Wallis statistic, Mann-Whitney test, or Wilcoxon matched-pairs signed-rank test. Antibody kinetics were predicted using fractional polynomial regression. RESULTS The 563 participants had median age of 39 years; 92% were female; 74% reported no underlying medical condition. Antibody levels peaked at 22-23 days in both 1AZ and 2SV vaccinees and dropped below assay's cutoff for positive (35.2 binding antibody units/ml [BAU/ml]) in 55 days among 1AZ vaccinees compared with 117 days among 2SV vaccinees. 1AZ + 1PZ vaccination regimen was highly immunogenic (median 2279 BAU/ml) 1-4 weeks post vaccination. 2SV + 1PZ vaccinees had significantly higher antibody levels than 2SV + 1AZ vaccinees 4 weeks post vaccination (3423 vs. 2105 BAU/ml; p-value < 0.01), and during weeks 5-8 (3656 vs. 1072 BAU/ml; p-value < 0.01). Antibodies peaked at 12-15 days in both 2SV + 1PZ and 2SV + 1AZ vaccinees, but those of 2SV + 1AZ declined more rapidly and dropped below assay's cutoff in 228 days while those of 2SV + 1PZ remained detectable. CONCLUSIONS 1AZ + 1PZ, 2SV + 1AZ, and 2SV + 1PZ vaccinees had substantial IgG levels, suggesting that these individuals likely mounted sufficient anti-S1 IgG antibodies for possible protection against SARS-CoV-2 infection.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza ProgramThai Ministry of Public Health – U.S. Centers for Disease Control and PreventionNonthaburiThailand
| | - Taweewun Hunsawong
- Virology DepartmentArmed Forces Research Institute of Medical SciencesBangkokThailand
| | | | - Thanapat Wongrapee
- Internal Medicine DepartmentPhaholpolpayuhasena HospitalKanchanaburiThailand
| | - Patama Suttha
- Internal Medicine DepartmentBamrasnaradura Infectious Diseases InstituteNonthaburiThailand
| | - Phunlerd Piyaraj
- Parasitology DepartmentPhramongkutklao College of MedicineBangkokThailand
| | | | | | - Pornsak Yoocharoen
- Department of Disease ControlMinistry of Public HealthNonthaburiThailand
| | - Anthony R. Jones
- Virology DepartmentArmed Forces Research Institute of Medical SciencesBangkokThailand
| | | | - Matthew Westercamp
- Division of Healthcare Quality PromotionU.S. Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Joshua A. Mott
- Influenza ProgramThai Ministry of Public Health – U.S. Centers for Disease Control and PreventionNonthaburiThailand
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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Rozo N, Valencia D, Newton SM, Avila G, Gonzalez MA, Sancken CL, Burkel VK, Ellington SR, Gilboa SM, Rao CY, Azziz‐Baumgartner E, Ospina ML, Prieto FE, Tong VT. Severity of illness by pregnancy status among laboratory-confirmed SARS-CoV-2 infections occurring in reproductive-aged women in Colombia. Paediatr Perinat Epidemiol 2022; 36:456-465. [PMID: 34467554 PMCID: PMC8662193 DOI: 10.1111/ppe.12808] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/28/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple studies have described increased risk of severe coronavirus disease (COVID-19) among pregnant women compared to nonpregnant women. The risk in middle-income countries where the distributions of age groups and preexisting conditions may differ is less known. OBJECTIVES To determine whether pregnant women with SARS-CoV-2 infection are at increased risk for severe COVID-19 compared to nonpregnant women in Colombia. METHODS We analysed national surveillance data from Colombia, of women aged 15-44 years with laboratory-confirmed infection with SARS-CoV-2 by molecular or antigen testing, from 6 March 2020 to 12 December 2020. An enhanced follow-up of pregnant women with COVID-19 was established to monitor pregnancy and birth outcomes. RESULTS Of 371,363 women aged 15-44 years with laboratory-confirmed SARS-CoV-2 infection, 1.5% (n = 5614) were reported as pregnant; among those, 2610 (46.5%) were considered a complete pregnancy for reporting purposes at the time of analysis. Hospitalisation (23.9%) and death (1.3%) occurred more frequently among pregnant symptomatic women compared to nonpregnant symptomatic women (2.9% and 0.3%, respectively). Compared to nonpregnant symptomatic women, pregnant symptomatic women were at increased risk of hospitalisation (adjusted risk ratio [RR] 2.19, 95% confidence interval [CI] 2.07, 2.32) and death (RR 1.82, 95% CI 1.60, 2.07), after adjusting for age, type of health insurance and presence of certain underlying medical conditions. Among complete pregnancies, 55 (2.1%) were pregnancy losses, 72 (2.8%) resulted in term low birthweight infants and 375 (14.4%) were preterm deliveries. CONCLUSIONS Although pregnant women were infrequently reported with laboratory-confirmed SARS-CoV-2 infection, pregnant symptomatic women with COVID-19 were at increased risk for hospitalisation and death compared to nonpregnant symptomatic women. Almost all infections we reported on were third-trimester infections; ongoing follow-up is needed to determine pregnancy outcomes among women infected earlier in pregnancy. Healthcare providers should counsel pregnant women about preventive measures to protect from SARS-CoV-2 infection and when to seek care.
