1
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Jin SL, Kolis J, Parker J, Proctor DA, Prybylski D, Wardle C, Abad N, Brookmeyer KA, Voegeli C, Chiou H. Social histories of public health misinformation and infodemics: case studies of four pandemics. Lancet Infect Dis 2024:S1473-3099(24)00105-1. [PMID: 38648811 DOI: 10.1016/s1473-3099(24)00105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 04/25/2024]
Abstract
Recognition of misinformation as a public health threat and interest in infodemics, defined as an inundation of information accompanying an epidemic or acute health event, have increased worldwide. However, scientists have no consensus on how to best define and identify misinformation and other essential characteristics of infodemics. We conducted a narrative review of secondary historical sources to examine previous infodemics in relation to four infectious diseases associated with pandemics (ie, smallpox, cholera, 1918 influenza, and HIV) and challenge the assumption that misinformation is a new phenomenon associated with increased use of social media or with the COVID-19 pandemic. On the contrary, we found that the spread of health misinformation has always been a public health challenge that has necessitated innovative solutions from medical and public health communities. We suggest expanding beyond the narrow scope of addressing misinformation to manage information ecosystems, defined as how people consume, produce, interact with, and behave around information, which include factors such as trust, stigma, and scientific literacy. Although misinformation can spread on a global scale, this holistic approach advocates for community-level interventions that improve relationships and trust between medical or public health entities and local populations.
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Affiliation(s)
- Sabrina L Jin
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Kolis
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jessica Parker
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Claire Wardle
- School of Public Health, Brown University, Providence, RI, USA
| | - Neetu Abad
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Howard Chiou
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, US Public Health Service, Rockville, MD, USA
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2
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Ishizumi A, Kolis J, Abad N, Prybylski D, Brookmeyer KA, Voegeli C, Wardle C, Chiou H. Beyond misinformation: developing a public health prevention framework for managing information ecosystems. Lancet Public Health 2024:S2468-2667(24)00031-8. [PMID: 38648815 DOI: 10.1016/s2468-2667(24)00031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 04/25/2024]
Abstract
The COVID-19 pandemic has highlighted how infodemics (defined as an overabundance of information, including misinformation and disinformation) pose a threat to public health and could hinder individuals from making informed health decisions. Although public health authorities and other stakeholders have implemented measures for managing infodemics, existing frameworks for infodemic management have been primarily focused on responding to acute health emergencies rather than integrated in routine service delivery. We review the evidence and propose a framework for infodemic management that encompasses upstream strategies and provides guidance on identifying different interventions, informed by the four levels of prevention in public health: primary, secondary, tertiary, and primordial prevention. On the basis of a narrative review of 54 documents (peer-reviewed and grey literature published from 1961 to 2023), we present examples of interventions that belong to each level of prevention. Adopting this framework requires proactive prevention and response through managing information ecosystems, beyond reacting to misinformation or disinformation.
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Affiliation(s)
- Atsuyoshi Ishizumi
- Task Force for Global Health, Decatur, GA, USA; US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Kolis
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Neetu Abad
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Claire Wardle
- School of Public Health, Brown University, Providence, RI, USA
| | - Howard Chiou
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, US Public Health Service, Rockville, MD, USA
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3
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Wilhelm E, Ballalai I, Belanger ME, Benjamin P, Bertrand-Ferrandis C, Bezbaruah S, Briand S, Brooks I, Bruns R, Bucci LM, Calleja N, Chiou H, Devaria A, Dini L, D'Souza H, Dunn AG, Eichstaedt JC, Evers SMAA, Gobat N, Gissler M, Gonzales IC, Gruzd A, Hess S, Ishizumi A, John O, Joshi A, Kaluza B, Khamis N, Kosinska M, Kulkarni S, Lingri D, Ludolph R, Mackey T, Mandić-Rajčević S, Menczer F, Mudaliar V, Murthy S, Nazakat S, Nguyen T, Nilsen J, Pallari E, Pasternak Taschner N, Petelos E, Prinstein MJ, Roozenbeek J, Schneider A, Srinivasan V, Stevanović A, Strahwald B, Syed Abdul S, Varaidzo Machiri S, van der Linden S, Voegeli C, Wardle C, Wegwarth O, White BK, Willie E, Yau B, Purnat TD. Measuring the Burden of Infodemics: Summary of the Methods and Results of the Fifth WHO Infodemic Management Conference. JMIR Infodemiology 2023; 3:e44207. [PMID: 37012998 PMCID: PMC9989916 DOI: 10.2196/44207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/09/2023] [Accepted: 01/26/2023] [Indexed: 01/27/2023]
Abstract
Background An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. Objective In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. Methods An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health-implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. Results The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. Conclusions Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.
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Affiliation(s)
- Elisabeth Wilhelm
- US Centers for Disease Control and Prevention Atlanta, GA United States
| | | | - Marie-Eve Belanger
- Department of Political Science and International Relations Université de Genève Geneva Switzerland
| | | | | | - Supriya Bezbaruah
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Sylvie Briand
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Ian Brooks
- Center for Health Informatics School of Information Sciences University of Illinois Champaign, IL United States
| | - Richard Bruns
- Johns Hopkins Center for Health Security Baltimore, MD United States
| | - Lucie M Bucci
- Immunize Canada Canadian Public Health Association Ottawa, ON Canada
| | - Neville Calleja
- Directorate for Health Information and Research Ministry for Health Valletta Malta
| | - Howard Chiou
- US Centers for Disease Control and Prevention Atlanta, GA United States
- US Public Health Service Commissioned Corps Rockville, MD United States
| | | | - Lorena Dini
- Working Group Health Policy and Systems Research and Innovation Institute for General Practice Charité Universitätsmedizin Berlin Berlin Germany
| | - Hyjel D'Souza
- The George Institute for Global Health New Delhi India
| | - Adam G Dunn
- Biomedical Informatics and Digital Health Faculty of Medicine and Health University of Sydney Sydney Australia
| | - Johannes C Eichstaedt
- Department of Psychology Stanford University Stanford, CA United States
- Institute for Human-Centered AI Stanford University Stanford, CA United States
| | - Silvia M A A Evers
- Department of Health Services Research Maastricht University Maastricht Netherlands
| | - Nina Gobat
- Department of Country Readiness Strengthening World Health Organization Geneva Switzerland
| | - Mika Gissler
- Department of Knowledge Brokers THL Finnish Institute for Health and Welfare Helsinki Finland
| | - Ian Christian Gonzales
- Field Epidemiology Training Program Epidemiology Bureau Department of Health Manila Philippines
| | - Anatoliy Gruzd
- Ted Rogers School of Management Toronto Metropolitan University Toronto, ON Canada
| | - Sarah Hess
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Atsuyoshi Ishizumi
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Oommen John
- The George Institute for Global Health New Delhi India
| | - Ashish Joshi
- Department of Epidemiology and Biostatistics Graduate School of Public Health and Health Policy City University of New York New York, NY United States
| | - Benjamin Kaluza
- Department Technological Analysis and Strategic Planning Fraunhofer Institute for Technological Trend Analysis INT Euskirchen Germany
| | - Nagwa Khamis
- Infection Prevention and Control Department Children's Cancer Hospital Egypt-57357 Ain Shams University Specialized Hospital Cairo Egypt
| | - Monika Kosinska
- Department of Social Determinants World Health Organization Geneva Switzerland
| | - Shibani Kulkarni
- US Centers for Disease Control and Prevention Atlanta, GA United States
| | - Dimitra Lingri
- European Healthcare Fraud and Corruption Network Aristotle Universtity of Thessaloniki Brussels Belgium
| | - Ramona Ludolph
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Tim Mackey
- Global Health Program Department of Anthropology University of California San Diego, CA United States
| | | | - Filippo Menczer
- Observatory on Social Media Luddy School of Informatics, Computing, and Engineering Indiana University Bloomington, IN United States
| | | | - Shruti Murthy
- The George Institute for Global Health New Delhi India
| | - Syed Nazakat
- DataLEADS (Health Analytics Asia) New Delhi India
| | - Tim Nguyen
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Jennifer Nilsen
- Technology and Social Change Project Harvard University Cambridge, MA United States
| | - Elena Pallari
- Health Innovation Network Guy's and St Thomas' Hospital London United Kingdom
| | - Natalia Pasternak Taschner
- Center of Science and Society Columbia University New York, NY United States
- Instituto Questão de Ciência São Paulo Brazil
| | - Elena Petelos
- Department of Health Services Research Care and Public Health Research Institute Maastricht University Maastricht Netherlands
- Clinic of Social and Family Medicine Faculty of Medicine University of Crete Heraklion Greece
| | - Mitchell J Prinstein
- American Psychological Association Washington DC, DC United States
- Department of Psychology and Neuroscience University of North Carolina at Chapel Hill Chapel Hill, NC United States
| | - Jon Roozenbeek
- Department of Psychology University of Cambridge Cambridge United Kingdom
| | - Anton Schneider
- Bureau for Global Health Office of Infectious Disease United States Agency for International Development Washington DC, DC United States
| | | | - Aleksandar Stevanović
- Institute of Social Medicine Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Brigitte Strahwald
- Pettenkofer School of Public Health Ludwig-Maximilians-Universität München Munich Germany
| | - Shabbir Syed Abdul
- The George Institute for Global Health New Delhi India
- Graduate Institute of Biomedical Informatics Taipei Medical University Taipei Taiwan
| | | | | | - Christopher Voegeli
- Office of the Director National Center for Immunization and Respiratory Diseases US Centers for Disease Control and Prevention Atlanta, GA United States
| | - Claire Wardle
- Information Futures Lab School of Public Health Brown University Providence, RI United States
| | - Odette Wegwarth
- Heisenberg Chair for Medical Risk Literacy & Evidence-Based Decisions Charite - Universitätsmedizin Berlin Berlin Germany
| | - Becky K White
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Estelle Willie
- Communications, Policy, Advocacy The Rockefeller Foundation New York, NY United States
| | - Brian Yau
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
| | - Tina D Purnat
- Department of Epidemic and Pandemic Preparedness and Prevention World Health Organization Geneva Switzerland
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4
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Chiou H, Voegeli C, Wilhelm E, Kolis J, Brookmeyer K, Prybylski D. The Future of Infodemic Surveillance as Public Health Surveillance. Emerg Infect Dis 2022; 28:S121-S128. [PMID: 36502389 DOI: 10.3201/eid2813.220696] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Public health systems need to be able to detect and respond to infodemics (outbreaks of misinformation, disinformation, information overload, or information voids). Drawing from our experience at the US Centers for Disease Control and Prevention, the COVID-19 State of Vaccine Confidence Insight Reporting System has been created as one of the first public health infodemic surveillance systems. Key functions of infodemic surveillance systems include monitoring the information environment by person, place, and time; identifying infodemic events with digital analytics; conducting offline community-based assessments; and generating timely routine reports. Although specific considerations of several system attributes of infodemic surveillance system must be considered, infodemic surveillance systems share several similarities with traditional public health surveillance systems. Because both information and pathogens are spread more readily in an increasingly hyperconnected world, sustainable and routine systems must be created to ensure that timely interventions can be deployed for both epidemic and infodemic response.
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5
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Woodruff RC, Eliapo-Unutoa I, Chiou H, Gayapa M, Noonan S, Podila PSB, Rayle V, Sanchez G, Tulafono R, Van Beneden CA, Ritchey M. Period Prevalence of Rheumatic Heart Disease and the Need for a Centralized Patient Registry in American Samoa, 2016 to 2018. J Am Heart Assoc 2021; 10:e020424. [PMID: 34612073 PMCID: PMC8751893 DOI: 10.1161/jaha.120.020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Rheumatic heart disease (RHD) is a severe, chronic complication of acute rheumatic fever, triggered by group A streptococcal pharyngitis. Centralized patient registries are recommended for RHD prevention and control, but none exists in American Samoa. Using existing RHD tracking systems, we estimated RHD period prevalence and the proportion of people with RHD documented in the electronic health record. Methods and Results RHD cases were identified from a centralized electronic health record system, which retrieved clinical encounters with RHD International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes, clinical problem lists referencing RHD, and antibiotic prophylaxis administration records; 3 RHD patient tracking spreadsheets; and an all‐cause mortality database. RHD cases had ≥1 clinical encounter with RHD ICD‐10‐CM codes, a diagnostic echocardiogram, or RHD as a cause of death, or were included in RHD patient tracking spreadsheets. Period prevalence per 1000 population among children aged <18 years and adults aged ≥18 years from 2016 to 2018 and the proportion of people with RHD with ≥1 clinical encounter with an RHD ICD‐10‐CM code were estimated. From 2016 to 2018, RHD was documented in 327 people (57.2%: children aged <18 years). Overall RHD period prevalence was 6.3 cases per 1000 and varied by age (10.0 pediatric cases and 4.3 adult cases per 1000). Only 67% of people with RHD had ≥1 clinical encounter with an RHD ICD‐10‐CM code. Conclusions RHD remains a serious public health problem in American Samoa, and the existing electronic health record does not include all cases. A centralized patient registry could improve tracking people with RHD to ensure they receive necessary care.
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Affiliation(s)
- Rebecca C Woodruff
- Epidemic Intelligence Service Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA.,Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA
| | | | - Howard Chiou
- Epidemic Intelligence Service Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA
| | - Maria Gayapa
- Lyndon B. Johnson Tropical Medical Centers Faga'alu American Samoa
| | - Sara Noonan
- RHDAustralia Menzies School of Health Research Casuarina Australia
| | - Pradeep S B Podila
- Public Health Informatics Fellowship Program Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA
| | - Victoria Rayle
- Office of Insular Affairs Center for State, Tribal, Local, and Territorial Support Centers for Disease Control and Prevention Atlanta GA
| | - Guillermo Sanchez
- Epidemic Intelligence Service Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA
| | - Ray Tulafono
- Lyndon B. Johnson Tropical Medical Centers Faga'alu American Samoa
| | - Chris A Van Beneden
- Division for Bacterial Diseases National Center for Immunization and Respiratory DiseasesCenters for Disease Control and Prevention Atlanta GA
| | - Matthew Ritchey
- Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA
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6
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Bechek S, Garcia M, Chiou H. Severe Gastrointestinal Involvement in Pediatric Stevens-Johnson Syndrome: A Case Report and Review of the Literature. Clin Exp Gastroenterol 2020; 13:377-383. [PMID: 33061516 PMCID: PMC7533238 DOI: 10.2147/ceg.s269349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis form a rare but severe disease spectrum characterized by widespread epidermal detachment. Gastrointestinal manifestations of the disease, however, are rarely described in the pediatric literature and have a high mortality among adults. There are limited data on the treatment of these cases, with conflicting evidence regarding the benefit of steroids, IVIG, or other immunosuppressive agents. We review previous instances of gastrointestinal involvement in children and report the case of a previously healthy 13-year-old who presented with the typical ocular and skin findings of Stevens-Johnson syndrome, subsequently developed severe life-threatening diarrhea, and was found to have severe esophagitis, duodenitis, and colitis on endoscopic evaluation. Treatment was initiated with an immediate, short course of steroids along with early introduction of an enteral diet via nasogastric tube, and resulted in full gastrointestinal recovery. This case highlights successful medical treatment of the first reported pediatric case of SJS/TEN with both upper and lower gastrointestinal tract involvement.
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Affiliation(s)
- Sophia Bechek
- Stanford University School of Medicine, Stanford, CA, USA
| | - Manuel Garcia
- Division of Pediatric Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Howard Chiou
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
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7
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Burke RM, Balter S, Barnes E, Barry V, Bartlett K, Beer KD, Benowitz I, Biggs HM, Bruce H, Bryant-Genevier J, Cates J, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu VT, Clark S, Cody SH, Cohen M, Conners EE, Dasari V, Dawson P, DeSalvo T, Donahue M, Dratch A, Duca L, Duchin J, Dyal JW, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Freeman-Ponder B, Fry AM, Gant J, Gautom R, Ghinai I, Gounder P, Grigg CT, Gunzenhauser J, Hall AJ, Han GS, Haupt T, Holshue M, Hunter J, Ibrahim MB, Jacobs MW, Jarashow MC, Joshi K, Kamali T, Kawakami V, Kim M, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Lang M, Layden J, Leidman E, Lindquist S, Lindstrom S, Link-Gelles R, Marlow M, Mattison CP, McClung N, McPherson TD, Mello L, Midgley CM, Novosad S, Patel MT, Pettrone K, Pillai SK, Pray IW, Reese HE, Rhodes H, Robinson S, Rolfes M, Routh J, Rubin R, Rudman SL, Russell D, Scott S, Shetty V, Smith-Jeffcoat SE, Soda EA, Spitters C, Stierman B, Sunenshine R, Terashita D, Traub E, Vahey GM, Verani JR, Wallace M, Westercamp M, Wortham J, Xie A, Yousaf A, Zahn M. Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS One 2020; 15:e0238342. [PMID: 32877446 DOI: 10.1101/2020.04.27.20081901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/15/2020] [Indexed: 05/24/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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Affiliation(s)
- Rachel M Burke
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon Balter
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Emily Barnes
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vaughn Barry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karri Bartlett
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Karlyn D Beer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaac Benowitz
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Holly M Biggs
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollianne Bruce
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Jonathan Bryant-Genevier
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jordan Cates
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Chatham-Stephens
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nora Chea
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Howard Chiou
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Demian Christiansen
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Victoria T Chu
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shauna Clark
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Sara H Cody
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Max Cohen
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Erin E Conners
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vishal Dasari
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick Dawson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Traci DeSalvo
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Matthew Donahue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alissa Dratch
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
| | - Lindsey Duca
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Duchin
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Jonathan W Dyal
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R Feldstein
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marty Fenstersheib
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Marc Fischer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Fisher
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Chelsea Foo
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Brandi Freeman-Ponder
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia M Fry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Gant
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Romesh Gautom
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Isaac Ghinai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Prabhu Gounder
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Cheri T Grigg
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Gunzenhauser
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Aron J Hall
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - George S Han
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Thomas Haupt
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Michelle Holshue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Jennifer Hunter
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mireille B Ibrahim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Max W Jacobs
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - M Claire Jarashow
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Kiran Joshi
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Talar Kamali
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vance Kawakami
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Moon Kim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Hannah L Kirking
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda Kita-Yarbro
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Rachel Klos
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Miwako Kobayashi
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Kocharian
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Misty Lang
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Jennifer Layden
- The COVID-19 Close Contact Investigation Team, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Eva Leidman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Lindquist
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Stephen Lindstrom
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Link-Gelles
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mariel Marlow
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claire P Mattison
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Nancy McClung
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tristan D McPherson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Lynn Mello
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Claire M Midgley
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Novosad
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan T Patel
- The COVID-19 Close Contact Investigation Team, United States of America
- Illinois Department of Public Health, Chicago, Illinois, United States of America
| | - Kristen Pettrone
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Satish K Pillai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ian W Pray
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Heather E Reese
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather Rhodes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wyoming Department of Health, Cheyenne, Wyoming, United States of America
| | - Susan Robinson
- The COVID-19 Close Contact Investigation Team, United States of America
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Melissa Rolfes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Janell Routh
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Rubin
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Sarah L Rudman
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Denny Russell
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Sarah Scott
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Varun Shetty
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah E Smith-Jeffcoat
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth A Soda
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher Spitters
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Bryan Stierman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Sunenshine
- The COVID-19 Close Contact Investigation Team, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Dawn Terashita
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Elizabeth Traub
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Grace M Vahey
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer R Verani
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan Wallace
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Westercamp
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Wortham
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy Xie
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Yousaf
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Zahn
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
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8
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Burke RM, Balter S, Barnes E, Barry V, Bartlett K, Beer KD, Benowitz I, Biggs HM, Bruce H, Bryant-Genevier J, Cates J, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu VT, Clark S, Cody SH, Cohen M, Conners EE, Dasari V, Dawson P, DeSalvo T, Donahue M, Dratch A, Duca L, Duchin J, Dyal JW, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Freeman-Ponder B, Fry AM, Gant J, Gautom R, Ghinai I, Gounder P, Grigg CT, Gunzenhauser J, Hall AJ, Han GS, Haupt T, Holshue M, Hunter J, Ibrahim MB, Jacobs MW, Jarashow MC, Joshi K, Kamali T, Kawakami V, Kim M, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Lang M, Layden J, Leidman E, Lindquist S, Lindstrom S, Link-Gelles R, Marlow M, Mattison CP, McClung N, McPherson TD, Mello L, Midgley CM, Novosad S, Patel MT, Pettrone K, Pillai SK, Pray IW, Reese HE, Rhodes H, Robinson S, Rolfes M, Routh J, Rubin R, Rudman SL, Russell D, Scott S, Shetty V, Smith-Jeffcoat SE, Soda EA, Spitters C, Stierman B, Sunenshine R, Terashita D, Traub E, Vahey GM, Verani JR, Wallace M, Westercamp M, Wortham J, Xie A, Yousaf A, Zahn M. Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS One 2020; 15:e0238342. [PMID: 32877446 PMCID: PMC7467265 DOI: 10.1371/journal.pone.0238342] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/15/2020] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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Affiliation(s)
- Rachel M. Burke
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon Balter
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Emily Barnes
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vaughn Barry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karri Bartlett
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Karlyn D. Beer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaac Benowitz
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Holly M. Biggs
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollianne Bruce
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Jonathan Bryant-Genevier
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jordan Cates
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Chatham-Stephens
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nora Chea
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Howard Chiou
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Demian Christiansen
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Victoria T. Chu
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shauna Clark
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Sara H. Cody
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Max Cohen
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Erin E. Conners
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vishal Dasari
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick Dawson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Traci DeSalvo
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Matthew Donahue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alissa Dratch
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
| | - Lindsey Duca
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Duchin
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Jonathan W. Dyal
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R. Feldstein
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marty Fenstersheib
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Marc Fischer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Fisher
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Chelsea Foo
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Brandi Freeman-Ponder
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia M. Fry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Gant
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Romesh Gautom
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Isaac Ghinai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Prabhu Gounder
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Cheri T. Grigg
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Gunzenhauser
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Aron J. Hall
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - George S. Han
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Thomas Haupt
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Michelle Holshue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Jennifer Hunter
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mireille B. Ibrahim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Max W. Jacobs
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - M. Claire Jarashow
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Kiran Joshi
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Talar Kamali
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vance Kawakami
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Moon Kim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Hannah L. Kirking
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda Kita-Yarbro
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Rachel Klos
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Miwako Kobayashi
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Kocharian
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Misty Lang
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Jennifer Layden
- The COVID-19 Close Contact Investigation Team, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Eva Leidman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Lindquist
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Stephen Lindstrom
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Link-Gelles
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mariel Marlow
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claire P. Mattison
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Nancy McClung
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tristan D. McPherson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Lynn Mello
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Claire M. Midgley
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Novosad
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan T. Patel
- The COVID-19 Close Contact Investigation Team, United States of America
- Illinois Department of Public Health, Chicago, Illinois, United States of America
| | - Kristen Pettrone
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Satish K. Pillai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ian W. Pray
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Heather E. Reese
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather Rhodes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wyoming Department of Health, Cheyenne, Wyoming, United States of America
| | - Susan Robinson
- The COVID-19 Close Contact Investigation Team, United States of America
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Melissa Rolfes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Janell Routh
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Rubin
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Sarah L. Rudman
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Denny Russell
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Sarah Scott
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Varun Shetty
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah E. Smith-Jeffcoat
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth A. Soda
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher Spitters
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Bryan Stierman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Sunenshine
- The COVID-19 Close Contact Investigation Team, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Dawn Terashita
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Elizabeth Traub
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Grace M. Vahey
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer R. Verani
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan Wallace
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Westercamp
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Wortham
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy Xie
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Yousaf
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Zahn
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
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Kujawski SA, Wong KK, Collins JP, Epstein L, Killerby ME, Midgley CM, Abedi GR, Ahmed NS, Almendares O, Alvarez FN, Anderson KN, Balter S, Barry V, Bartlett K, Beer K, Ben-Aderet MA, Benowitz I, Biggs H, Binder AM, Black SR, Bonin B, Brown CM, Bruce H, Bryant-Genevier J, Budd A, Buell D, Bystritsky R, Cates J, Charles EM, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu V, Cody S, Cohen M, Conners E, Curns A, Dasari V, Dawson P, DeSalvo T, Diaz G, Donahue M, Donovan S, Duca LM, Erickson K, Esona MD, Evans S, Falk J, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Fricchione MJ, Friedman O, Fry AM, Galang RR, Garcia MM, Gerber SI, Gerrard G, Ghinai I, Gounder P, Grein J, Grigg C, Gunzenhauser JD, Gutkin GI, Haddix M, Hall AJ, Han G, Harcourt J, Harriman K, Haupt T, Haynes A, Holshue M, Hoover C, Hunter JC, Jacobs MW, Jarashow C, Jhung MA, Joshi K, Kamali T, Kamili S, Kim L, Kim M, King J, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Komatsu KK, Koppaka R, Layden JE, Li Y, Lindquist S, Lindstrom S, Link-Gelles R, Lively J, Livingston M, Lo K, Lo J, Lu X, Lynch B, Madoff L, Malapati L, Marks G, Marlow M, Mathisen GE, McClung N, McGovern O, McPherson TD, Mehta M, Meier A, Mello L, Moon SS, Morgan M, Moro RN, Murray J, Murthy R, Novosad S, Oliver SE, O'Shea J, Pacilli M, Paden CR, Pallansch MA, Patel M, Patel S, Pedraza I, Pillai SK, Pindyck T, Pray I, Queen K, Quick N, Reese H, Rha B, Rhodes H, Robinson S, Robinson P, Rolfes M, Routh J, Rubin R, Rudman SL, Sakthivel SK, Scott S, Shepherd C, Shetty V, Smith EA, Smith S, Stierman B, Stoecker W, Sunenshine R, Sy-Santos R, Tamin A, Tao Y, Terashita D, Thornburg NJ, Tong S, Traub E, Tural A, Uehara A, Uyeki TM, Vahey G, Verani JR, Villarino E, Wallace M, Wang L, Watson JT, Westercamp M, Whitaker B, Wilkerson S, Woodruff RC, Wortham JM, Wu T, Xie A, Yousaf A, Zahn M, Zhang J. Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nat Med 2020; 26:861-868. [PMID: 32327757 DOI: 10.1101/2020.03.09.20032896] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/06/2020] [Indexed: 05/28/2023]
Abstract
Data on the detailed clinical progression of COVID-19 in conjunction with epidemiological and virological characteristics are limited. In this case series, we describe the first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020, including 4 patients described previously1-3. Respiratory, stool, serum and urine specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing, viral culture and whole genome sequencing. Median age was 53 years (range: 21-68); 8 patients were male. Common symptoms at illness onset were cough (n = 8) and fever (n = 7). Patients had mild to moderately severe illness; seven were hospitalized and demonstrated clinical or laboratory signs of worsening during the second week of illness. No patients required mechanical ventilation and all recovered. All had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset. Lowest real-time PCR with reverse transcription cycle threshold values in the upper respiratory tract were often detected in the first week and SARS-CoV-2 was cultured from early respiratory specimens. These data provide insight into the natural history of SARS-CoV-2. Although infectiousness is unclear, highest viral RNA levels were identified in the first week of illness. Clinicians should anticipate that some patients may worsen in the second week of illness.
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Hsieh F, Huang J, Lien L, Chiou H. Significant association of SIRT1 rs12765828 T allele with risk of early-onset ischemic stroke. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Chiou H, Jopling JK, Scott JY, Ramsey M, Vranas K, Wagner TH, Milstein A. Detecting organisational innovations leading to improved ICU outcomes: a protocol for a double-blinded national positive deviance study of critical care delivery. BMJ Open 2017; 7:e015930. [PMID: 28615274 PMCID: PMC5541524 DOI: 10.1136/bmjopen-2017-015930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is substantial variability in intensive care unit (ICU) utilisation and quality of care. However, the factors that drive this variation are poorly understood. This study uses a novel adaptation of positive deviance approach-a methodology used in public health that assumes solutions to challenges already exist within the system to detect innovations that are likely to improve intensive care. METHODS AND ANALYSIS We used the Philips eICU Research Institute database, containing 3.3 million patient records from over 50 health systems across the USA. Acute Physiology and Chronic Health Evaluation IVa scores were used to identify the study cohort, which included ICU patients whose outcomes were felt to be most sensitive to organisational innovations. The primary outcomes included mortality and length of stay. Outcome measurements were directly standardised, and bootstrapped CIs were calculated with adjustment for false discovery rate. