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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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Hanquet G, Theilacker C, Vietri J, Sepúlveda-Pachón I, Menon S, Gessner B, Begier E. Best Practices for Identifying Hospitalized Lower Respiratory Tract Infections Using Administrative Data: A Systematic Literature Review of Validation Studies. Infect Dis Ther 2024; 13:921-940. [PMID: 38498108 DOI: 10.1007/s40121-024-00949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Estimating the burden of lower respiratory tract infections (LRTIs) increasingly relies on administrative databases using International Classification of Diseases (ICD) codes, but no standard methodology exists. We defined best practices for ICD-based algorithms that estimate LRTI incidence in adults. METHODS We conducted a systematic review of validation studies assessing the use of ICD code-based algorithms to identify hospitalized LRTIs in adults, published in Medline, EMBASE, and LILACS between January 1996 and January 2022, according to PRISMA guidelines. We assessed sensitivity, specificity, and other accuracy measures of different algorithms. RESULTS We included 26 publications that used a variety of ICD code-based algorithms and gold standard criteria, and 18 reported sensitivity and/or specificity. Sensitivity was below 80% in 72% (38/53) of algorithms and specificity exceeded 90% in 77% (37/48). Algorithms for all-cause LRTI (n = 18) that included only pneumonia codes in primary position (n = 3) had specificity greater than 90% but low sensitivity (55-72%). Sensitivity increased by 5-15%, with minimal loss in specificity, with the addition of primary codes for severe pneumonia (e.g. sepsis) while pneumonia codes were in secondary position, and by 13% with codes from LRTI-related infections (e.g. viral) or other respiratory diseases (e.g. empyema). Sensitivity increased by 8% when pneumonia codes were in any position, but specificity was not reported. In hospital-acquired pneumonia and pneumococcal-specific pneumonia, algorithms containing only nosocomial- or pathogen-specific ICD codes had poor sensitivity, which improved when broader pneumonia codes were added, in particular codes for unspecified organisms. CONCLUSION Our systematic review highlights that most ICD code-based algorithms are relatively specific, but miss a substantial number of hospitalized LRTI adult cases. Best practices to estimate LRTI incidence in this population include the use of all pneumonia ICD codes for any LRTI outcome and, to a lesser extent, those for other LRTI-related infections or respiratory diseases.
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Affiliation(s)
- Germaine Hanquet
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III Laan 1, 3001, Louvain, Belgium
| | | | - Jeffrey Vietri
- Pfizer Inc., 500 Arcola Rd, Collegeville, PA, 19426, USA
| | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III Laan 1, 3001, Louvain, Belgium
| | | | - Elizabeth Begier
- Scientific Affairs, Older Adult RSV Vaccine Program, Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Pfizer Inc., 9 Riverwalk, Citywest Business Campus, Dublin 24, Dublin, Ireland.
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Bruyndonckx R, Polkowska-Kramek A, Liang C, Nuttens C, Tran TMP, Gessner BD, Begier E. Estimation of Symptomatic Respiratory Syncytial Virus Infection Incidence in Adults in Multiple Countries: A Time-Series Model-Based Analysis Protocol. Infect Dis Ther 2024; 13:953-963. [PMID: 38499832 DOI: 10.1007/s40121-024-00948-9] [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: 12/04/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Estimating respiratory syncytial virus (RSV) burden in adults is challenging because of non-specific symptoms, infrequent standard-of-care testing, resolution of viral shedding before seeking medical care, test positivity that varies by specimen site in the upper airway and lower diagnostic test sensitivity compared to children. Conducting prospective observational studies to assess RSV burden in adults is time- and resource-intensive. Thus, model-based approaches can be applied using existing data to obtain more accurate estimates of RSV burden. This protocol establishes essential elements for estimating RSV incidence rate in adults using a time series model-based approach. It can be tailored to specific databases and applied globally across countries, enabling estimation of local RSV disease burden to inform public health decision-making, including immunization policy. METHODS Data are analysed using a quasi-Poisson regression model, considering the effect of baseline trends and pathogen co-circulation, stratified by age and risk status. Pathogen co-circulation is represented by viral proxies defined based on ICD code groupings indicating RSV and influenza-specific hospitalizations, lagged 0 up to 4 weeks based on the model selection. A final model is constructed in two steps: optimization of the time trend (using p-values) and selection of the viral proxy lag time (using test statistics, to prioritize the most biologically plausible option). The yearly incidence rate and percentage of events attributable to RSV are estimated from the final model. Confidence intervals are calculated using residual bootstrapping. PLANNED OUTCOMES Outcomes to be modelled are based on administrative ICD code groupings and include the number of cardiorespiratory, respiratory and cardiovascular events in a specific care setting (e.g., general practitioner visit, emergency department visit, hospitalization and death). Cardiovascular events are limited to those for which existing evidence suggests an association with RSV infection. Additional secondary outcomes are constructed as a subset of the primary outcomes based on specific ICD code groups.
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Affiliation(s)
| | | | | | | | | | | | - Elizabeth Begier
- Pfizer Inc, Dublin, Republic of Ireland.
- Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Republic of Ireland.
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Polkowska-Kramek A, Begier E, Bruyndonckx R, Liang C, Beese C, Brestrich G, Tran TMP, Nuttens C, Casas M, Bayer LJ, Huebbe B, Ewnetu WB, Agudelo JLR, Gessner BD, von Eiff C, Rohde G. Estimated Incidence of Hospitalizations and Deaths Attributable to Respiratory Syncytial Virus Infections Among Adults in Germany Between 2015 and 2019. Infect Dis Ther 2024; 13:845-860. [PMID: 38520629 DOI: 10.1007/s40121-024-00951-0] [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: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) burden in adults is underestimated mainly due to unspecific symptoms and limited standard-of-care testing. We estimated the population-based incidence of hospitalization and mortality attributable to RSV among adults with and without risk factors in Germany. METHODS Weekly counts of hospitalizations and deaths for respiratory, cardiovascular, and cardiorespiratory diseases were obtained (Statutory Health Insurance database, 2015-2019). A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends, and viral activity while allowing for potential overdispersion. Weekly counts of RSV and influenza hospitalizations in children < 2 years and adults ≥ 60 years, respectively, were used as viral activity indicators. Models were stratified by age group and risk status (defined as presence of selected comorbidities). RESULTS Population-based RSV-attributable hospitalization incidence rates were high among adults ≥ 60 years: respiratory hospitalizations (236-363 per 100,000 person-years) and cardiorespiratory hospitalizations (584-912 per 100,000 person-years). RSV accounted for 2-3% of all cardiorespiratory hospitalizations in this age group. The increase in cardiorespiratory hospitalization risk associated with underlying risk factors was greater in 18-44 year old persons (five to sixfold higher) than in ≥ 75 year old persons (two to threefold higher). CONCLUSIONS This is a first model-based study to comprehensively assess adult RSV burden in Germany. Estimated cardiorespiratory RSV hospitalization rates increased with age and were substantially higher in people with risk factors compared to those without risk factors. Our study indicates that RSV, like other respiratory viruses, contributes to both respiratory and cardiovascular hospitalizations. Effective prevention strategies are needed, especially among older adults ≥ 60 years and among adults with underlying risk factors.
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Affiliation(s)
| | | | | | - Caihua Liang
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
| | | | | | | | | | - Maribel Casas
- P95 Pharmacovigilance and Epidemiology Services, Leuven, Belgium
| | | | | | | | | | | | | | - Gernot Rohde
- Medical Clinic I, Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
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Hyams C, Lahuerta M, Theilacker C, King J, Adegbite D, McGuinness S, Grimes C, Campling J, Southern J, Pride MW, Begier E, Maskell N, Oliver J, Jodar L, Gessner BD, Finn A. Surveillance of pneumococcal serotypes in adults hospitalised with acute lower respiratory tract infection in Bristol, UK. Vaccine 2024; 42:1599-1607. [PMID: 38336560 DOI: 10.1016/j.vaccine.2024.02.007] [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: 11/05/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Pneumococcus remains a major cause of adult lower respiratory tract infections (LRTI). Few data exist on the relative contribution of serotypes included in pneumococcal vaccines to community-acquired pneumonia (CAP) and non-pneumonic (NP) LRTI. We measured the burden of all and vaccine-serotype pneumococcal respiratory infection following SARS-CoV-2 emergence to inform evidence-based vaccination policy. METHODS A prospective cohort study at two Bristol hospitals (UK) including all adults age ≥ 18-years hospitalised with acute lower respiratory tract disease (aLRTD) from Nov2021-Nov2022. LRTI patients were classified as: a) radiographically-confirmed CAP (CAP+/RAD+), b) clinically-diagnosed CAP without radiological confirmation (CAP+/RAD-), or c) NP-LRTI. Pneumococcus was identified by blood culture, BinaxNOW™and serotype-specific urine antigen detection assays (UAD). RESULTS Of 12,083 aLRTD admissions, 10,026 had LRTI and 2,445 provided urine: 1,097 CAP + RAD+; 207 CAP + RAD-; and 1,141 NP-LRTI. Median age was 71.1y (IQR57.9-80.2) and Charlson comorbidity index = 4 (IQR2-5); 2.7 % of patients required intensive care, and 4.4 % died within 30-days of hospitalisation. Pneumococcus was detected in 280/2445 (11.5 %) participants. Among adults aged ≥ 65y and 18-64y, 12.9 % (198/1534) and 9.0 % (82/911), respectively, tested pneumococcus positive. We identified pneumococcus in 165/1097 (15.0 %) CAP + RAD+, 23/207 (11.1 %) CAP + RAD-, and 92/1141 (8.1 %) NP-LRTI cases. Of the 280 pneumococcal cases, 102 (36.4 %) were due to serotypes included in PCV13 + 6C, 115 (41.7 %) in PCV15 + 6C, 210 (75.0 %) in PCV20 + 6C/15C and 228 (81.4 %) in PPV23 + 15C. The most frequently identified serotypes were 8 (n = 78; 27.9 % of all pneumococcus), 7F (n = 25; 8.9 %), and 3 (n = 24; 8.6 %). DISCUSSION Among adults hospitalised with respiratory infection, pneumococcus is an important pathogen across all subgroups, including CAP+/RAD- and NP-LRTI. Despite 20-years of PPV23 use in adults ≥ 65-years and herd protection due to 17-years of PCV use in infants, vaccine-serotype pneumococcal disease still causes a significant proportion of LRTI adult hospitalizations. Direct adult vaccination with high-valency PCVs may reduce pneumococcal disease burden.
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Affiliation(s)
- Catherine Hyams
- Population Health Sciences, University of Bristol, Bristol, UK.
| | | | | | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, UK
| | - David Adegbite
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Serena McGuinness
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | | | | | | | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Jennifer Oliver
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Adam Finn
- Bristol Vaccine Centre, Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, UK
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Averin A, Atwood M, Sato R, Yacisin K, Begier E, Shea K, Curcio D, Houde L, Weycker D. Attributable Cost of Adult Respiratory Syncytial Virus Illness Beyond the Acute Phase. Open Forum Infect Dis 2024; 11:ofae097. [PMID: 38486815 PMCID: PMC10939437 DOI: 10.1093/ofid/ofae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
Background Estimates of the cost of medically attended lower respiratory tract illness (LRTI) due to respiratory syncytial virus (RSV) in adults, especially beyond the acute phase, is limited. This study was undertaken to estimate the attributable costs of RSV-LRTI among US adults during, and up to 1 year after, the acute phase of illness. Methods A retrospective observational matched-cohort design and a US healthcare claims repository (2016-2019) were employed. The study population comprised adults aged ≥18 years with RSV-LRTI requiring hospitalization (RSV-H), an emergency department visit (RSV-ED), or physician office/hospital outpatient visit (RSV-PO/HO), as well as matched comparison patients. All-cause healthcare expenditures were tallied during the acute phase of illness (RSV-H: from admission through 30 days postdischarge; ambulatory RSV: during the episode) and long-term phase (end of acute phase to end of following 1-year period). Results The study population included 4526 matched pairs of RSV-LRTI and comparison patients (RSV-H: n = 970; RSV-ED: n = 590; RSV-PO/HO: n = 2966). Mean acute-phase expenditures were $42 179 for RSV-H (vs $5154 for comparison patients), $4409 for RSV-ED (vs $377), and $922 for RSV-PO/HO (vs $201). By the end of the 1-year follow-up period, mean expenditures-including acute and long-term phases-were $101 532 for RSV-H (vs $36 302), $48 701 for RSV-ED (vs $27 131), and $28 851 for RSV-PO/HO (vs $20 523); overall RSV-LRTI attributable expenditures thus totaled $65 230, $21 570, and $8327, respectively. Conclusions The cost of RSV-LRTI requiring hospitalization or ambulatory care among US adults is substantial, and the economic impact of RSV-LTRI may extend well beyond the acute phase of illness.
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Affiliation(s)
| | - Mark Atwood
- Policy Analysis Inc, Boston, Massachusetts, USA
| | - Reiko Sato
- Pfizer Inc, Collegeville, Pennsylvania, USA
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Poukka E, van Roekel C, Turunen T, Baum U, Kramer R, Begier E, Presser L, Teirlinck A, Heikkinen T, Knol M, Nohynek H. Effectiveness of Vaccines and Monoclonal Antibodies Against Respiratory Syncytial Virus: Generic Protocol for Register-Based Cohort Study. J Infect Dis 2024; 229:S84-S91. [PMID: 37930815 DOI: 10.1093/infdis/jiad484] [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: 07/21/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
Several immunization products are currently being developed against respiratory syncytial virus (RSV) for children, pregnant females, and older adults, and some products have already received authorization. Therefore, studies to monitor the effectiveness of these products are needed in the following years. To assist researchers to conduct postmarketing studies, we developed a generic protocol for register-based cohort studies to evaluate immunization product effectiveness against RSV-specific and nonspecific outcomes. To conduct a study on the basis of this generic protocol, the researchers can use any relevant databases or healthcare registers that are available at the study site.
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Affiliation(s)
- Eero Poukka
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
- Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| | - Caren van Roekel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Topi Turunen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
| | - Ulrike Baum
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
| | | | | | - Lance Presser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Anne Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Finland
| | - Mirjam Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
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Haeberer M, Bruyndonckx R, Polkowska-Kramek A, Torres A, Liang C, Nuttens C, Casas M, Lemme F, Ewnetu WB, Tran TMP, Atwell JE, Diez CM, Gessner BD, Begier E. Estimated Respiratory Syncytial Virus-Related Hospitalizations and Deaths Among Children and Adults in Spain, 2016-2019. Infect Dis Ther 2024; 13:463-480. [PMID: 38319540 DOI: 10.1007/s40121-024-00920-7] [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: 11/02/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes a substantial disease burden among infants. In older children and adults, incidence is underestimated due to nonspecific symptoms and limited standard-of-care testing. We aimed to estimate RSV-attributable hospitalizations and deaths in Spain during 2016-2019. METHODS Nationally representative hospitalization and mortality databases were obtained from the Ministry of Health and the National Statistical Office. A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends and viral activity, while allowing for potential overdispersion. RESULTS In children, the RSV-attributable respiratory hospitalization incidence was highest among infants aged 0-5 months (3998-5453 cases/100,000 person-years, representing 72% of all respiratory hospitalizations) and decreased with age. In 2019, estimated rates in children 0-5, 6-11, 12-23 months and 6-17 years were approximately 1.3, 1.4, 1.5, and 6.5 times higher than those based on standard-of-care RSV-specific codes. In adults, the RSV-attributable cardiorespiratory hospitalization rate increased with age and was highest among persons ≥ 80 years (1325-1506 cases/100,000, 6.5% of all cardiorespiratory hospitalizations). In 2019, for persons aged 18-49, 50-59, 60-79, and ≥ 80 years, estimated rates were approximately 8, 6, 8, and 16 times higher than those based on standard-of-care RSV-specific codes. The RSV-attributable cardiorespiratory mortality rate was highest among ≥ 80 age group (126-150 deaths/100,000, 3.5-4.1% of all cardiorespiratory deaths), when reported mortality rate ranged between 0 and 0.5/100,000. CONCLUSIONS When accounting for under-ascertainment, estimated RSV-attributable hospitalizations were higher than those reported based on standard-of-care RSV-specific codes in all age groups but particularly among older children and older adults. Like other respiratory viruses, RSV contributes to both respiratory and cardiovascular complications. Efficacious RSV vaccines could have a high public health impact in these age and risk groups.
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Affiliation(s)
| | | | | | | | | | | | - Maribel Casas
- Epidemiology and Pharmacovigilance, P95, Leuven, Belgium
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van Roekel C, Poukka E, Turunen T, Nohynek H, Presser L, Meijer A, Heikkinen T, Kramer R, Begier E, Teirlinck AC, Knol MJ. Effectiveness of Immunization Products Against Medically Attended Respiratory Syncytial Virus Infection: Generic Protocol for a Test-Negative Case-Control Study. J Infect Dis 2024; 229:S92-S99. [PMID: 37935046 DOI: 10.1093/infdis/jiad483] [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: 07/15/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
Monitoring the real-life effectiveness of respiratory syncytial virus (RSV) products is of major public health importance. This generic protocol for a test-negative design study aims to address currently envisioned approaches for RSV prevention (monoclonal antibodies and vaccines) to study effectiveness of these products among target groups: children, older adults, and pregnant women. The generic protocol approach was chosen to allow for flexibility in adapting the protocol to a specific setting. This protocol includes severe acute respiratory infection (SARI) and acute respiratory infection (ARI), both due to RSV, as end points. These end points can be applied to studies in hospitals, primarily targeting patients with more severe disease, but also to studies in general practitioner clinics targeting ARI.
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Affiliation(s)
- Caren van Roekel
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Eero Poukka
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Topi Turunen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lance Presser
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Adam Meijer
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | | | | | - Anne C Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
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Grant LR, Begier E, Theilacker C, Barry R, Hall-Murray C, Yan Q, Pope V, Pride MW, Jodar L, Gessner BD. Multicountry Review of Streptococcus pneumoniae Serotype Distribution Among Adults With Community-Acquired Pneumonia. J Infect Dis 2024; 229:282-293. [PMID: 37665210 PMCID: PMC10786249 DOI: 10.1093/infdis/jiad379] [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: 03/08/2023] [Revised: 07/24/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Nonbacteremic community-acquired pneumonia (CAP) is a leading presentation of severe pneumococcal disease in adults. Serotype-specific urinary antigen detection (UAD) assay can detect serotypes causing pneumococcal CAP, including nonbacteremic cases, and guide recommendations for use of higher valency pneumococcal conjugate vaccines (PCVs). METHODS Adult CAP serotype distribution studies that used both Pfizer UADs (UAD1, detects PCV13 serotypes; UAD2, detects PCV20 non-PCV13 serotypes plus 2, 9N, 17F, and 20) were identified by review of an internal study database and included if results were published. The percentages of all-cause radiologically confirmed CAP (RAD + CAP) due to individual or grouped (PCV13, PCV15, and PCV20) serotypes as detected from culture or UAD were reported. RESULTS Six studies (n = 2, United States; n = 1 each, Germany, Sweden, Spain, and Greece) were included. The percentage of RAD + CAP among adults ≥18 years with PCV13 serotypes equaled 4.6% to 12.9%, with PCV15 serotypes 5.9% to 14.5%, and with PCV20 serotypes 7.8% to 23.8%. The percentage of RAD + CAP due to PCV15 and PCV20 serotypes was 1.1-1.3 and 1.3-1.8 times higher than PCV13 serotypes, respectively. CONCLUSIONS PCV13 serotypes remain a cause of RAD + CAP among adults even in settings with pediatric PCV use. Higher valency PCVs among adults could address an important proportion of RAD + CAP in this population.
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Affiliation(s)
- Lindsay R Grant
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Elizabeth Begier
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Dublin, Ireland
| | - Christian Theilacker
- Vaccines, Antivirals, and Evidence Generation, Pfizer Pharma GmbH, Berlin, Germany
| | - Rachid Barry
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Cassandra Hall-Murray
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Qi Yan
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Veneta Pope
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Michael W Pride
- Vaccine Research and Development, Pfizer Vaccines, Pearl River, New York, USA
| | - Luis Jodar
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Bradford D Gessner
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
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11
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Weycker D, Averin A, Houde L, Ottino K, Shea K, Sato R, Gessner BD, Yacisin K, Curcio D, Begier E, Rozenbaum M. Rates of Lower Respiratory Tract Illness in US Adults by Age and Comorbidity Profile. Infect Dis Ther 2024; 13:207-220. [PMID: 38236516 PMCID: PMC10828164 DOI: 10.1007/s40121-023-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION While it is widely recognized that older adults, adults with chronic medical conditions (CMC), and adults with immunocompromising conditions (IC) are at increased risk of lower respiratory tract illness (LRTI), evidence of the magnitude of increased risk is limited. This study was thus undertaken to characterize rates of hospitalized and ambulatory LRTI among United States (US) adults by age and comorbidity profile. METHODS A retrospective cohort design and US healthcare claims database (2016-2019) were employed. Study population included adults aged ≥ 18 years and was stratified by age and comorbidity profile (CMC-, CMC+ , IC). LRTI was ascertained overall and by pathogen pathogen (e.g., respiratory syncytial virus [RSV]), and was classified by care setting (hospital, emergency department [ED], physician office/hospital outpatient [PO/HO]). RESULTS Relative rates (RR) of LRTI generally increased with older age across care settings (vs. 18-49 years), with the most marked increase for hospitalizations: for LRTI-hospitalized, RRs ranged from 3.3 for 50-64 years to 46.6 for ≥ 85 years; for LRTI-ED and LRTI-PO/HO, RRs ranged from 1.0 to 2.7 and from 1.3 to 1.5, respectively. Within age groups, LRTI rates were also consistently higher among CMC+ and IC adults (vs. CMC- adults). Age-specific RRs of LRTI patients hospitalized due to RSV were largely comparable to overall LRTI; age-specific RRs for other care settings, and RRs for CMC+ and IC adults (vs. CMC- adults), were generally higher for LRTI due to RSV. CONCLUSIONS Incidence of LRTI, including that due to RSV, especially for events requiring acute inpatient care, is markedly higher among older adults and adults of all ages with CMC or IC.
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12
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Begier E, Pilz A, Loew-Baselli A, Harper LR, Stark JH, Bowdery M, Halsby K, Dzingina M, Bézay N, Allen KE, Parslow B, Gessner BD. Prospective incidence epidemiology study protocol: conducting active surveillance to assess the burden of Lyme disease (BOLD) in primary care practices in endemic areas of six European countries. BMJ Open 2023; 13:e070903. [PMID: 38072499 PMCID: PMC10729257 DOI: 10.1136/bmjopen-2022-070903] [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] [Received: 12/27/2022] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Lyme disease (LD) is the most frequent tick-borne disease in the moderate climates of Europe. This study will inform the phase III efficacy study for Pfizer and Valneva's investigational Lyme disease vaccine, VLA15. VLA15 phase III will be conducted in the USA and Europe due to the vaccine's serotype coverage and public health burden of LD. In Europe, the existence and location of sites that have access to populations with high LD annual incidence is uncertain. This active, prospective surveillance study assesses annual LD incidence at general practice (GP)/primary care sites, allowing for phase III site vetting and better characterisation of LD burden in selected regions for study size calculations. METHODS AND ANALYSIS This burden of Lyme disease (BOLD) study will assess LD incidence overall and by site at 15 GP/primary care practices in endemic areas of 6 European countries from Spring 2021 to December 2022 and will be summarised with counts (n), percentages (%) and associated 95% CIs. Suspected LD cases identified from site's practice panels are documented on screening logs, where clinical LD manifestations, diagnoses and standard of care diagnostic results are recorded. In the initial 12-month enrolment phase, suspected LD cases are offered enrolment. Participants undergo interview and clinical assessments to establish medical history, final clinical diagnosis, clinical manifestations and quality of life impact. Study-specific procedures include LD serology, skin punch biopsies and Lyme manifestation photographs. For every enrolled participant diagnosed with LD, 6-10 age-matched controls are randomly selected and offered enrolment for an embedded LD risk factor analysis. Persistent symptoms or post-treatment LD will be assessed at follow-up visits up to 2 years after initial diagnosis, while patients remain symptomatic. ETHICS AND DISSEMINATION This study has been approved by all sites' local ethics committees. The results will be presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
| | | | | | - Lisa R Harper
- Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - James H Stark
- Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
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13
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Onwuchekwa C, Atwell J, Moreo LM, Menon S, Machado B, Siapka M, Agarwal N, Rubbrecht M, Aponte-Torres Z, Rozenbaum M, Curcio D, Nair H, Kalina WV, Vroling H, Gessner B, Begier E. Pediatric Respiratory Syncytial Virus Diagnostic Testing Performance: A Systematic Review and Meta-analysis. J Infect Dis 2023; 228:1516-1527. [PMID: 37285396 PMCID: PMC10681870 DOI: 10.1093/infdis/jiad185] [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: 11/29/2022] [Revised: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Adding additional specimen types (eg, serology or sputum) to nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) increases respiratory syncytial virus (RSV) detection among adults. We assessed if a similar increase occurs in children and quantified underascertainment associated with diagnostic testing. METHODS We searched databases for studies involving RSV detection in persons <18 years using ≥2 specimen types or tests. We assessed study quality using a validated checklist. We pooled detection rates by specimen and diagnostic tests and quantified performance. RESULTS We included 157 studies. Added testing of additional specimens to NP aspirate (NPA), NPS, and/or nasal swab (NS) RT-PCR resulted in statistically nonsignificant increases in RSV detection. Adding paired serology testing increased RSV detection by 10%, NS by 8%, oropharyngeal swabs by 5%, and NPS by 1%. Compared to RT-PCR, direct fluorescence antibody tests, viral culture, and rapid antigen tests were 87%, 76%, and 74% sensitive, respectively (pooled specificities all ≥98%). Pooled sensitivity of multiplex versus singleplex RT-PCR was 96%. CONCLUSIONS RT-PCR was the most sensitive pediatric RSV diagnostic test. Adding multiple specimens did not substantially increase RSV detection, but even small proportional increases could result in meaningful changes in burden estimates. The synergistic effect of adding multiple specimens should be evaluated.
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Affiliation(s)
| | | | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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14
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Njue A, Nuabor W, Lyall M, Margulis A, Mauskopf J, Curcio D, Kurosky S, Gessner BD, Begier E. Systematic Literature Review of Risk Factors for Poor Outcomes Among Adults With Respiratory Syncytial Virus Infection in High-Income Countries. Open Forum Infect Dis 2023; 10:ofad513. [PMID: 38033988 PMCID: PMC10686344 DOI: 10.1093/ofid/ofad513] [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: 04/12/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Identification of risk factors for severe respiratory syncytial virus (RSV) disease in adults could facilitate their appropriate vaccine recommendations. We conducted a systematic literature review (last 10 years in PubMed/Embase) to identify quantitative estimates of risk factors for severe RSV infection outcomes in high-income countries. Severe outcomes from RSV infection included hospitalization, excess mortality, lower respiratory tract infection, or a composite measure: severe RSV, which included these outcomes and others, such as mechanical ventilation and extended hospital stay. Among 1494 articles screened, 26 met eligibility criteria. We found strong evidence that the following increased the risk of severe outcomes: age, preexisting comorbid conditions (eg, cardiac, pulmonary, and immunocompromising diseases, as well as diabetes and kidney disease), and living conditions (socioeconomic status and nursing home residence). The frequency of severe outcomes among younger adults with comorbidities was generally similar to that experienced by older adults, suggesting that immunosenescence and chronic conditions are both contributing factors for elevated risk. Trial registration PROSPERO (CRD42022315239).
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Affiliation(s)
- Annete Njue
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Weyinmi Nuabor
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Matthew Lyall
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Andrea Margulis
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Josephine Mauskopf
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Daniel Curcio
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Samantha Kurosky
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Bradford D Gessner
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Elizabeth Begier
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
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15
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Hyams C, Qian G, Nava G, Challen R, Begier E, Southern J, Lahuerta M, Nguyen JL, King J, Morley A, Clout M, Maskell N, Jodar L, Oliver J, Ellsbury G, McLaughlin JM, Gessner BD, Finn A, Danon L, Dodd JW. Impact of SARS-CoV-2 infective exacerbation of chronic obstructive pulmonary disease on clinical outcomes in a prospective cohort study of hospitalised adults. J R Soc Med 2023; 116:371-385. [PMID: 37404021 PMCID: PMC10686205 DOI: 10.1177/01410768231184162] [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: 01/05/2023] [Accepted: 06/04/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVES To determine whether acute exacerbations of chronic obstructive pulmonary disease (AECOPD) triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have worse outcomes than AECOPD caused by other infectious agents or non-infective AECOPD (NI-COPD). DESIGN A two-hospital prospective cohort study of adults hospitalised with acute respiratory disease. We compared outcomes with AECOPD and a positive test for SARS-CoV-2 (n = 816), AECOPD triggered by other infections (n = 3038) and NI-COPD (n = 994). We used multivariable modelling to adjust for potential confounders and assessed variation by seasons associated with different SARS-CoV-2 variants. SETTING Bristol UK, August 2020-May 2022. PARTICIPANTS Adults (≥18 y) hospitalised with AECOPD. MAIN OUTCOME MEASURES We determined the risk of positive pressure support, longer hospital admission and mortality following hospitalisation with AECOPD due to non-SARS-CoV-2 infection compared with SARS-CoV-2 AECOPD and NI-COPD. RESULTS Patients with SARS-CoV-2 AECOPD, in comparison to non-SARS-CoV-2 infective AECOPD or NI-COPD, more frequently required positive pressure support (18.5% and 7.5% vs. 11.7%, respectively), longer hospital stays (median [interquartile range, IQR]: 7 [3-15] and 5 [2-10] vs. 4 [2-9] days, respectively) and had higher 30-day mortality (16.9% and 11.1% vs. 5.9%, respectively) (all p < 0.001). In adjusted analyses, SARS-CoV-2 AECOPD was associated with a 55% (95% confidence interval [95% CI]: 24-93), 26% (95% CI: 15-37) and 35% (95% CI: 10-65) increase in the risk of positive pressure support, hospitalisation length and 30-day mortality, respectively, relative to non-SARS-CoV-2 infective AECOPD. The difference in risk remained similar during periods of wild-type, Alpha and Delta SARS-CoV-2 strain dominance, but diminished during Omicron dominance. CONCLUSIONS SARS-CoV-2-related AECOPD had worse patient outcomes compared with non-SARS-CoV-2 AECOPD or NI-AECOPD, although the difference in risks was less pronounced during Omicron dominance.
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Affiliation(s)
- Catherine Hyams
- Academic Respiratory Unit and Bristol Vaccine Centre, University of Bristol, Bristol, BS15, UK
| | - George Qian
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
| | - George Nava
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, Bristol, BS15, UK
| | - Robert Challen
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
| | - Elizabeth Begier
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jo Southern
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Maria Lahuerta
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jennifer L Nguyen
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, Bristol, BS2, UK
| | - Anna Morley
- Academic Respiratory Unit, Southmead Hospital, Bristol, Bristol, BS15, UK
| | - Madeleine Clout
- Bristol Vaccine Centre and Population Health Sciences, University of Bristol, Bristol, BS2, UK
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, Bristol, BS15, UK
| | - Luis Jodar
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Jennifer Oliver
- Bristol Vaccine Centre and Population Health Sciences, University of Bristol, Bristol, BS2, UK
| | | | - John M McLaughlin
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
| | - Adam Finn
- Bristol Vaccine Centre, Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, BS2, UK
| | - Leon Danon
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
| | - James W Dodd
- Academic Respiratory Unit and Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, BS15, UK
| | - The Avon CAP Research Group
- Academic Respiratory Unit and Bristol Vaccine Centre, University of Bristol, Bristol, BS15, UK
- Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, Bristol, BS15, UK
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, Bristol, BS2, UK
- Academic Respiratory Unit, Southmead Hospital, Bristol, Bristol, BS15, UK
- Bristol Vaccine Centre and Population Health Sciences, University of Bristol, Bristol, BS2, UK
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth, KT20, UK
- Bristol Vaccine Centre, Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, BS2, UK
- Academic Respiratory Unit and Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, BS15, UK
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16
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Onwuchekwa C, Moreo LM, Menon S, Machado B, Curcio D, Kalina W, Atwell JE, Gessner BD, Siapka M, Agarwal N, Rubbrecht M, Nair H, Rozenbaum M, Aponte-Torres Z, Vroling H, Begier E. Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis. J Infect Dis 2023; 228:173-184. [PMID: 36661222 PMCID: PMC10345483 DOI: 10.1093/infdis/jiad012] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 08/11/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Most observational population-based studies identify respiratory syncytial virus (RSV) by nasal/nasopharyngeal swab reverse transcriptase real-time PCR (RT-PCR) only. We conducted a systematic review and meta-analyses to quantify specimen and diagnostic testing-based underascertainment of adult RSV infection. METHODS EMBASE, PubMed, and Web of Science were searched (January 2000-December 2021) for studies including adults using/comparing >1 RSV testing approach. We quantified test performance and RSV detection increase associated with using multiple specimen types. RESULTS Among 8066 references identified, 154 met inclusion. Compared to RT-PCR, other methods were less sensitive: rapid antigen detection test (RADT; pooled sensitivity, 64%), direct fluorescent antibody (DFA; 83%), and viral culture (86%). Compared to singleplex PCR, multiplex PCR's sensitivity was lower (93%). Compared to nasal/nasopharyngeal swab RT-PCR alone, adding another specimen type increased detection: sputum RT-PCR, 52%; 4-fold rise in paired serology, 44%; and oropharyngeal swab RT-PCR, 28%. Sensitivity was lower in estimates limited to only adults (for RADT, DFA, and viral culture), and detection rate increases were largely comparable. CONCLUSIONS RT-PCR, particularly singleplex testing, is the most sensitive RSV diagnostic test in adults. Adding additional specimen types to nasopharyngeal swab RT-PCR testing increased RSV detection. Synergistic effects of using ≥3 specimen types should be assessed, as this approach may improve the accuracy of adult RSV burden estimates.
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Affiliation(s)
| | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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17
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Rozenbaum MH, Begier E, Kurosky SK, Whelan J, Bem D, Pouwels KB, Postma M, Bont L. Incidence of Respiratory Syncytial Virus Infection in Older Adults: Limitations of Current Data. Infect Dis Ther 2023:10.1007/s40121-023-00802-4. [PMID: 37310617 DOI: 10.1007/s40121-023-00802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/30/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is an important cause of severe respiratory illness in older adults and adults with respiratory or cardiovascular comorbidities. Published estimates of its incidence and prevalence in adult groups vary widely. This article reviews the potential limitations affecting RSV epidemiology studies and suggests points to consider when evaluating or designing them. METHODS Studies reporting the incidence or prevalence of RSV infection in adults in high-income Western countries from 2000 onwards were identified via a rapid literature review. Author-reported limitations were recorded, together with presence of other potential limitations. Data were synthesized narratively, with a focus on factors affecting incidence estimates for symptomatic infection in older adults. RESULTS A total of 71 studies met the inclusion criteria, most in populations with medically attended acute respiratory illness (ARI). Only a minority used case definitions and sampling periods tailored specifically to RSV; many used influenza-based or other criteria that are likely to result in RSV cases being missed. The great majority relied solely on polymerase chain reaction (PCR) testing of upper respiratory tract samples, which is likely to miss RSV cases compared with dual site sampling and/or addition of serology. Other common limitations were studying a single season, which has potential for bias due to seasonal variability; failure to stratify results by age, which underestimates the burden of severe disease in older adults; limited generalizability beyond a limited study setting; and absence of measures of uncertainty in the reporting of results. CONCLUSIONS A significant proportion of studies are likely to underestimate the incidence of RSV infection in older adults, although the effect size is unclear and there is also potential for overestimation. Well-designed studies, together with increased testing for RSV in patients with ARI in clinical practice, are required to accurately capture both the burden of RSV and the potential public health impact of vaccines.
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Affiliation(s)
| | | | | | | | | | | | | | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Ramirez J, Carrico R, Wilde A, Junkins A, Furmanek S, Chandler T, Schulz P, Hubler R, Peyrani P, Liu Q, Trivedi S, Uppal S, Kalina WV, Falsey AR, Walsh EE, Yacisin K, Jodar L, Gessner BD, Begier E. Diagnosis of Respiratory Syncytial Virus in Adults Substantially Increases When Adding Sputum, Saliva, and Serology Testing to Nasopharyngeal Swab RT-PCR. Infect Dis Ther 2023:10.1007/s40121-023-00805-1. [PMID: 37148463 PMCID: PMC10163290 DOI: 10.1007/s40121-023-00805-1] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/06/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Nearly all existing respiratory syncytial virus (RSV) incidence estimates are based on real-time polymerase chain reaction (RT-PCR) testing of nasal or nasopharyngeal (NP) swabs. Adding testing of additional specimen types to NP swab RT-PCR increases RSV detection. However, prior studies only made pairwise comparisons and the synergistic effect of adding multiple specimen types has not been quantified. We compared RSV diagnosis by NP swab RT-PCR alone versus NP swab plus saliva, sputum, and serology. METHODS This was a prospective cohort study over two study periods (27 December 2021 to 1 April 2022 and 22 August 2022 to 11 November 2022) of patients aged ≥ 40 years hospitalized for acute respiratory illness (ARI) in Louisville, KY. NP swab, saliva, and sputum specimens were collected at enrollment and PCR tested (Luminex ARIES platform). Serology specimens were obtained at acute and convalescent timepoints (enrollment and 30-60-day visit). RSV detection rate was calculated for NP swab alone and for NP swab plus all other specimen type/test. RESULTS Among 1766 patients enrolled, 100% had NP swab, 99% saliva, 34% sputum, and 21% paired serology specimens. RSV was diagnosed in 56 (3.2%) patients by NP swab alone, and in 109 (6.2%) patients by NP swab plus additional specimens, corresponding to a 1.95 times higher rate [95% confidence interval (CI) 1.62, 2.34]. Limiting the comparison to the 150 subjects with all four specimen types available (i.e., NP swab, saliva, sputum, and serology), there was a 2.60-fold increase (95% CI 1.31, 5.17) compared to NP swab alone (3.3% versus 8.7%). Sensitivities by specimen type were: NP swab 51%, saliva 70%, sputum 72%, and serology 79%. CONCLUSIONS Diagnosis of RSV in adults was several-fold greater when additional specimen types were added to NP swab, even with a relatively low percentage of subjects with sputum and serology results available. Hospitalized RSV ARI burden estimates in adults based solely on NP swab RT-PCR should be adjusted for underestimation.
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Affiliation(s)
- Julio Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA.
| | - Ruth Carrico
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Ashley Wilde
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Alan Junkins
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Stephen Furmanek
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Thomas Chandler
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Paul Schulz
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | | | | | - Qing Liu
- Pfizer Inc, Collegeville, PA, USA
| | | | | | | | - Ann R Falsey
- Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Edward E Walsh
- Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, 14642, USA
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Hassanzadeh H, Baber J, Begier E, Noriega DC, Konishi H, Yato Y, Wang MY, Le Huec JC, Patel V, Varga P, Liljenqvist U, Conly J, Sabharwal C, Munjal I, Cooper D, Radley D, Jaques A, Patton M, Gruber WC, Jansen KU, Anderson AS, Gurtman A. Efficacy of a 4-Antigen Staphylococcus aureus Vaccine in Spinal Surgery: The STRIVE Randomized Clinical Trial. Clin Infect Dis 2023:7147455. [PMID: 37125490 PMCID: PMC10371312 DOI: 10.1093/cid/ciad218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/02/2022] [Revised: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is a global pathogen frequently responsible for healthcare-associated infections, including surgical site infections (SSIs). Current infection prevention and control approaches may be limited, with S aureus antibiotic resistance remaining problematic. Thus, a vaccine to prevent or reduce S aureus infection is critically needed. This study evaluated efficacy and safety of an investigational 4-antigen S aureus vaccine (SA4Ag) in adults undergoing elective open posterior spinal fusion procedures with multilevel instrumentation. METHODS In this multicenter, site-level, randomized, double-blind trial, subjects 18-85 years old received a single dose of SA4Ag or placebo 10-60 days before surgery. SA4Ag efficacy in preventing postoperative S aureus bloodstream infection and/or deep incisional or organ/space SSI was the primary endpoint. Safety evaluations included local reactions, systemic events, and adverse events (AEs). Immunogenicity and colonization were assessed. RESULTS Study enrollment was halted when a prespecified interim efficacy analysis met predefined futility criteria. SA4Ag showed no efficacy (0.0%) in preventing postoperative S aureus infection (14 cases in each group through postoperative Day 90), despite inducing robust functional immune responses to each antigen compared with placebo. Colonization rates across groups were similar through postoperative Day 180. Local reactions and systemic events were mostly mild or moderate in severity, with AEs reported at similar frequencies across groups. CONCLUSIONS In patients undergoing elective spinal fusion surgical procedures, SA4Ag was safe, well tolerated, but despite eliciting substantial antibody responses that blocked key S aureus virulence mechanisms, was not efficacious in preventing S aureus infection. ClinicalTrials.gov: NCT02388165.
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Affiliation(s)
| | - James Baber
- Pfizer Vaccine Clinical Research, L15, 151 Clarence St, Sydney, NSW 2000, Australia
| | - Elizabeth Begier
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - David C Noriega
- Hospital Universitario de Valladolid, Valladolid, 47005, Spain
| | - Hiroaki Konishi
- Nagasaki Rosai Hospital, 2-12-5, Setogoe, Sasebo, Nagasaki, 857-0134, Japan
| | - Yoshiyuki Yato
- National Hospital Organization Murayama Medical Center, 2-37-1, Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | | | - Jean Charles Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux University, Bordeaux, 33076, France
| | - Vikas Patel
- 12631 E. 17th Ave, Mail Stop B202, Academic Office 1, Room 4615, Denver, CO 80045, USA
| | - Peter Varga
- National Center for Spinal Disorders, Buda Health Center, Kiralyhago u. 1-3., Budapest, 1126, Hungary
| | - Ulf Liljenqvist
- St. Franziskus-Hospital Munster Orthopaedie II, Hohenzollernring 72, 48155 Muenster, Germany
| | - John Conly
- Foothills Medical Centre, Alberta Health Services and University of Calgary, 1403 29th St NW, Calgary, AB T2N 2T9, Canada
| | - Charu Sabharwal
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Iona Munjal
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - David Cooper
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - David Radley
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Anna Jaques
- Pfizer Vaccine Clinical Research, L15, 151 Clarence St, Sydney, NSW 2000, Australia
| | - Michael Patton
- Pfizer Vaccine Clinical Research, Hurley SL6 6RJ, United Kingdom
| | - William C Gruber
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | | | - Alejandra Gurtman
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
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20
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Skufca J, De Smedt N, Pilz A, Vyse A, Begier E, Blum M, Riera M, Gessner BD, Stark JH. Incidence of Lyme Borreliosis in Finland: Exploring Observed Trends Over Time Using Public Surveillance Data, 2015-2020. Vector Borne Zoonotic Dis 2023; 23:256-264. [PMID: 37071400 PMCID: PMC10122252 DOI: 10.1089/vbz.2022.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Background: Lyme borreliosis (LB) is a tick-borne zoonotic disease endemic in many European countries, including Finland. We describe the incidence, time trends, and geographical distribution of LB in Finland for the period 2015-2020. The data generated can help inform public health policy, including prevention strategies. Methods: We retrieved online-available LB cases and incidence from two Finnish national databases. Microbiologically confirmed LB cases were identified from the National Infectious Disease Register and clinically diagnosed LB cases from the National Register of Primary Health Care Visits (Avohilmo), with the total LB cases equal to the sum from these two sources. Results: A total of 33,185 LB cases were reported for the 2015-2020 period, of which 12,590 (38%) were microbiologically confirmed and 20,595 (62%) were clinically diagnosed. The average annual national incidences for total, microbiologically confirmed, and clinically diagnosed LB were, respectively, 99.6, 38.1, and 61.4 per 100,000 population. The total LB incidence was highest in the south to southwestern coastal areas by the Baltic Sea and in eastern areas, with average annual incidences of 109.0 to 207.3/100,000. The Åland Islands were a hyperendemic region with an average annual incidence of 2473.9/100,000. The highest incidence was among persons aged >60 years, peaking at age 70-74 years. Most cases were reported between May and October, with a peak in July and August. Conclusions: The incidence of LB varied substantially by hospital district, and many regions reached incidences comparable with other high incidence countries, suggesting preventive measures such as vaccines may be an efficient use of resources.
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Affiliation(s)
- Jozica Skufca
- Epidemiology and Pharmacovigilance, P95, Koning Leopold III Iaan 1, Leuven, Belgium
| | - Nick De Smedt
- Epidemiology and Pharmacovigilance, P95, Koning Leopold III Iaan 1, Leuven, Belgium
| | - Andreas Pilz
- Vaccines, Pfizer Corporation Austria, Wien, Vienna, Austria
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd, Walton Oaks, Tadworth, United Kingdom
| | - Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Maxim Blum
- Epidemiology and Pharmacovigilance, P95, Koning Leopold III Iaan 1, Leuven, Belgium
| | - Margarita Riera
- Epidemiology and Pharmacovigilance, P95, Koning Leopold III Iaan 1, Leuven, Belgium
| | - Bradford D Gessner
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - James H Stark
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
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21
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Skufca J, Tran TMP, Brestrich G, Pilz A, Vyse A, Malerczyk C, Dzingina M, Begier E, Blum M, Riera-Montes M, Gessner BD, Stark JH. Incidence of Lyme Borreliosis in Germany: Exploring Observed Trends Over Time Using Public Surveillance Data, 2016-2020. Vector Borne Zoonotic Dis 2023; 23:237-246. [PMID: 37071399 PMCID: PMC10122258 DOI: 10.1089/vbz.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Background: Public surveillance of Lyme borreliosis (LB) occurs in 9 out of 16 federal states of Germany and remains a critical facet of disease epidemiology and trends. We describe the incidence, time trends, seasonality, and geographic distribution of LB in Germany using publicly reported surveillance data. Methods: We obtained LB cases and incidence (2016-2020) from the online platform SurvStat@RKI 2.0, maintained by the Robert Koch Institute (RKI). Data included clinically diagnosed and laboratory-confirmed LB reported by nine out of 16 federal states of Germany where LB notification is mandatory. Results: During 2016-2020, the nine federal states reported 63,940 LB cases, of which 60,570 (94.7%) were clinically diagnosed, and 3370 (5.3%) also had laboratory confirmation, with an average of 12,789 cases annually. Incidence rates were mostly stable over time. The average annual LB incidence was 37.2/100,000 person-years and varied by spatial level, ranging from 22.9 to 64.6/100,000 person-years among nine states; from 16.8 to 85.6/100,000 person-years among 19 regions; and from 2.9 to 172.8/100,000 person-years among 158 counties. Incidence was lowest among persons 20-24 years old (16.1/100,000 person-years) and highest among those 65-69 years old (60.9/100,000 person-years). Most cases were reported between June and September, with a peak in July of every year. Conclusion: The risk of LB varied substantially at the smallest geographic unit and by age group. Our results underscore the importance of presenting LB data at the most spatially granular unit and by age to allow implementation of efficient preventive interventions and reduction strategies.
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Affiliation(s)
- Jozica Skufca
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | | | | | - Andreas Pilz
- Pfizer Global Medical Affairs, Vaccines, Vienna, Austria
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd., Walton Oaks, United Kingdom
| | | | - Mendwas Dzingina
- Patient Health and Impact, Chief Business Office, Pfizer Inc, New York, New York, USA
| | - Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, New York, New York, USA
| | - Maxim Blum
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | | | - Bradford D Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - James H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
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22
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Paradowska-Stankiewicz I, Zbrzeźniak J, Skufca J, Nagarajan A, Ochocka P, Pilz A, Vyse A, Begier E, Dzingina M, Blum M, Riera-Montes M, Gessner BD, Stark JH. A Retrospective Database Study of Lyme Borreliosis Incidence in Poland from 2015 to 2019: A Public Health Concern. Vector Borne Zoonotic Dis 2023; 23:247-255. [PMID: 37071404 PMCID: PMC10122228 DOI: 10.1089/vbz.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Background: In Poland, Lyme borreliosis (LB) has been subject to mandatory public health surveillance since 1996 and, in accordance with EU regulations, Lyme neuroborreliosis has been reported to the European Centre for Disease Prevention and Control since 2019. In this study, the incidence, temporal trends, and geographic distribution of LB and its manifestations in Poland are described for the period 2015-2019. Methods: This retrospective incidence study of LB and its manifestations in Poland was based on data sent to the National Institute of Public Health-National Institute of Hygiene-National Research Institute (NIPH-NIH-NRI) by district sanitary epidemiological stations using the electronic Epidemiological Records Registration System and data from the National Database on Hospitalization. Incidence rates were calculated using population data from the Central Statistical Office. Results: During 2015-2019, Poland reported 94,715 cases of LB with an overall average incidence of 49.3 cases per 100,000 population. Cases increased from 2015 (11,945) to 2016 (20,857) and then remained stable through 2019. Hospitalization due to LB also rose during these years. LB was more common among women (55.7%). Erythema migrans and Lyme arthritis were the most common manifestations of LB. The highest incidence rates occurred among >50-year-olds, with a peak in 65-69-year-olds. The highest number of cases was recorded in the third and fourth quarters of the year (July-December). Incidence rates in the eastern and northeastern regions of the country were higher than the national average. Conclusions: LB is endemic in all regions of Poland, and many regions reported high incidence rates. Large variations in spatially granular incidence rates highlight the need for targeted prevention strategies.
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Affiliation(s)
- Iwona Paradowska-Stankiewicz
- National Institute of Public Health-National Institute of Hygiene-National Research Institute, Department of Infectious Disease Epidemiology and Surveillance, Warsaw, Poland
| | - Jakub Zbrzeźniak
- National Institute of Public Health-National Institute of Hygiene-National Research Institute, Department of Infectious Disease Epidemiology and Surveillance, Warsaw, Poland
| | - Jozica Skufca
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | - Paulina Ochocka
- National Institute of Public Health-National Institute of Hygiene-National Research Institute, Department of Infectious Disease Epidemiology and Surveillance, Warsaw, Poland
| | - Andreas Pilz
- Pfizer Global Medical Affairs, Vaccines, Vienna, Austria
| | - Andrew Vyse
- Patient and Health Impact, Pfizer R&D UK LTD, Walton Oaks, United Kingdom
| | - Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Mendwas Dzingina
- Patient and Health Impact, Pfizer R&D UK LTD, Walton Oaks, United Kingdom
| | - Maxim Blum
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | - Bradford D Gessner
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - James H Stark
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
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23
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Nagarajan A, Skufca J, Vyse A, Pilz A, Begier E, Riera-Montes M, Gessner BD, Stark JH. The Landscape of Lyme Borreliosis Surveillance in Europe. Vector Borne Zoonotic Dis 2023; 23:142-155. [PMID: 37071402 PMCID: PMC10122255 DOI: 10.1089/vbz.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Purpose: Lyme borreliosis (LB) is the most prevalent tick-borne disease in Europe and the incidence of LB is increasing owing to an expansion in tick habitats. However, LB surveillance is quite heterogeneous across the continent, and for those countries with publicly available data, it is difficult to understand the differences in incidence between countries. The objective of our study was to summarize the publicly available data from surveillance for LB in the form of surveillance reports and/or dashboards and to compare the information available for various countries. Methods: We identified publicly available LB data (online dashboards and surveillance reports) in the European Union, European Economic Area, the United Kingdom, Russia, and Switzerland. Results: Of the 36 countries studied, 28 had LB surveillance in place; 23 had surveillance reports, and 10 had dashboards. The dashboards, in general, had more granular data compared with the surveillance reports, but the reports covered longer time periods. LB annual cases, incidence, age, and sex-stratified LB data; manifestations; and regional data were available for most of the countries. LB case definitions varied significantly among the countries. Conclusion: The study highlights large differences in LB surveillance systems, including representativeness, case definitions, type of data available that might inhibit comparison of data between countries and accurate determination of burden of disease, and risk groups within countries. Standardization of case definitions across countries would be a useful first step enabling comparisons between countries and contribute to recognizing the true burden of LB in Europe.
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Affiliation(s)
| | - Jozica Skufca
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer UK Ltd, Tadworth, United Kingdom
| | - Andreas Pilz
- Pfizer Global Medical Affairs, Vaccines, Vienna, Austria
| | - Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, New York, USA
| | | | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - James H Stark
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
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24
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Houben E, de Jong H, Penning-van Beest F, Kuiper J, Holthuis E, Blum M, Skufca J, Riera-Montes M, Gessner BD, Pilz A, Vyse AJ, Begier E, Dzingina M, Herings R, Stark JH. Incidence of Lyme Borreliosis in the Dutch General Practice Population: A Large-Scale Population-Based Cohort Study Across the Netherlands Between 2015 and 2019. Vector Borne Zoonotic Dis 2023; 23:230-236. [PMID: 37071403 PMCID: PMC10122225 DOI: 10.1089/vbz.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Background: There is a need for updated incidence rates (IRs) of Lyme borreliosis (LB) in Europe, including the Netherlands. We estimated LB IRs stratified by geographic area, year, age, sex, immunocompromised status, and socioeconomic status (SES). Methods: All subjects registered in the PHARMO General Practitioner (GP) Database without prior diagnosis of LB or disseminated LB and having ≥1 year of continuous database enrolment were included. IRs and corresponding confidence intervals (CIs) of GP-recorded LB, erythema migrans (EM), and disseminated LB were estimated during the period 2015‒2019. Results: We identified 14,794 events (suspected, probable, or confirmed) with a diagnostic code for LB that included 8219 with a recorded clinical manifestation: 7985 (97%) with EM and 234 (3%) with disseminated LB. National annual LB IRs were relatively consistent, ranging from 111 (95% CI 106‒115) in 2019 to 131 (95% CI 126‒136) in 2018 per 100,000 person-years. Incidence of LB showed a bimodal age distribution, with peak IRs observed among subjects aged 5‒14 and 60‒69 years in men and women. Higher LB incidence was found in subjects who were residents of the provinces of Drenthe and Overijssel, immunocompromised, or of lower SES. Similar patterns were observed for EM and disseminated LB. Conclusions: Our findings confirm that LB incidence remains substantial throughout the Netherlands with no indication of decline in the past 5 years. Foci in two provinces and among vulnerable populations suggest potential initial target groups for preventive strategies such as vaccination.
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Affiliation(s)
- Eline Houben
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Hilda de Jong
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | - Josephina Kuiper
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Emily Holthuis
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Maxim Blum
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium
| | - Jozica Skufca
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium
| | | | - Bradford D Gessner
- Pfizer, Inc., Vaccines Medical Development and Scientific and Clinical Affairs, Collegeville, Pennsylvania, USA
| | - Andreas Pilz
- Pfizer Corporation, Vaccines Medical Development and Scientific and Clinical Affairs, Wien, Austria
| | | | - Elizabeth Begier
- Pfizer, Inc., Vaccines Medical Development and Scientific and Clinical Affairs, Collegeville, Pennsylvania, USA
| | - Mendwas Dzingina
- Pfizer, Inc., Patient Health & Impact, Chief Business Office, Pfizer, New York, New York, USA
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - James H Stark
- Pfizer, Inc., Vaccines Medical Development and Scientific and Clinical Affairs, Collegeville, Pennsylvania, USA
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25
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Li Y, Kulkarni D, Begier E, Wahi-Singh P, Wahi-Singh B, Gessner B, Nair H. Adjusting for Case Under-Ascertainment in Estimating RSV Hospitalisation Burden of Older Adults in High-Income Countries: a Systematic Review and Modelling Study. Infect Dis Ther 2023; 12:1137-1149. [PMID: 36941483 PMCID: PMC10027261 DOI: 10.1007/s40121-023-00792-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Previous studies suggest diagnostic testing characteristics (i.e. variations in clinical specimens and diagnostic tests) can contribute to underestimation of RSV disease burden. We aimed to improve the understanding of RSV hospitalisation burden in older adults (aged ≥ 65 years) in high-income countries through adjusting for case under-ascertainment. METHODS We conducted a systematic review to include data on RSV-associated acute respiratory infection (ARI) hospitalisation burden in older adults in high-income countries. To adjust for case under-ascertainment, we developed a two-step framework that incorporated empirical data on the RSV detection proportion of different clinical specimens and testing approaches as well as their statistical uncertainty. We estimated the unadjusted and adjusted RSV-associated hospitalisation burden through multilevel random-effects meta-analysis. We further explored RSV-associated in-hospital mortality burden. RESULTS We included 12 studies with eligible RSV hospitalisation burden data. We estimated that pooled unadjusted hospitalisation rate was 157 per 100,000 (95% CI 98-252) for adults aged ≥ 65 years; the rate was adjusted to 347 per 100,000 (203-595) after accounting for under-ascertainment. The adjusted rate could be translated into 787,000 (460,000-1,347,000) RSV-associated hospitalisations in high-income countries in 2019, which was about 2.2 times the unadjusted estimate. Stratified analysis by age group showed that the adjusted rate increased with age, from 231 per 100,000 in adults aged 65-74 years to 692 per 100,000 in adults aged > 85 years. The in-hospital case fatality ratio of RSV was 6.1% (3.3-11.0) and the total RSV-associated in-hospital deaths in high-income countries in 2019 could be between 22,000 and 47,000. CONCLUSION This study improves the understanding of RSV-associated hospitalisation burden in older adults and shows that the true RSV-associated hospitalisation burden could be 2.2 times what was reported in existing studies. This study has implications for calculating the benefit of interventions to treat and prevent RSV-associated disease.
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Affiliation(s)
- You Li
- School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, China.
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Durga Kulkarni
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Begier
- Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Dublin, Ireland
| | - Pia Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bhanu Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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26
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Hyams C, Challen R, Marlow R, Nguyen J, Begier E, Southern J, King J, Morley A, Kinney J, Clout M, Oliver J, Gray S, Ellsbury G, Maskell N, Jodar L, Gessner B, McLaughlin J, Danon L, Finn A. Severity of Omicron (B.1.1.529) and Delta (B.1.617.2) SARS-CoV-2 infection among hospitalised adults: A prospective cohort study in Bristol, United Kingdom. Lancet Reg Health Eur 2023; 25:100556. [PMID: 36530491 PMCID: PMC9742675 DOI: 10.1016/j.lanepe.2022.100556] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
Background There is an urgent public health need to evaluate disease severity in adults hospitalised with Delta and Omicron SARS-CoV-2 variant infections. However, limited data exist assessing severity of disease in adults hospitalised with Omicron SARS-CoV-2 infections, and to what extent patient-factors, including vaccination, age, frailty and pre-existing disease, affect variant-dependent disease severity. Methods A prospective cohort study of adults (≥18 years of age) hospitalised with acute lower respiratory tract disease at acute care hospitals in Bristol, UK conducted over 10-months. Delta or Omicron SARS-CoV-2 infection was defined by positive SARS-CoV-2 PCR and variant identification or inferred by dominant circulating variant. We constructed adjusted regression analyses to assess disease severity using three different measures: FiO2 >28% (fraction inspired oxygen), World Health Organization (WHO) outcome score >5 (assessing need for ventilatory support), and hospital length of stay (LOS) >3 days following admission for Omicron or Delta infection. Findings Independent of other variables, including vaccination, Omicron variant infection in hospitalised adults was associated with lower severity than Delta. Risk reductions were 58%, 67%, and 16% for supplementary oxygen with >28% FiO2 [Relative Risk (RR) = 0.42 (95%CI: 0.34-0.52), P < 0.001], WHO outcome score >5 [RR = 0.33 (95%CI: 0.21-0.50), P < 0.001], and to have had a LOS > 3 days [RR = 0.84 (95%CI: 0.76-0.92), P < 0.001]. Younger age and vaccination with two or three doses were also independently associated with lower COVID-19 severity. Interpretation We provide reassuring evidence that Omicron infection results in less serious adverse outcomes than Delta in hospitalised patients. Despite lower severity relative to Delta, Omicron infection still resulted in substantial patient and public health burden and an increased admission rate of older patients with Omicron which counteracts some of the benefit arising from less severe disease. Funding AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.
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Affiliation(s)
- Catherine Hyams
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Robert Challen
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
- Engineering Mathematics, University of Bristol, Bristol, UK
| | - Robin Marlow
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jennifer Nguyen
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Elizabeth Begier
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Jo Southern
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Jade King
- Vaccine and Testing Team, Clinical Research Facility, UHBW NHS Trust, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Jane Kinney
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Madeleine Clout
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jennifer Oliver
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sharon Gray
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Gillian Ellsbury
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Luis Jodar
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Bradford Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - John McLaughlin
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Leon Danon
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
- Engineering Mathematics, University of Bristol, Bristol, UK
| | - Adam Finn
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
- Corresponding author. Bristol Vaccine Centre, University of Bristol, Level 6, UHB Education and Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
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Walker NF, Byrne RL, Howard A, Nikolaou E, Farrar M, Glynn S, Cheliotis KS, Cubas Atienzar AI, Davies K, Reiné J, Rashid-Gardner Z, German EL, Solórzano C, Blandamer T, Hitchins L, Myerscough C, Gessner BD, Begier E, Collins AM, Beadsworth M, Todd S, Hill H, Houlihan CF, Nastouli E, Adams ER, Mitsi E, Ferreira DM. Detection of SARS-CoV-2 infection by saliva and nasopharyngeal sampling in frontline healthcare workers: An observational cohort study. PLoS One 2023; 18:e0280908. [PMID: 36706119 PMCID: PMC9882898 DOI: 10.1371/journal.pone.0280908] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has caused an unprecedented strain on healthcare systems worldwide, including the United Kingdom National Health Service (NHS). We conducted an observational cohort study of SARS-CoV-2 infection in frontline healthcare workers (HCW) working in an acute NHS Trust during the first wave of the pandemic, to answer emerging questions surrounding SARS-CoV-2 infection, diagnosis, transmission and control. METHODS Using self-collected weekly saliva and twice weekly combined oropharyngeal/nasopharyngeal (OP/NP) samples, in addition to self-assessed symptom profiles and isolation behaviours, we retrospectively compared SARS-CoV-2 detection by RT-qPCR of saliva and OP/NP samples. We report the association with contemporaneous symptoms and isolation behaviour. RESULTS Over a 12-week period from 30th March 2020, 40·0% (n = 34/85, 95% confidence interval 31·3-51·8%) HCW had evidence of SARS-CoV-2 infection by surveillance OP/NP swab and/or saliva sample. Symptoms were reported by 47·1% (n = 40) and self-isolation by 25·9% (n = 22) participants. Only 44.1% (n = 15/34) participants with SARS-CoV-2 infection reported any symptoms within 14 days of a positive result and only 29·4% (n = 10/34) reported self-isolation periods. Overall agreement between paired saliva and OP/NP swabs was 93·4% (n = 211/226 pairs) but rates of positive concordance were low. In paired samples with at least one positive result, 35·0% (n = 7/20) were positive exclusively by OP/NP swab, 40·0% (n = 8/20) exclusively by saliva and in only 25·0% (n = 5/20) were the OP/NP and saliva result both positive. CONCLUSIONS HCW are a potential source of SARS-CoV-2 transmission in hospitals and symptom screening will identify the minority of infections. Without routine asymptomatic SARS-CoV-2 screening, it is likely that HCW with SARS-CoV-2 infection would continue to attend work. Saliva, in addition to OP/NP swab testing, facilitated ascertainment of symptomatic and asymptomatic SARS-CoV-2 infections. Combined saliva and OP/NP swab sampling would improve detection of SARS-CoV-2 for surveillance and is recommended for a high sensitivity strategy.
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Affiliation(s)
- Naomi F. Walker
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Rachel L. Byrne
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Madlen Farrar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sharon Glynn
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Ana I. Cubas Atienzar
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kelly Davies
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Zalina Rashid-Gardner
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Esther L. German
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Tess Blandamer
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lisa Hitchins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Elizabeth Begier
- Pfizer Vaccines, Collegeville, Pennsylvania, United States of America
| | - Andrea M. Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- National Institute for Health Research North West Coast, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Mike Beadsworth
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stacy Todd
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Liverpool Health Partners, Liverpool, United Kingdom
| | - Helen Hill
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Catherine F. Houlihan
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
- Department of Infection, Immunity and inflammation, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Eleni Nastouli
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
| | - Emily R. Adams
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Daniela M. Ferreira
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
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Orsi A, Domnich A, Mosca S, Ogliastro M, Sticchi L, Prato R, Fortunato F, Martinelli D, Tramuto F, Costantino C, Restivo V, Baldo V, Baldovin T, Begier E, Theilacker C, Montuori EA, Beavon R, Gessner B, Icardi G. Prevalence of Pneumococcal Serotypes in Community-Acquired Pneumonia among Older Adults in Italy: A Multicenter Cohort Study. Microorganisms 2022; 11:microorganisms11010070. [PMID: 36677362 PMCID: PMC9864441 DOI: 10.3390/microorganisms11010070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/01/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
Pneumococcal community-acquired pneumonia (CAP) is a leading cause of mortality. Following the introduction of pneumococcal conjugate vaccines (PCVs) in children, a decrease in the burden of the disease was reported. In parallel, an increase in non-vaccine serotypes was also noted. The objective of this study was to assess the current serotype-specific epidemiology of pneumococci among Italian older adults hospitalized for CAP. A prospective study was conducted between 2017 and 2020 in four Italian regions. Subjects aged ≥65 years hospitalized with confirmed CAP were tested for pneumococci using both pneumococcal urinary antigen and serotype-specific urine antigen tests able to identify all 24 serotypes included in the available vaccines. Of the 1155 CAP cases, 13.1% were positive for pneumococci. The most prevalent serotypes were 3 (2.0%), 8 (1.7%), 22F (0.8 %) and 11A (0.7%). These serotypes are all included in the newly licensed PCV20. The serotypes included in PCV13, PCV15 and PCV20 contributed to 3.3%, 4.4% and 7.5% of the CAP cases, respectively. In the context of a low PCV13 coverage among older adults and a high PCV coverage in children, a substantial proportion of CAP is caused by PCV13 serotypes. Higher valency PCV15 and PCV20 may provide additional benefits for the prevention of CAP in vaccinated older adults.
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Affiliation(s)
- Andrea Orsi
- Dipartimento di Scienze della Salute (DiSSal), University of Genoa, 16132 Genoa, Italy
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Alexander Domnich
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS Genoa, 16132 Genoa, Italy
| | - Stefano Mosca
- Dipartimento di Scienze della Salute (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Matilde Ogliastro
- Dipartimento di Scienze della Salute (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Laura Sticchi
- Dipartimento di Scienze della Salute (DiSSal), University of Genoa, 16132 Genoa, Italy
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS Genoa, 16132 Genoa, Italy
| | - Rosa Prato
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Francesca Fortunato
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Domenico Martinelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Fabio Tramuto
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica d’Eccellenza (PROSAMI) “G. D’Alessandro”—Sezione di Igiene—University of Palermo, 90127 Palermo, Italy
| | - Claudio Costantino
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica d’Eccellenza (PROSAMI) “G. D’Alessandro”—Sezione di Igiene—University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Restivo
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica d’Eccellenza (PROSAMI) “G. D’Alessandro”—Sezione di Igiene—University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Baldo
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University of Padua, 35100 Padua, Italy
| | - Tatjana Baldovin
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University of Padua, 35100 Padua, Italy
| | | | | | | | - Rohini Beavon
- Global Vaccines, Pfizer Inc., Collegeville, PA 19426, USA
| | | | - Giancarlo Icardi
- Dipartimento di Scienze della Salute (DiSSal), University of Genoa, 16132 Genoa, Italy
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS Genoa, 16132 Genoa, Italy
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Ramirez JA, Carrico R, Wilde AM, Junkins A, Furmanek S, Chandler TR, Schulz PS, Hubler R, Peyrani P, Peyrani P, Trivedi S, Uppal S, Liu Q, Gessner BJ, Begier E. 371. Adding sputum and saliva to nasopharyngeal swab samples for PCR detection of Respiratory Syncytial Virus in adults hospitalized with acute respiratory illness may double case detection. Open Forum Infect Dis 2022. [PMCID: PMC9751621 DOI: 10.1093/ofid/ofac492.449] [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
Background In hospitalized patients, nasopharyngeal (NP) swabs are the most common samples obtained for Respiratory Syncytial Virus (RSV) PCR testing. However, adding sputum is known to increase diagnostic yield, and saliva has been successfully used for viral respiratory infection diagnosis. We sought to compare RSV prevalence detected by PCR testing of NP swab alone versus NP swab plus saliva and sputum in adult patients hospitalized with acute respiratory illness (ARI). Methods This ongoing, prospective cohort study enrolled patients aged ≥40 years hospitalized for ARI in 4 hospitals in Louisville, Kentucky (Season 1: 27 Dec 21 – 1 Apr 22). NP swab, saliva, and sputum samples were obtained at enrollment or scavenged from standard-of-care specimens (all collected ≤3 days of admission), and PCR tested with Luminex ARIES FluA/B/RSV platform. We produced Venn diagrams of RSV positive samples by sample type for all patients and restricted to those with all 3 sample types. RSV prevalence for NP swab alone was calculated as number of patients with RSV-positive NP swabs divided by total number of patients tested. RSV prevalence by NP swab plus saliva and sputum was calculated as number of patients with RSV-positive NP swab, saliva, or sputum samples divided by total number of patients tested. Results We enrolled 653 patients and collected NP swabs (100% of patients), saliva (96%), and sputum (43% overall and 93% of the 303 sputum-producing patients). Among all patients, 28 patients tested RSV positive (Figure 1A), and when restricted to those with all 3 samples (Figure 1B), 14 tested positive. The overall cohort’s RSV prevalence by NP swab alone was 1.8% (12/653) and by NP swab plus saliva and/or sputum was 4.3% (28/653): 2.33 times higher with addition of saliva and sputum samples. Among patients with all 3 specimen types, the RSV prevalence increase was the same, and none were positive by NP swab only.
Venn diagrams of positive RSV PCR tests ![]() (Left) A. Positive RSV PCR tests for 653 patients in overall cohort (Right) B. Positive RSV PCR tests for 275 patients with all 3 samples obtained. Conclusion RSV was most commonly detected in saliva samples. Current standard-of-care utilizing NP swab for RSV PCR testing appears to underestimate true RSV prevalence in hospitalized adult patients with ARI by more than 2-fold. Disclosures Alan Junkins, PhD, D(ABMM), Biomerieux: Advisor/Consultant Paul S. Schulz, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria Robin Hubler, MS, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds|Pfizer, Inc: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds|Pfizer, Inc: Stocks/Bonds Qing Liu, M.S., Pfizer Inc.: I am a full time employee of Pfizer and hold Pfizer stocks Bradford J. Gessner, M.D., M.P.H., Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Qing Liu
- Pfizer Inc., Collegeville, Pennsylvania
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30
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Paradowska-Stankiewicz II, Zbrzeźniak J, Skufca J, Nagarajan A, Ochocka P, Pilz A, Vyse A, Begier E, Dzingina M, Blum M, Riera M, Gessner B, Stark J. 1351. A Retrospective Database Study of Lyme Borreliosis Incidence and Distribution in Poland from 2015 to 2019. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1180] [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
Lyme borreliosis (LB), a tick-borne disease caused by Borrelia burgdorferi sensu lato, has been subject to mandatory public health surveillance since 1996 in Poland. Here, the incidence, temporal trends, and geographical distribution of LB and its manifestations in Poland are described for the period 2015-2019.
Methods
This retrospective incidence study of LB and its manifestations in Poland was based on the data sent to the National Institute of Public Health (NIPH-NIH–NRI) by district sanitary-epidemiological stations using the electronic Epidemiological Records Registration System and data from the National Database on Hospitalization. LB and its manifestations were reported in two categories- probable and confirmed (through laboratory tests). Incidence rates were calculated using the population data from the Central Statistical Office of Poland.
Results
In Poland, a total of 94,715 cases of LB with an overall mean incidence of 49.3 cases per 100,000 population were reported between 2015-2019. Cases increased from 2015 (11,945) to 2016 (20,857), and then remained stable through 2019. LB was more common among women (55.7%). The highest incidence rates occurred among >50-year-olds, with a peak in 65-69-year-olds. 48,717 persons with LB were hospitalized in the 5-year period, with higher number of hospitalizations in age groups 55-69 years old. Erythema migrans and Lyme arthritis were the most common manifestations of LB with incidence rates of 36.2 and 15.8 per 100,000 population, respectively. EM accounted for approximately 74% of all manifestations of LB. The highest number of cases were recorded in the 3rd and 4th quarters of the year (July – December). Incidence rates in the East and Northeastern regions (Podlaskie, Lubelskie, and Warmińsko-Mazurskie voivodeships) of the country were higher than the national average. These regions correspond to greater forest cover and/or agricultural areas.
Time trend of LB cases and incidence in Poland, 2015-2019.
Conclusion
LB is endemic in all regions of Poland, and many regions reported high incidence rates. LB is reported year-round in Poland. Thus, large variations in temporal and spatially granular incidence rates highlight the need for targeted prevention strategies, such as vaccines.
Disclosures
Jozica Skufca, Epidemiologist, p95: Paid by Pfizer to perform the study Archana Nagarajan, Ph.D., P95: Paid by Pfizer to perform the study Andreas Pilz, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds|Pfizer: Stocks/Bonds Andrew Vyse, Ph.D., Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds Mendwas Dzingina, Ph.D., Pfizer: Stocks/Bonds Maxim Blum, Ph.D., P95: Paid by Pfizer to perform the study Margarita Riera, MD, MPH, P95: Paid by Pfizer to perform the study Bradford Gessner, MD, MPH, Pfizer: Stocks/Bonds James Stark, Ph.D., Pfizer: Stocks/Bonds.
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Affiliation(s)
- Iwona Iwona Paradowska-Stankiewicz
- National Institute of Public Health - NIH National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance, , Warsaw, Mazowieckie , Poland
| | - Jakub Zbrzeźniak
- National Institute of Public Health - NIH National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance, , Warsaw, Mazowieckie , Poland
| | | | | | - Paulina Ochocka
- National Institute of Public Health - NIH National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance, , Warsaw, Mazowieckie , Poland
| | - Andreas Pilz
- Pfizer Corporation Austria , Vienna, Wien , Austria
| | - Andrew Vyse
- Pfizer UK , Tadworth, England , United Kingdom
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Weycker D, Averin A, Houde L, Ottino K, Shea KM, Gessner BJ, Yacisin K, Curcio D, Begier E, Rozenbaum M. 2207. Rates of Lower Respiratory Tract Infections Among US Adults Aged ≥18 Years With and Without Chronic Medical Conditions. Open Forum Infect Dis 2022. [PMCID: PMC9752982 DOI: 10.1093/ofid/ofac492.1826] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background While it is widely recognized that older adults and adults with chronic medical conditions are at increased risk of lower respiratory tract infections (LRTI), available evidence on the magnitude of increased risk is limited. Methods A retrospective observational cohort study using IBM MarketScan Commercial/Medicare Databases (2016–2019) was conducted. The study population included all adults (age ≥ 18 years) and was stratified by age and comorbidity profile (with vs. without high-risk conditions, based on recommendations for influenza vaccination in the United States). LRTI was ascertained on an overall basis as well as by causative pathogen (e.g., respiratory syncytial virus [RSV]) based on corresponding diagnosis codes, and was classified based on care setting (hospital, emergency department [ED], physician office/hospital outpatient [PO/HO]). Incidence rates (and relative rates [RRs]) were generated by age, and within each age group, by comorbidity profile. Results Using adults aged 18-34 years as the reference, RR of LRTI generally increased with older age across care settings, with the most marked increase for hospitalizations: for hospitalized-LRTI, RRs ranged from 1.7 for 35-49 years to 78.9 for ≥ 85 years; for ED-LRTI and PO/HO-LRTI, RRs ranged from 1.0 to 3.4 and from 1.4 to 2.1, respectively (Table). Within age groups, LRTI rates were also consistently higher among adults with versus without high-risk conditions: for hospitalized-LRTI, RRs ranged from 9.9 to 21.1; for ED-LRTI, from 2.3 to 3.2; and for PO/HO-LRTI, from 1.6 to 2.5. Age-specific RRs of hospitalized-LRTI due to RSV were largely comparable to overall LRTI results; age-specific RRs for other care settings, and RRs for adults with versus without high-risk conditions across care settings, were generally higher for LRTI due to RSV.
![]() Conclusion LRTI incidence, especially for events requiring acute inpatient care, is markedly higher among older adults and adults of all ages with chronic medical conditions. Effective vaccines against respiratory pathogens could help reduce this elevated risk of LRTI. Disclosures Derek Weycker, Ph.D., Pfizer Inc.: Grant/Research Support Ahuva Averin, M.P.P., Pfizer Inc.: Grant/Research Support Linnea Houde, M.S., Pfizer Inc.: Grant/Research Support Kevin Ottino, M.H.S., Pfizer Inc.: Grant/Research Support Kimberly M. Shea, Ph.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds Bradford J. Gessner, M.D., M.P.H., Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Kari Yacisin, M.D., Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Daniel Curcio, M.Sc., Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds Mark Rozenbaum, Ph.D., M.B.A., Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds.
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Affiliation(s)
| | - Ahuva Averin
- Policy Analysis Inc., Chestnut Hill, Massachusetts
| | - Linnea Houde
- Policy Analysis Inc., Chestnut Hill, Massachusetts
| | - Kevin Ottino
- Policy Analysis Inc., Chestnut Hill, Massachusetts
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Skufca J, DeSmedt N, Pilz A, Vyse A, Begier E, Riera M, Blum M, Gessner B, Stark J. 1352. Exploring spatial and temporal trends in the incidence of Lyme borreliosis in Finland using surveillance data, 2015 - 2020. Open Forum Infect Dis 2022. [PMCID: PMC9752542 DOI: 10.1093/ofid/ofac492.1181] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Lyme borreliosis (LB) is a tick-borne zoonotic disease endemic in many European countries, including Finland. We describe the incidence, time trends and geographical distribution of LB in Finland for the period 2015–2020. The data generated can help inform public health policy, including prevention strategies. Methods We retrieved online available LB cases and incidence from two Finnish national databases. Microbiologically confirmed disseminated LB cases were identified from The National Infectious Disease Register (NIDR) and clinically diagnosed LB cases, from the National Register of Primary Health Care Visits (Avohilmo), with the total LB cases equal to the sum from these two sources. Both registers contain data from the entire country and by hospital districts (HDs) and municipalities. Total LB incidence was calculated as the sum of microbiologically confirmed and clinically diagnosed LB cases divided by the population size. Results A total of 33,185 LB cases were reported over the 2015-2020 period, of which 12,590 (38%) were microbiologically confirmed and 20,595 (62%), clinically diagnosed. The average annual national incidence for total, microbiologically confirmed and clinically diagnosed LB were, respectively, 99.6, 38.1, and 61.4 per 100,000 population. The overall LB incidence was highest in the south to southwestern coastal areas by the Baltic Sea and in eastern areas, with average annual incidences of 109.0 to 207.3/100,000. The Ahvenanmaa Island was a hyperendemic region with an average annual incidence of 2,473.9/100,000 and the only HD to report more microbiologically confirmed cases (69%) as compared to clinically diagnosed cases. The highest incidence rates were among persons aged over 60 years, peaking at age 70–74 years. Below 40 years, the highest incidence rates were observed among 5-9-year-olds. Most cases were reported between May and October, with a peak in July and August. Average annual incidence (per 100,000 residents) by the Finnish hospital districts (HD) from 2015-2020. A) Clinically diagnosed LB; B) Microbiologically confirmed LB; C) Both combined, clinically diagnosed, and microbiologically confirmed LB.
![]() Conclusion The incidence of LB in Finland is among the highest in Europe but varied substantially by HD and many regions reported incidence much higher than the national average. These regions also corresponded to high population density areas, suggesting preventive measures such as vaccines may be an efficient use of resources. Disclosures Jozica Skufca, Epidemiologist, p95: Paid by Pfizer to perform the study Nick DeSmedt, Masters in Computer Engineering, P95: P95 was paid by Pfizer to perform the study Andreas Pilz, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds|Pfizer: Stocks/Bonds Andrew Vyse, Ph.D., Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds Margarita Riera, MD, MPH, P95: Paid by Pfizer to perform the study Maxim Blum, Ph.D., P95: Paid by Pfizer to perform the study Bradford Gessner, MD, MPH, Pfizer: Stocks/Bonds James Stark, Ph.D., Pfizer: Stocks/Bonds.
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Affiliation(s)
| | | | - Andreas Pilz
- Pfizer Corporation Austria, Vienna, Wien, Austria
| | - Andrew Vyse
- Pfizer UK, Tadworth, England, United Kingdom
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McLaughlin JM, Khan FL, Begier E, Swerdlow D, Jodar L, Falsey AR. 2208. Rates of Medically-Attended RSV among US Adults: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2022. [PMCID: PMC9752724 DOI: 10.1093/ofid/ofac492.1827] [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
Background Adult respiratory syncytial virus (RSV) vaccines are in late stages of development. A comprehensive synthesis of adult RSV burden is needed to inform public health decision-making. Methods We performed a systematic review and meta-analysis of studies describing the incidence of medically-attended RSV (MA-RSV) among US adults. We also identified studies reporting nasopharyngeal (NP) or nasal swab RT-PCR results with paired serology (four-fold-rise) or sputum (RT-PCR) to calculate RSV detection ratios quantifying improved diagnostic yield after adding a second specimen type (ie, serology or sputum). Results We identified 14 studies with 15 unique MA-RSV incidence estimates, all based on NP or nasal swab RT-PCR testing alone. Pooled annual RSV-associated incidence per 100,000 adults ≥65 years of age was 178 (95%CI: 152‒204; n=8 estimates) hospitalizations (4 prospective studies: 189; 4 model-based studies: 157), 133 (95%CI: 0‒319, n=2) emergency department (ED) admissions, and 1519 (95%CI: 1109‒1929, n=3) outpatient visits. Based on 6 studies, RSV detection was ∼1.5 times higher when adding paired serology or sputum. After adjustment for this increased yield, annual RSV-associated rates per 100,000 adults ≥65 years were 267 hospitalizations (UI: 228‒306) (prospective: 282; model-based: 236), 200 ED admissions (UI: 0‒478), and 2278 outpatient visits (UI: 1663‒2893). Persons < 65 years with chronic medical conditions were 1.2−28 times more likely to be hospitalized for RSV depending on risk condition. Conclusion The true burden of RSV has been underestimated and is significant among older adults and individuals with chronic medical conditions. A highly effective adult RSV vaccine would have substantial public-health impact. Disclosures John M. McLaughlin, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Farid L. Khan, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds David Swerdlow, MD, Pfizer: Advisor/Consultant|Pfizer: Stocks/Bonds Luis Jodar, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Ann R. Falsey, MD, BioFire Diagnostics: Grant/Research Support|Janssen: Grant/Research Support|Merck, Sharp and Dohme: Grant/Research Support|Novavax: Advisor/Consultant|Pfizer: Grant/Research Support.
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Affiliation(s)
| | | | | | | | - Luis Jodar
- Pfizer Vaccines, Dublin, Dublin, Ireland
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34
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Skufca J, DeSmedt N, Pilz A, Vyse A, Begier E, Blum M, Riera M, Gessner B, Skovdal M, Stark J. 1354. Incidence, time trends and geographic distribution of Lyme neuroborreliosis in Denmark using public surveillance data, 2015-2019. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1183] [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
Lyme neuroborreliosis (LNB) is a potentially severe manifestation of Lyme borreliosis (LB), a spirochetal tick-borne infectious disease caused by Borrelia burgdorferi. We describe the incidence, time trends and geographic distribution of LNB in Denmark, with the aim to inform public health policy, including the potential use of new vaccines under development.
Methods
Based on the case definition for LNB (clinical diagnosis of LB plus detection of antibodies in blood and cerebral spinal fluid [confirmed case], OR clinical symptoms compatible with LNB and detection of antibodies in blood [probable case]), we obtained cases reported by laboratories and physicians (2015–2019) from the online platform maintained by the Statens Serum Institut (SSI). The LNB incidence (per 100,000 persons) was calculated by dividing LNB cases by the population data (denominator) obtained from Statistics Denmark.
Results
Between 2015 and 2019, laboratories reported annually 162 to 200 LNB cases, while physicians reported 48 to 68 cases (Figure). The annual LNB incidence notified by laboratories ranged from 2.8 (95% CI: 2.4‒3.3) to 3.4 (95% CI: 3.0‒4.0) per 100,000 persons for the 5 study years. The average annual LNB incidence per 100,000 persons for 5 Danish regions ranged from 2.3 to 3.3; for 11 provinces, from 1.9 to 7.6; and for 98 municipalities, from 0 to 22.1. Incidence peaks occurred in persons 5‒14 and 65‒74 years of age. Higher incidences were observed among males versus females in all age groups. LNB cases were reported throughout the year, with peaks in July to September.
Number of LNB cases and annual incidence (per 100,000 population) notified by (A)physicians and (B) laboratories
Conclusion
LNB incidence in Denmark is moderate with no evidence of decline. Cases occurred across all regions but were focally concentrated among residents of some municipalities. By analyzing and reporting spatially granular data, we could identify areas with the highest LNB incidence. This may assist policy makers with assessing the efficiency of geographically targeted versus national prevention interventions, including vaccines should these be licensed. To this end, expanding the current surveillance system to include other manifestations of LB would be valuable to better understand geographic endemicity.
Disclosures
Jozica Skufca, Epidemiologist, p95: Paid by Pfizer to perform the study Nick DeSmedt, Masters in Computer Engineering, P95: P95 was paid by Pfizer to perform the study Andreas Pilz, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds|Pfizer: Stocks/Bonds Andrew Vyse, Ph.D., Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds Maxim Blum, Ph.D., P95: Paid by Pfizer to perform the study Margarita Riera, MD, MPH, P95: Paid by Pfizer to perform the study Bradford Gessner, MD, MPH, Pfizer: Stocks/Bonds Mette Skovdal, Ph.D., Pfizer Denmark: Stocks/Bonds James Stark, Ph.D., Pfizer: Stocks/Bonds.
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Affiliation(s)
| | | | - Andreas Pilz
- Pfizer Corporation Austria , Vienna, Wien , Austria
| | - Andrew Vyse
- Pfizer UK , Tadworth, England , United Kingdom
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35
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Robinson RE, Mitsi E, Nikolaou E, Pojar S, Chen T, Reiné J, Nyazika TK, Court J, Davies K, Farrar M, Gonzalez-Dias P, Hamilton J, Hill H, Hitchins L, Howard A, Hyder-Wright A, Lesosky M, Liatsikos K, Matope A, McLenaghan D, Myerscough C, Murphy A, Solórzano C, Wang D, Burhan H, Gautam M, Begier E, Theilacker C, Beavon R, Anderson AS, Gessner BD, Gordon SB, Collins AM, Ferreira DM. Human Infection Challenge with Serotype 3 Pneumococcus. Am J Respir Crit Care Med 2022; 206:1379-1392. [PMID: 35802840 DOI: 10.1164/rccm.202112-2700oc] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Streptococcus pneumoniae serotype 3 (SPN3) is a cause of invasive pneumococcal disease and associated with low carriage rates. Following the introduction of pediatric 13-valent pneumococcal conjugate vaccine (PCV13) programs, SPN3 declines are less than other vaccine serotypes and incidence has increased in some populations coincident with a shift in predominant circulating SPN3 clade, from I to II. A human challenge model provides an effective means for assessing the impact of PCV13 on SPN3 in the upper airway. Objectives: To establish SPN3's ability to colonize the nasopharynx using different inoculum clades and doses, and the safety of an SPN3 challenge model. Methods: In a human challenge study involving three well-characterized and antibiotic-sensitive SPN3 isolates (PFESP306 [clade Ia], PFESP231 [no clade], and PFESP505 [clade II]), inoculum doses (10,000, 20,000, 80,000, and 160,000 cfu/100 μl) were escalated until maximal colonization rates were achieved, with concurrent acceptable safety. Measurement and Main Results: Presence and density of experimental SPN3 nasopharyngeal colonization in nasal wash samples, assessed using microbiological culture and molecular methods, on Days 2, 7, and 14 postinoculation. A total of 96 healthy participants (median age 21, interquartile range 19-25) were inoculated (n = 6-10 per dose group, 10 groups). Colonization rates ranged from 30.0-70.0% varying with dose and isolate. 30.0% (29/96) reported mild symptoms (82.8% [24/29] developed a sore throat); one developed otitis media requiring antibiotics. No serious adverse events occurred. Conclusions: An SPN3 human challenge model is feasible and safe with comparable carriage rates to an established Serotype 6B human challenge model. SPN3 carriage may cause mild upper respiratory symptoms.
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Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elissavet Nikolaou
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sherin Pojar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jesús Reiné
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tinashe K Nyazika
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Court
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madlen Farrar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Josh Hamilton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lisa Hitchins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Agnes Matope
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniella McLenaghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Annabel Murphy
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Manish Gautam
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | | | | | | | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
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36
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Skufca J, De Smedt N, Pilz A, Vyse A, Begier E, Blum M, Riera-Montes M, Gessner B, Skovdal M, Stark JH. Incidence of Lyme neuroborreliosis in Denmark: Exploring observed trends using public surveillance data, 2015-2019. Ticks Tick Borne Dis 2022; 13:102039. [PMID: 36166915 DOI: 10.1016/j.ttbdis.2022.102039] [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: 12/29/2021] [Revised: 08/30/2022] [Accepted: 09/10/2022] [Indexed: 11/24/2022]
Abstract
Lyme neuroborreliosis (LNB) can be a serious manifestation of Lyme borreliosis. We describe the incidence, time trends and geographic distribution of LNB in Denmark. We obtained LNB cases reported by laboratories and physicians (2015-2019) from the online platform maintained by the Statens Serum Institut (SSI) (2021b). The LNB incidence (per 100,000 persons) was calculated by dividing LNB cases by the population data (denominator) obtained from Statistics Denmark (2021). Between 2015 and 2019, laboratories reported annually 162 to 200 LNB cases, while physicians reported 48 to 68 cases. The annual LNB incidence notified by laboratories ranged from 2.8 (95% CI: 2.4‒3.3) to 3.4 (95% CI: 3.0‒4.0) per 100,000 persons for the 5 study years. The average annual LNB incidence per 100,000 persons for 5 Danish regions ranged from 2.3 to 3.3; for 11 provinces, from 1.9 to 7.6; and for 98 municipalities, from 0 to 22.1. Incidence peaks occurred in persons 5‒14 and 65‒74 years of age. Higher incidences were observed among males versus females in all age groups. LNB cases were reported throughout the year, with peaks in July to September. Notified LNB incidence in Denmark was moderate with no evidence of decline. Cases occurred across all regions but were focally concentrated among residents of some municipalities. Expanding the current surveillance system to include other manifestations of LB would be valuable to better understand geographic endemicity to inform targeted preventive measures.
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Affiliation(s)
- Jozica Skufca
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | - Nick De Smedt
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | - Andreas Pilz
- Pfizer Global Medical Affairs, Vaccines, Vienna, Austria
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK
| | - Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Maxim Blum
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | | | - Bradford Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USA
| | - Mette Skovdal
- Pfizer Denmark, Pfizer Inc, Lautrupvang 8 2750 Ballerup, Denmark
| | - James H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USA.
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Hyams C, Challen R, Begier E, Southern J, King J, Morley A, Szasz-Benczur Z, Gonzalez MG, Kinney J, Campling J, Gray S, Oliver J, Hubler R, Valluri S, Vyse A, McLaughlin JM, Ellsbury G, Maskell NA, Gessner BD, Danon L, Finn A. Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study. Lancet Reg Health Eur 2022; 21:100473. [PMID: 35965672 PMCID: PMC9359590 DOI: 10.1016/j.lanepe.2022.100473] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background The emergence of COVID-19 and public health measures implemented to reduce SARS-CoV-2 infections have both affected acute lower respiratory tract disease (aLRTD) epidemiology and incidence trends. The severity of COVID-19 and non-SARS-CoV-2 aLRTD during this period have not been compared in detail. Methods We conducted a prospective cohort study of adults age ≥18 years admitted to either of two acute care hospitals in Bristol, UK, from August 2020 to November 2021. Patients were included if they presented with signs or symptoms of aLRTD (e.g., cough, pleurisy), or a clinical or radiological aLRTD diagnosis. Findings 12,557 adult aLRTD hospitalisations occurred: 10,087 were associated with infection (pneumonia or non-pneumonic lower respiratory tract infection [NP-LRTI]), 2161 with no infective cause, with 306 providing a minimal surveillance dataset. Confirmed SARS-CoV-2 infection accounted for 32% (3178/10,087) of respiratory infections. Annual incidences of overall, COVID-19, and non- SARS-CoV-2 pneumonia were 714.1, 264.2, and 449.9, and NP-LRTI were 346.2, 43.8, and 302.4 per 100,000 adults, respectively. Weekly incidence trends in COVID-19 aLRTD showed large surges (median 6.5 [IQR 0.7-10.2] admissions per 100,000 adults per week), while other infective aLRTD events were more stable (median 14.3 [IQR 12.8-16.4] admissions per 100,000 adults per week) as were non-infective aLRTD events (median 4.4 [IQR 3.5-5.5] admissions per 100,000 adults per week). Interpretation While COVID-19 disease was a large component of total aLRTD during this pandemic period, non- SARS-CoV-2 infection still caused the majority of respiratory infection hospitalisations. COVID-19 disease showed significant temporal fluctuations in frequency, which were less apparent in non-SARS-CoV-2 infection. Despite public health interventions to reduce respiratory infection, disease incidence remains high. Funding AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.
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Affiliation(s)
- Catherine Hyams
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
- Academic Respiratory Unit, University of Bristol, UK
| | | | - Elizabeth Begier
- Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Ireland
| | - Jo Southern
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, UK
| | | | | | - Jane Kinney
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
| | - James Campling
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Sharon Gray
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | - Robin Hubler
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Srinivas Valluri
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - John M. McLaughlin
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | - Bradford D. Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Leon Danon
- Engineering Mathematics, University of Bristol, UK
| | - Adam Finn
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
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38
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Hyams C, Challen R, Begier E, Southern J, King J, Morley A, Szasz-Benczur Z, Gonzalez MG, Kinney J, Campling J, Gray S, Oliver J, Hubler R, Valluri S, Vyse A, McLaughlin JM, Ellsbury G, Maskell NA, Gessner BD, Danon L, Finn A. Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study. Lancet Reg Health Eur 2022; 21:100473. [PMID: 35965672 DOI: 10.2139/ssrn.4087373] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The emergence of COVID-19 and public health measures implemented to reduce SARS-CoV-2 infections have both affected acute lower respiratory tract disease (aLRTD) epidemiology and incidence trends. The severity of COVID-19 and non-SARS-CoV-2 aLRTD during this period have not been compared in detail. METHODS We conducted a prospective cohort study of adults age ≥18 years admitted to either of two acute care hospitals in Bristol, UK, from August 2020 to November 2021. Patients were included if they presented with signs or symptoms of aLRTD (e.g., cough, pleurisy), or a clinical or radiological aLRTD diagnosis. FINDINGS 12,557 adult aLRTD hospitalisations occurred: 10,087 were associated with infection (pneumonia or non-pneumonic lower respiratory tract infection [NP-LRTI]), 2161 with no infective cause, with 306 providing a minimal surveillance dataset. Confirmed SARS-CoV-2 infection accounted for 32% (3178/10,087) of respiratory infections. Annual incidences of overall, COVID-19, and non- SARS-CoV-2 pneumonia were 714.1, 264.2, and 449.9, and NP-LRTI were 346.2, 43.8, and 302.4 per 100,000 adults, respectively. Weekly incidence trends in COVID-19 aLRTD showed large surges (median 6.5 [IQR 0.7-10.2] admissions per 100,000 adults per week), while other infective aLRTD events were more stable (median 14.3 [IQR 12.8-16.4] admissions per 100,000 adults per week) as were non-infective aLRTD events (median 4.4 [IQR 3.5-5.5] admissions per 100,000 adults per week). INTERPRETATION While COVID-19 disease was a large component of total aLRTD during this pandemic period, non- SARS-CoV-2 infection still caused the majority of respiratory infection hospitalisations. COVID-19 disease showed significant temporal fluctuations in frequency, which were less apparent in non-SARS-CoV-2 infection. Despite public health interventions to reduce respiratory infection, disease incidence remains high. FUNDING AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.
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Affiliation(s)
- Catherine Hyams
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
- Academic Respiratory Unit, University of Bristol, UK
| | | | - Elizabeth Begier
- Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Ireland
| | - Jo Southern
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, UK
| | | | | | - Jane Kinney
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
| | - James Campling
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Sharon Gray
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | - Robin Hubler
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Srinivas Valluri
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - John M McLaughlin
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Leon Danon
- Engineering Mathematics, University of Bristol, UK
| | - Adam Finn
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
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Liatsikos K, Hyder-Wright A, Pojar S, Chen T, Wang D, Davies K, Myerscough C, Reine J, Robinson RE, Urban B, Mitsi E, Solorzano C, Gordon SB, Quinn A, Pan K, Anderson AS, Theilacker C, Begier E, Gessner BD, Collins A, Ferreira DM. Protocol for a phase IV double-blind randomised controlled trial to investigate the effect of the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine on pneumococcal colonisation using the experimental human pneumococcal challenge model in healthy adults (PREVENTING PNEUMO 2). BMJ Open 2022; 12:e062109. [PMID: 35798520 PMCID: PMC9263934 DOI: 10.1136/bmjopen-2022-062109] [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: 02/21/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite widely available vaccinations, Streptococcus pneumoniae (SPN) remains a major cause of morbidity and mortality worldwide, causing community-acquired pneumonia, meningitis, otitis media, sinusitis and bacteraemia. Here, we summarise an ethically approved protocol for a double-blind, randomised controlled trial investigating the effect of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPV23) on pneumococcal nasopharyngeal colonisation acquisition, density and duration using experimental human pneumococcal challenge (EHPC). METHODS AND ANALYSIS Healthy adult participants aged 18-50 years will be randomised to receive PCV13, PPV23 or placebo and then undergo one or two EHPCs involving intranasal administration of SPN at 1-month post-vaccination with serotype 3 (SPN3) and 6 months with serotype 6B (SPN6B). Participants randomised to PCV13 and placebo will also be randomised to one of two clinically relevant SPN3 strains from distinct lineages within clonal complex 180, clades Ia and II, creating five study groups. Following inoculation, participants will be seen on days 2, 7, 14 and 23. During the follow-up period, we will monitor safety, colonisation status, density and duration, immune responses and antigenuria. The primary outcome of the study is comparing the rate of SPN3 acquisition between the vaccinated (PCV13 or PPV23) and unvaccinated (placebo) groups as defined by classical culture. Density and duration of colonisation, comparison of acquisition rates using molecular methods and evaluation of the above measurements for individual SPN3 clades and SPN6B form the secondary objectives. Furthermore, we will explore the immune responses associated with these vaccines, their effect on colonisation and the relationship between colonisation and urinary pneumococcal antigen detection. ETHICS AND DISSEMINATION The study is approved by the NHS Research and Ethics Committee (Reference: 20/NW/0097) and by the Medicines and Healthcare products Regulatory Agency (Reference: CTA 25753/0001/001-0001). Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN15728847, NCT04974294.
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Affiliation(s)
| | - Angela Hyder-Wright
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sherin Pojar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Jesus Reine
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ryan E Robinson
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Britta Urban
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solorzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen B Gordon
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Liverpool School of Tropical Medicine, Blantyre, Malawi
| | - Angela Quinn
- Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Kaijie Pan
- Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | | | | | | | | | - Andrea Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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40
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McLaughlin JM, Khan F, Begier E, Swerdlow DL, Jodar L, Falsey AR. Rates of Medically-Attended RSV among US Adults: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2022; 9:ofac300. [PMID: 35873302 PMCID: PMC9301578 DOI: 10.1093/ofid/ofac300] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 04/06/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Adult respiratory syncytial virus (RSV) vaccines are in late stages of development. A comprehensive synthesis of adult RSV burden is needed to inform public health decision-making.
Methods
We performed a systematic review and meta-analysis of studies describing the incidence of medically-attended RSV (MA-RSV) among US adults. We also identified studies reporting nasopharyngeal (NP) or nasal swab RT-PCR results with paired serology (four-fold-rise) or sputum (RT-PCR) to calculate RSV detection ratios quantifying improved diagnostic yield after adding a second specimen type (ie, serology or sputum).
Results
We identified 14 studies with 15 unique MA-RSV incidence estimates, all based on NP or nasal swab RT-PCR testing alone. Pooled annual RSV-associated incidence per 100,000 adults ≥65 years of age was 178 (95%CI: 152‒204; n = 8 estimates) hospitalizations (4 prospective studies: 189; 4 model-based studies: 157), 133 (95%CI: 0‒319, n = 2) emergency department (ED) admissions, and 1519 (95%CI: 1109‒1929, n = 3) outpatient visits. Based on 6 studies, RSV detection was ∼1.5 times higher when adding paired serology or sputum. After adjustment for this increased yield, annual RSV-associated rates per 100,000 adults ≥65 years were 267 hospitalizations (UI: 228‒306) (prospective: 282; model-based: 236), 200 ED admissions (UI: 0‒478), and 2278 outpatient visits (UI: 1663‒2893). Persons <65 years with chronic medical conditions were 1.2−28 times more likely to be hospitalized for RSV depending on risk condition.
Conclusions
The true burden of RSV has been underestimated and is significant among older adults and individuals with chronic medical conditions. A highly effective adult RSV vaccine would have substantial public-health impact.
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Affiliation(s)
| | - Farid Khan
- Pfizer Vaccines , Collegeville, PA , USA
| | | | | | - Luis Jodar
- Pfizer Vaccines , Collegeville, PA , USA
| | - Ann R Falsey
- Department of Medicine, Division of Infectious Diseases, University of Rochester , Rochester, NY , USA
- Rochester General Hospital , Rochester, NY , USA
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Liapikou A, Konstantinidis A, Kossyvaki V, Skiadas J, Menegas D, Méndez C, Beavon R, Begier E, Gessner BD, Milionis H, Tsimihodimos V, Baxevanos G, Argiriadou T, Terrovitou C, Toumbis M, Study Group TE, Moses E, Angelos L, Ilias T, Aikaterini P, Valentina S, Iro R, Konstantinos E, Konstantina G, Christos K, Elias L, Thomas T, Georgios D, Evaggelia C, Nikolaos Z, Lampros P, Vasilios I, Elisavet F, Daniil D, Ioanna K, Anastasia C, Eleni T. Pneumococcal serotypes in adults hospitalized with community-acquired pneumonia in Greece using urinary antigen detection tests: the EGNATIA study, November 2017 - April 2019. Hum Vaccin Immunother 2022; 18:2079923. [PMID: 35703733 DOI: 10.1080/21645515.2022.2079923] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Greece introduced a 13-valent pneumococcal conjugate vaccine (PCV13) into the infant national immunization program in 2010 (3 + 1 schedule until June 2019). Since 2015, PCV13 has been recommended for adults aged 19-64 years with comorbidities and adults ≥65 years sequentially with 23-valent pneumococcal polysaccharide vaccine (PPSV23). We examined pneumococcal serotype distribution among Greek adults aged ≥19 years hospitalized with community-acquired pneumonia (CAP) during November 2017-April 2019. This was an interim analysis of EGNATIA, a prospective study of adult hospitalized CAP in the cities of Ioannina and Kavala. Pneumococcus was identified using cultures, BinaxNow®, serotype-specific urinary antigen detection assays (UAD-1/2). Our analysis included overall 482 hospitalized CAP patients (mean age: 70.5 years; 56.4% male). 53.53% of patients belonged to the highest pneumonia severity index (PSI) classes (IV-V). Pneumococcus was detected in 65 (13.5%) patients, with more than half (57%) of cases detected only by UAD. Approximately two-thirds of pneumococcal CAP occurred in those aged ≥65 years (n = 40, 8.3% of CAP). More than half of pneumococcal CAP (n = 35, 53.8%) was caused by PCV13 serotypes. Most frequently detected PCV13 serotypes were 3, 19A, 23F, collectively accounting for 83% of PCV13 vaccine-type (VT) CAP and 6% of all-cause CAP. Overall, 82.9% of PCV13 VT CAP occurred among persons with an indication (age/risk-based) for PCV13 vaccination. Even with a mature PCV13 childhood immunization program, a persistent burden of PCV13 VT CAP exists in Greek adults. Strategies to increase PCV13 (and higher-valency PCVs, when licensed) coverage in adults should be implemented to reduce the disease burden.
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Affiliation(s)
- Adamantia Liapikou
- Hellenic Thoracic Society (HTS), Infectious Diseases Working Group, Athens, Greece.,6th Respiratory Medicine Department, "Sotiria" Hospital of Chest Diseases, Athens, Greece
| | | | | | | | | | | | - Rohini Beavon
- Pfizer Ltd, Global Vaccines, Medical Development and Scientific/Clinical Affairs (MDSCA), London, United Kingdo
| | - Elizabeth Begier
- Pfizer Inc., Global Vaccines, Collegeville, Pennsylvania, United States of America
| | - Bradford D Gessner
- Pfizer Inc., Global Vaccines, Collegeville, Pennsylvania, United States of America
| | - Haralampos Milionis
- 1st Internal Medicine Department, University Hospital of Ioannina, Loannina, Greece
| | | | - Gerasimos Baxevanos
- Internal Medicine Department, General Hospital of Ioannina G. Hatzikosta, Loannina, Greece
| | - Theodora Argiriadou
- 1st Respiratory Medicine Department, General Hospital of Kavala, Kavala, Greece
| | | | - Michael Toumbis
- Hellenic Thoracic Society (HTS), Infectious Diseases Working Group, Athens, Greece
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Hyams C, Begier E, Garcia Gonzalez M, Southern J, Campling J, Gray S, Oliver J, Gessner BD, Finn A. Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology. BMJ Open 2022; 12:e057464. [PMID: 35705333 PMCID: PMC9204403 DOI: 10.1136/bmjopen-2021-057464] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK. SETTING Single-centre, secondary care hospital, Bristol, UK. DESIGN We estimated aLRTD hospitalisations incidence in adults (≥18 years) in Bristol, UK, using two approaches. First, retrospective International Classification of Diseases 10th revision (ICD-10) code analysis (first five positions/hospitalisation) identified aLRTD events over a 12-month period (March 2018 to February 2019). Second, during a 21-day prospective review (19 August 2019 to 9 September 2019), aLRTD admissions were identified, categorised by diagnosis and subsequently annualised. Hospital catchment denominators were calculated using linked general practice and hospitalisation data, with each practice's denominator contribution calculated based on practice population and per cent of the practices' hospitalisations admitted to the study hospital. PARTICIPANTS Prospective review: 1322 adults screened; 410 identified with aLRTD. Retrospective review: 7727 adult admissions. PRIMARY AND SECONDARY OUTCOME MEASURES The incidence of aLRTD and its subsets in the adult population of Southmead Hospital, Bristol UK. RESULTS Based on ICD-10 code analysis, annual incidences per 100 000 population were: aLRTD, 1901; pneumonia, 591; LRTI, 739; heart failure, 402. aLRTD incidence was highest among those ≥65 years: 65-74 (3684 per 100 000 adults), 75-84 (6962 per 100 000 adults) and ≥85 (11 430 per 100 000 adults). During the prospective review, 410/1322 (31%) hospitalised adults had aLRTD signs/symptoms and annualised incidences closely replicated retrospective analysis results. CONCLUSIONS The aLRTD disease burden was high, increasing sharply with age. The aLRTD incidence is probably higher than estimated previously due to criteria specifying respiratory-specific symptoms or radiological change, usage of only the first diagnosis code and mismatch between case count sources and population denominators. This may have significant consequences for healthcare planning, including usage of current and future vaccinations against respiratory infection.
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Affiliation(s)
- Catherine Hyams
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Bristol Vaccine Centre, University of Bristol, Bristol, UK
| | - Elizabeth Begier
- Global Medical and Scientific Affairs, Pfizer Inc, New York City, New York, USA
| | - Maria Garcia Gonzalez
- Population Health Sciences, University of Bristol, Bristol, UK
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
| | - Jo Southern
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth, Surrey, UK
| | - James Campling
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth, Surrey, UK
| | - Sharon Gray
- Global Medical and Scientific Affairs, Pfizer Inc, New York City, New York, USA
| | - Jennifer Oliver
- Bristol Vaccine Centre, University of Bristol, Bristol, UK
- Schools of Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, UK
| | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Adam Finn
- Bristol Vaccine Centre, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
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Mitsi E, Reiné J, Urban BC, Solórzano C, Nikolaou E, Hyder-Wright AD, Pojar S, Howard A, Hitchins L, Glynn S, Farrar MC, Liatsikos K, Collins AM, Walker NF, Hill HC, German EL, Cheliotis KS, Byrne RL, Williams CT, Cubas-Atienzar AI, Fletcher TE, Adams ER, Draper SJ, Pulido D, Beavon R, Theilacker C, Begier E, Jodar L, Gessner BD, Ferreira DM. Streptococcus pneumoniae colonization associates with impaired adaptive immune responses against SARS-CoV-2. J Clin Invest 2022; 132:157124. [PMID: 35139037 PMCID: PMC8970672 DOI: 10.1172/jci157124] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although recent epidemiological data suggest that pneumococci may contribute to the risk of SARS-CoV-2 disease, cases of coinfection with Streptococcus pneumoniae in patients with coronavirus disease 2019 (COVID-19) during hospitalization have been reported infrequently. This apparent contradiction may be explained by interactions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pneumococci in the upper airway, resulting in the escape of SARS-CoV-2 from protective host immune responses. Methods Here, we investigated the relationship of these 2 respiratory pathogens in 2 distinct cohorts of health care workers with asymptomatic or mildly symptomatic SARS-CoV-2 infection identified by systematic screening and patients with moderate to severe disease who presented to the hospital. We assessed the effect of coinfection on host antibody, cellular, and inflammatory responses to the virus. Results In both cohorts, pneumococcal colonization was associated with diminished antiviral immune responses, which primarily affected mucosal IgA levels among individuals with mild or asymptomatic infection and cellular memory responses in infected patients. Conclusion Our findings suggest that S. pneumoniae impair host immunity to SARS-CoV-2 and raise the question of whether pneumococcal carriage also enables immune escape of other respiratory viruses and facilitates reinfection. Trial registration ISRCTN89159899 (FASTER study) and ClinicalTrials.gov NCT03502291 (LAIV study).
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Affiliation(s)
- Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Britta C Urban
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Sherin Pojar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lisa Hitchins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sharon Glynn
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Madlen C Farrar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Andrea M Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Naomi F Walker
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Helen C Hill
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Esther L German
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Katerina S Cheliotis
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachel L Byrne
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Christopher T Williams
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ana I Cubas-Atienzar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tom E Fletcher
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emily R Adams
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Simon J Draper
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - David Pulido
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Luis Jodar
- Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | | | - Daniela M Ferreira
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Begier E, Rosenthal NA, Gurtman A, Kartashov A, Donald RGK, Lockhart SP. Epidemiology of Invasive Escherichia coli Infection and Antibiotic Resistance Status Among Patients Treated in US Hospitals: 2009-2016. Clin Infect Dis 2021; 73:565-574. [PMID: 33420788 DOI: 10.1093/cid/ciab005] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 05/22/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Published data is limited on the prevalence and risk of recurrence of extraintestinal invasive Escherichia coli infections (IEIs) in the United States. METHODS The analysis included all inpatient and hospital-based outpatient visits occurring between 2009 and 2016 at hospitals with continuous microbiology data submission to the Premier Healthcare Database for 90 days before and 12 months after the admission or visit. IEI was defined as having positive E. coli culture from a normally sterile site (eg, blood, cerebrospinal fluid). The prevalence of IEI, 12-month risk of recurrent IEI, and antibiotic resistance were assessed. RESULTS Overall, 144 944 725 hospital visits among 37 207 510 patients were analyzed, and 71 909 IEI events occurred in 67 583 patients, corresponding to an IEI prevalence of 0.50 events per 1000 visits and 1.82 events per 1000 patients. Recurrence was common: 26.9 per 1000 patients had a recurrent IEI in the 12 months after their infection. Most infections were community acquired (66.4%), and urosepsis was most common clinical syndrome (66.0%). The 30-day risk of IEI among patients undergoing transrectal ultrasound-guided prostate biopsy was high: 5.03 events per 1000 patients. Among all IEI cases with antibiotic susceptibility testing, 9.18% were resistant to extended-spectrum cephalosporins, 28.22% to fluoroquinolones, and 0.14% to carbapenems. Resistance to extended-spectrum cephalosporins increased from 5.46% to 12.97% during the 8-year study period. CONCLUSIONS This real-world study indicates a substantial burden of IEI and recurrent IEI exists in the United States, as well as increasing resistance to extended-spectrum cephalosporins. Future research should explore risk factors of recurrent IEI aiming to effectively prevent such infections.
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Affiliation(s)
- Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer, Pearl River, New York, USA
| | - Ning A Rosenthal
- Premier Applied Sciences, Premier Healthcare Solutions, Charlotte, North Carolina, USA
| | - Alejandra Gurtman
- Vaccine Clinical Research and Development, Pfizer, Pearl River, New York, USA
| | - Alex Kartashov
- Premier Applied Sciences, Premier Healthcare Solutions, Charlotte, North Carolina, USA
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Begier E, Rosenthal NA, Richardson W, Chung J, Gurtman A. Invasive Staphylococcus aureus Infection among Patients Undergoing Elective, Posterior, Instrumented Spinal Fusion Surgeries: A Retrospective Cohort Study. Surg Infect (Larchmt) 2021; 23:12-21. [PMID: 34494895 DOI: 10.1089/sur.2021.019] [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: 11/12/2022] Open
Abstract
Background: Post-surgical invasive Staphylococcus aureus infections among spinal fusion patients are serious complications that can worsen clinical outcomes and increase healthcare utilization. Risk of such infections at the population level remains unknown. This study assessed the post-surgical risk of invasive Staphylococcus aureus infections among patients undergoing elective posterior instrumented spinal fusion surgeries in 129 U.S. hospitals. Patients and Methods: This retrospective cohort study analyzed adult patients ≥18 years of age who underwent thoracolumbar/lumbar and cervical fusion surgeries during 2010 - 2014 using the Premier Healthcare Database, the largest hospital discharge database in the United States. Risks of blood stream infection (BSI), deep or organ/space surgical site infections (SSI) caused by Staphylococcus aureus during 90 and 180 days post-index surgery were estimated. Infections were identified based on positive culture results, related International Classification of Diseases, Ninth Revision (ICD-9) procedure codes, and specific claims information. Results: Among 11,236 patients with thoracolumbar/lumbar fusion, 90- and 180-day BSI/SSI infection risks were higher for multilevel than single level fusion (90-day, 1.52% vs. 1.07%, p = 0.05; 180-day, 1.66% vs. 1.07%, p = 0.014). Among 1,641 patients with cervical fusion, 90- and 180-day BSI/SSI infection risks were also higher in multilevel fusions but not statistically significant (90-day, 1.66% vs. 0.52%, p = 0.350; 180-day, 1.80% vs. 0.51%, p = 0.241). The risk for SSI/BSI was more than twice as high among multilevel thoracolumbar/lumbar fusion patients with more than two comorbidities than those with no comorbidity at both 90-day (2.78% vs. 1.00%, p < 0.05) and 180-day (3.01% vs. 1.10%, p < 0.05). Similar trend without statistical significance was seen in multilevel cervical fusion cohort (90-day, 2.91% vs. 1.25%, p > 0.05; 180-day, 3.88% vs. 1.41%, p > 0.05). Conclusions: The risk of BSI/SSI infection for elective posterior instrumented spinal fusions ranged between 0.5% and 2%. Higher risk was observed in multilevel thoracolumbar/lumbar surgery, with infection risk greatest in patients with more than two comorbidities. These real-world findings highlight the need for additional measures, in addition to antibiotic prophylaxis, to reduce invasive Staphylococcus aureus infections in this setting.
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Affiliation(s)
| | - Ning A Rosenthal
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
| | | | - Jessica Chung
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
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Njuma Libwea J, A. Fletcher M, Koki Ndombo P, Boula A, Ashukem NT, Ngo Baleba M, Kingue Bebey RS, Nkolo Mviena EG, Tageube J, Kobela Mbollo M, Koulla-Shiro S, Madhi S, Njanpop-Lafourcade BM, Mohammad A, Begier E, Southern J, Beavon R, Gessner B. Impact of 13-valent pneumococcal conjugate vaccine on laboratory-confirmed pneumococcal meningitis and purulent meningitis among children ˂5 years in Cameroon, 2011-2018. PLoS One 2021; 16:e0250010. [PMID: 33857235 PMCID: PMC8049353 DOI: 10.1371/journal.pone.0250010] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The 13-valent pneumococcal conjugate vaccine (PCV13) entered Cameroon's childhood national immunization programme (NIP) in July 2011 under a 3-dose schedule (6, 10, 14 weeks of age) without any catch-up. We described the impact of PCV13 onserotype distribution among pneumococcal meningitis cases over time. METHODS We used laboratory-based sentinel surveillance data to identify meningitis cases among 2- to 59-month-old children with clinically-suspected bacterial meningitis (CSBM) admitted to hospitals in Yaoundé (August 2011-December 2018). Purulent meningitis cases had a cerebrospinal fluid (CSF) white blood cell (WBC) count ≥20 per mm3. Pneumococcal meningitis cases had S. pneumoniae identified from CSF, with serotyping by polymerase chain reaction. Years 2011-2014 were described as early PCV13 era (EPE) and years 2015-2018 as late PCV13 era (LPE) impact periods. RESULTS Among children hospitalized with CSBM who had a lumbar puncture obtained, there was no significant change from the EPE versus the LPE in the percentage identified with purulent meningitis: 7.5% (112/1486) versus 9.4% (154/1645), p = 0.0846. The percentage of pneumococcal meningitis cases due to PCV13 vaccine-serotype (VST) decreased from 62.0% (31/50) during the EPE to 35.8% (19/53) in the LPE, p = 0.0081. The most frequent pneumococcal meningitis VSTs during the EPE were 6A/6B (30%) and 5 (6%), and during the LPE were 14 (13.2%), 3 (7.6%), 4 (5.6%) and 18C (5.6%). CONCLUSION Four to seven years after PCV13 introduction, the proportion of pneumococcal meningitis due to vaccine serotypes has declined, mainly due to reductions of serotypes 6A/6B, 1, 19A, and 23F; nevertheless, PCV13 VSTs remain common. Because the analyzed surveillance system was not consistent or population based, we could not estimate incidence or overall impact; this emphasizes the need for improved surveillance to document further the utility of PCV13 immunization in Cameroon.
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Affiliation(s)
- John Njuma Libwea
- National Institute for Health and Welfare (THL), Helsinki, Finland
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Expanded Programme on Immunization, Cameroon
| | - Mark A. Fletcher
- Emerging Markets Medical Affairs, Vaccines, Pfizer, Inc, Paris, France
| | - Paul Koki Ndombo
- Expanded Programme on Immunization, Cameroon
- Mother & Child Hospital (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
| | - Angeline Boula
- Mother & Child Hospital (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
| | - Nadesh Taku Ashukem
- Mother & Child Hospital (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
- Ministry of Public Health, Yaoundé, Cameroon
| | | | | | | | - Jean Tageube
- Mother & Child Hospital (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
| | - Marie Kobela Mbollo
- Expanded Programme on Immunization, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, Faculty of HealthSciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ali Mohammad
- Pfizer Vaccines Medical Development & Medical/Scientific Affairs, New York, New York, United States of America
| | - Elizabeth Begier
- Pfizer Vaccines Medical Development & Medical/Scientific Affairs, New York, New York, United States of America
| | - Joanna Southern
- Pfizer Vaccines Medical Development & Medical/Scientific Affairs, New York, New York, United States of America
| | - Rohini Beavon
- Pfizer Vaccines Medical Development & Medical/Scientific Affairs, New York, New York, United States of America
| | - Bradford Gessner
- Pfizer Vaccines Medical Development & Medical/Scientific Affairs, New York, New York, United States of America
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Arena PJ, Mo J, Sabharwal C, Begier E, Zhou X, Gurtman A, Liu Q, Shen R, Wentworth C, Huang K. The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study. BMC Musculoskelet Disord 2020; 21:612. [PMID: 32928165 PMCID: PMC7488711 DOI: 10.1186/s12891-020-03631-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/03/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Although stroke is a rare complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among selected adults undergoing elective posterior lumbar fusion (PLF) during various post-operative risk windows and among different subgroups. METHODS A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. The incidence of stroke was estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operation. RESULTS A total of 43,063 patients were eligible for the study. The incidence of stroke following elective PLF was 0.29% (95% confidence interval [CI]: 0.25, 0.35%) during index hospitalization, 0.44% (95% CI: 0.38, 0.50%) ≤ 30 days, 0.59% (95% CI: 0.52, 0.67%) ≤ 90 days, 0.76% (95% CI: 0.68, 0.85%) ≤ 180 days, and 1.12% (95% CI: 1.03, 1.23%) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences. Post-operative stroke incidence was higher among patients with a history of type 2 diabetes than among patients without such history; similarly, stroke incidence was higher among patients with a history of stroke compared to patients without such history. CONCLUSIONS The incidence of stroke following elective PLF using an EHR database in this study is slightly higher than that reported in the literature. Our results suggest that stroke risk modification prior to PLF may be important for patients who are older, black, type 2 diabetic, and/or have a history of stroke.
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Affiliation(s)
- Patrick J Arena
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA.
| | - Jingping Mo
- Safety Surveillance Research, Pfizer Inc, New York, NY, USA
| | - Charu Sabharwal
- Vaccine Research & Development, Pfizer Inc, Pearl River, NY, USA
| | - Elizabeth Begier
- Vaccine Research & Development, Pfizer Inc, Pearl River, NY, USA
| | - Xiaofeng Zhou
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
| | | | - Qing Liu
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, Collegeville, PA, USA
| | - Rongjun Shen
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
| | - Charles Wentworth
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
| | - Kui Huang
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
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48
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Dreyfus J, Yu H, Begier E, Gayle J, Olsen MA. Incidence of Staphylococcus aureus Infections After Elective Surgeries in US Hospitals. Clin Infect Dis 2020; 73:e2635-e2646. [DOI: 10.1093/cid/ciaa913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/30/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Although Staphylococcus aureus is a leading cause of postsurgical infections, national estimates of these infections after elective surgeries based on microbiology data are limited. This study assessed cumulative 180-day postsurgical S. aureus incidence in real-world hospital settings.
Methods
A retrospective study of adults (≥18 years) undergoing inpatient or hospital-based outpatient elective surgeries from 1/7/2010–30/6/2015 at hospitals (N = 181) reporting microbiology results in the Premier Healthcare Database (PHD). 86 surgical categories were identified from the National Healthcare Safety Network procedures. We classified positive S. aureus cultures using a hierarchy (bloodstream [BSI], surgical site [SSI], and all other types [urinary tract, respiratory, other/unknown site]) and calculated incidence (number of infections divided by the number of elective surgery discharges). We estimated national infection case volumes by multiplying incidence by national inpatient elective surgical discharge estimates using the entire PHD and weights based on hospital characteristics.
Results
Following 884 803 inpatient elective surgical discharges, 180-day S. aureus infection incidence was 1.35% (0.30% BSI, 0.74% SSI no BSI, 0.32% all other types only). Among 1 116 994 hospital-based outpatient elective surgical discharges, 180-day S. aureus incidence was 1.19% (0.25% BSI, 0.75% SSI no BSI, 0.19% all other types only). Methicillin resistance was observed in ~45% of the S. aureus infections. We estimated 55 764 S. aureus postsurgical infections occurred annually in the US following 4.2 million elective inpatient surgical discharges.
Conclusions
The high burden of S. aureus infections after both inpatient and outpatient elective surgeries highlights the continued need for surveillance and novel infection prevention efforts.
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Affiliation(s)
- Jill Dreyfus
- Premier Applied Sciences, Premier, Inc, Charlotte, North Carolina, USA
| | - Holly Yu
- Health Economics and Outcomes Research, Pfizer, Inc, Collegeville, Pennsylvania, USA
| | - Elizabeth Begier
- Pfizer Vaccine Research and Development; Pfizer, Inc, Pearl River, New York, USA
| | - Julie Gayle
- Premier Applied Sciences, Premier, Inc, Charlotte, North Carolina, USA
| | - Margaret A Olsen
- Department of Medicine and Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Rashid N, Begier E, Lin KJ, Yu H. Culture-Confirmed Staphylococcus aureus Infection after Elective Hysterectomy: Burden of Disease and Risk Factors. Surg Infect (Larchmt) 2019; 21:169-178. [PMID: 31580776 DOI: 10.1089/sur.2019.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/27/2022] Open
Abstract
Background: Our study sought to describe the incidence of culture-confirmed postsurgical Staphylococcus aureus infection after elective hysterectomy and evaluate patient characteristics, risk factors, and economic consequences associated with Staphylococcus aureus infection. Methods: This was a retrospective cohort study of patients in the United States (≥18 years old; Kaiser Permanente health plan members) who underwent elective hysterectomy from 2007 to 2013. Hysterectomies were categorized by surgical setting (inpatient vs. outpatient) and procedure (abdominal, laparoscopic, or vaginal). We estimated the cumulative incidence of culture-confirmed Staphylococcus aureus infection (90 days post-surgery) and compared healthcare resource utilization and costs (within 120 days post-surgery) among patients with/without Staphylococcus aureus infection or with other infection. Results: Among 30,960 patients identified, 20,675 underwent inpatient hysterectomy (abdominal: 47.8%; laparoscopic: 24.8%; vaginal: 27.3%), and 10,285 underwent outpatient hysterectomy (laparoscopic: 86.1%; vaginal: 13.9%). The incidence of culture-confirmed Staphylococcus aureus infection was 0.8% and 0.4% for inpatient (abdominal: 1.2%; laparoscopic: 0.5%; vaginal: 0.2%) and outpatient (laparoscopic: 0.5%; vaginal: 0.1%) surgery, respectively. Patients with Staphylococcus aureus infection had more emergency department visits, hospitalizations, and re-operations compared with patients without infection or with non-Staphylococcus aureus infection. Mean total costs for patients with Staphylococcus aureus infection were higher (inpatient: $18,261; outpatient: $4,422) compared with patients without infection (inpatient: $6,171; p < 0.0001; outpatient: $905; p = 0.0023) or non-Staphylococcus aureus infection (inpatient: $11,207; p = 0.0117; outpatient: $3,005; p = 0.2117). Conclusions: Culture-confirmed postsurgical Staphylococcus aureus infection incidence was predominately associated with procedure type rather than surgical setting. Patients with post-surgical Staphylococcus aureus infection had higher health care utilization and costs than those without infection or with other infection types. Additional effective infection control strategies are needed to reduce the morbidity and costs associated with Staphylococcus aureus infection.
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Affiliation(s)
- Nazia Rashid
- Kaiser Permanente Southern California, Drug Information Services Research Group, Downey, California
| | | | - Kathy J Lin
- Kaiser Permanente Southern California, Drug Information Services Research Group, Downey, California
| | - Holly Yu
- Pfizer Inc, Outcomes & Evidence, Global Health & Value, New York, New York
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Dreyfus J, Begier E, Yu H, Quintana A, Gayle J, Olsen MA. 1228. Incidence of Staphylococcus aureus Infection after Elective Surgeries Among Adults in US Hospitals. Open Forum Infect Dis 2018. [PMCID: PMC6253451 DOI: 10.1093/ofid/ofy210.1061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Abstract
Abstract
Background
Staphylococcus aureus is a leading cause of postsurgical infections. National estimates of these infections after elective surgeries based on microbiology data are limited. This study assessed 180-day postsurgical S. aureus incidence in real-world hospital settings.
Methods
Adults (≥18 years) who underwent elective surgery during a hospital-based outpatient or inpatient encounter from July 1, 2010–June 30, 2015 at one of 181 hospitals reporting microbiology results in the Premier Healthcare Database (PHD). Eighty-seven surgical categories were defined using ICD-9-CM and CPT procedure codes according to National Hospital Surveillance Network groupings plus additional categories. Microbiology results and ICD-9-CM diagnosis codes were used to identify invasive (e.g., deep incisional and organ-space SSI, bloodstream) and overall (i.e., invasive, superficial incisional, urinary tract, respiratory) S. aureus infections. Cumulative 180-day S. aureus infection rates were calculated as number of infections divided by number of discharges with elective surgeries. National infection volumes were calculated by multiplying infection rates by national inpatient elective surgery estimates using surgery counts in the entire PHD (665 hospitals) and weights based on hospital characteristics.
Results
Following 1,116,994 hospital-based outpatient elective surgeries, 180-day S. aureus incidence was 1.19% overall, with 0.38% complicated by invasive S. aureus infections. Among 884,803 inpatient elective surgeries, overall and invasive 180-day S. aureus infection incidence was 1.35% and 0.53%, respectively. This translated to an estimated 57,200 S. aureus infections (22,400 invasive) among an estimated 4.2 million elective inpatient surgeries annually in the US methicillin-resistance (MRSA) was observed in 45% and 46% of S. aureus infections after inpatient and outpatient surgeries, respectively. Figure 1 shows cumulative S. aureus incidence rates at each time point after outpatient and inpatient elective surgeries. Figure 2 delineates the incidence rates for each type of S. aureus infection.
Conclusion
Our study indicated similar S. aureus infection rates after inpatient and outpatient elective surgeries. The results highlight the much larger burden of disease of S. aureus infection in the United States beyond inpatient surgeries.
Disclosures
J. Dreyfus, Premier, Inc.: Employee and Shareholder, Salary. E. Begier, Pfizer, Inc.: Employee and Shareholder, Salary. H. Yu, Pfizer, Inc.: Employee and Shareholder, Salary. A. Quintana, Pfizer, Inc.: Employee and Shareholder, Salary. J. Gayle, Premier, Inc.: Employee, Salary. M. A. Olsen, Pfizer: Consultant, Consulting fee.
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Affiliation(s)
- Jill Dreyfus
- Premier Applied Sciences, Premier, Inc., Stillwater, Minnesota
| | | | - Holly Yu
- Pfizer, Inc., Collegeville, Pennsylvania
| | - Alvaro Quintana
- WW Medicines Development and Scientific Affairs, Pfizer Inc., Collegeville, Pennsylvania
| | | | - Margaret A Olsen
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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