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Affiliation(s)
| | - Diana Valencia
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Suzanne M. Newton
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | - Christina L. Sancken
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Veronica K. Burkel
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Sascha R. Ellington
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Suzanne M. Gilboa
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Carol Y. Rao
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Van T. Tong
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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8
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Naleway AL, Grant L, Caban‐Martinez AJ, Wesley MG, Burgess JL, Groover K, Gaglani M, Yoon SK, Tyner HL, Meece J, Kuntz JL, Yoo YM, Schaefer‐Solle N, Olsho LEW, Gerald JK, Rose S, Thiese MS, Lundgren J, Groom HC, Mak J, Louzado Feliciano P, Edwards LJ, Lutrick K, Dunnigan K, Phillips AL, Lamberte JM, Noriega R, Sokol BE, Odean M, Ellingson KD, Smith M, Hegmann KT, Respet K, Dickerson M, Cruz A, Fleary DE, Murthy K, Hunt A, Azziz‐Baumgartner E, Gallimore‐Wilson D, Harder JA, Odame‐Bamfo L, Viergutz J, Arvay M, Jones JM, Mistry P, Thompson MG, Fowlkes AL. Incidence of SARS-CoV-2 infection among COVID-19 vaccinated and unvaccinated healthcare personnel, first responders, and other essential and frontline workers: Eight US locations, January-September 2021. Influenza Other Respir Viruses 2022; 16:585-593. [PMID: 35023288 PMCID: PMC8983896 DOI: 10.1111/irv.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2. METHODS We analyzed data from a prospective frontline worker cohort to estimate the incidence of COVID-19 by month as well as the association of COVID-19 vaccination, occupation, demographics, physical distancing, and mask use with infection risk. Participants completed baseline and quarterly surveys, and each week self-collected mid-turbinate nasal swabs and reported symptoms. RESULTS Among 1018 unvaccinated and 3531 fully vaccinated workers, the monthly incidence of laboratory-confirmed SARS-CoV-2 infection in January 2021 was 13.9 (95% confidence interval [CI]: 10.4-17.4), declining to 0.5 (95% CI -0.4-1.4) per 1000 person-weeks in June. By September 2021, when the Delta variant predominated, incidence had once again risen to 13.6 (95% CI 7.8-19.4) per 1000 person-weeks. In contrast, there was no reportable incidence among fully vaccinated participants at the end of January 2021, and incidence remained low until September 2021 when it rose modestly to 4.1 (95% CI 1.9-3.8) per 1000. Below average facemask use was associated with a higher risk of infection for unvaccinated participants during exposure to persons who may have COVID-19 and vaccinated participants during hours in the community. CONCLUSIONS COVID-19 vaccination was significantly associated with a lower risk of SARS-CoV-2 infection despite Delta variant predominance. Our data demonstrate the added protective benefit of facemask use among both unvaccinated and vaccinated frontline workers.
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Affiliation(s)
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | | | - Manjusha Gaglani
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Sarang K. Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Jennifer Meece
- Marshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Jennifer L. Kuntz
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Young M. Yoo
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Joe K. Gerald
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Spencer Rose
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Kayan Dunnigan
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Andrew L. Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Roger Noriega
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Marilyn Odean
- Whiteside Institute for Clinical Research, St. Luke'sDuluthMinnesotaUSA
| | | | | | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Karley Respet
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Alexandra Cruz
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | | | - Angela Hunt
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | | | | | | | | | | | - Melissa Arvay
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - John M. Jones
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Mark G. Thompson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Ashley L. Fowlkes
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
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9
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Otieno NA, Nyawanda BO, McMorrow M, Oneko M, Omollo D, Lidechi S, Widdowson M, Flannery B, Chaves SS, Azziz‐Baumgartner E, Emukule GO. The burden of influenza among Kenyan pregnant and postpartum women and their infants, 2015–2020. Influenza Other Respir Viruses 2022; 16:452-461. [PMID: 35066993 PMCID: PMC8983887 DOI: 10.1111/irv.12950] [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: 11/11/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background In tropical Africa, data about influenza‐associated illness burden are needed to assess potential benefits of influenza vaccination among pregnant women. We estimated the incidence of influenza among pregnant women and their infants in Siaya County, Kenya. Methods We enrolled women at <31 weeks of gestation and conducted weekly follow‐up until 6‐month postpartum to identify acute respiratory illnesses (ARIs). We defined ARI among mothers as reported cough, rhinorrhoea or sore throat and among infants as maternal‐reported cough, difficulty breathing, rhinorrhoea or clinician diagnosis of respiratory illness. We collected nasal/nasopharyngeal and oropharyngeal swabs from mothers/infants with ARI and tested for influenza A and B using molecular assays. We calculated antenatal incidence of laboratory‐confirmed influenza among mothers and postnatal incidence among mothers and infants. Results During June 2015 to May 2020, we analysed data from 3,026 pregnant women at a median gestational age of 16 weeks (interquartile range [IQR], 13, 18) and followed 2,550 infants. Incidence of laboratory‐confirmed influenza during pregnancy (10.3 episodes per 1,000 person‐months [95% confidence interval {CI} 8.6–11.8]) was twofold higher than in the postpartum period (4.0 [95% CI 2.6–5.5]; p < 0.01). Incidence was significantly higher among human immunodeficiency virus (HIV)‐infected pregnant women (15.6 [95% CI 11.0–20.6] vs. 9.1 [95% CI 7.5–10.8]; p < 0.01). Incidence among young infants was 4.4 (95% CI 3.0–5.9) and similar among HIV‐exposed and HIV‐unexposed infants. Conclusion Our findings suggest a substantial burden of influenza illnesses during pregnancy, with a higher burden among HIV‐infected mothers. Kenyan authorities should consider the value of vaccinating pregnant women, especially if HIV infected.
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Affiliation(s)
- Nancy A. Otieno
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Bryan O. Nyawanda
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Meredith McMorrow
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
| | - Martina Oneko
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Daniel Omollo
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Shirley Lidechi
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Marc‐Alain Widdowson
- Centers for Disease Control and Prevention Division of Global Health Protection Nairobi Kenya
- Institute of Tropical Medicine Antwerp Belgium
| | - Brendan Flannery
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
| | - Sandra S. Chaves
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
- Centers for Disease Control and Prevention, Influenza Program Nairobi Kenya
| | - Eduardo Azziz‐Baumgartner
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
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10
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Ahmed M, Aleem MA, Roguski K, Abedin J, Islam A, Alam KF, Gurley ES, Rahman M, Azziz‐Baumgartner E, Homaira N, Sturm‐Ramirez K, Danielle Iuliano A. Estimates of seasonal influenza-associated mortality in Bangladesh, 2010-2012. Influenza Other Respir Viruses 2018; 12:65-71. [PMID: 29197174 PMCID: PMC5818342 DOI: 10.1111/irv.12490] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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] [Accepted: 08/19/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Seasonal influenza-associated mortality estimates help identify the burden of disease and assess the value of public health interventions such as annual influenza immunization. Vital registration is limited in Bangladesh making it difficult to estimate seasonal influenza mortality. OBJECTIVES Our study aimed to estimate seasonal influenza-associated mortality rates for 2010-2012 in Bangladesh. METHODS We conducted surveillance among hospitalized patients with severe acute respiratory illness (SARI) for persons aged ≥5 years and severe pneumonia for children <5 years in 11 sites across Bangladesh. We defined the catchment areas of these sites and conducted a community survey in 22 randomly selected unions (administrative units) within the catchment areas to identify respiratory deaths. We multiplied the proportion of influenza-positive patients at our surveillance sites by the age-specific number of respiratory deaths identified to estimate seasonal influenza-associated mortality. RESULTS Among 4221 surveillance case-patients, 553 (13%) were positive for influenza viruses. Concurrently, we identified 1191 persons who died within 2 weeks of developing an acute respiratory illness within the catchment areas of the surveillance hospitals. In 2010-2011, the estimated influenza-associated mortality rate was 6 (95% CI 4-9) per 100 000 for children <5 years and 41 (95% CI 35-47) per 100 000 for persons >60 years. During 2011-2012, the estimated influenza-associated mortality rate was 13 (95% CI 10-16) per 100 000 among children <5 years and 88 (95% CI 79-98) per 100 000 among persons aged >60 years. CONCLUSIONS We identified a substantial burden of influenza-associated deaths in Bangladesh suggesting that the introduction of prevention and control measures including seasonal vaccination should be considered by local public health decision-makers.
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Affiliation(s)
- Makhdum Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
- The University of Texas Health Science Center at HoustonHoustonTXUSA
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Mohammad Abdul Aleem
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | | | - Jaynal Abedin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Ariful Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Kazi Faisal Alam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Emily S. Gurley
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR)DhakaBangladesh
| | | | - Nusrat Homaira
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
- School of Women's and Children's HealthThe University of New South Wales (UNSW)SydneyNSWAustralia
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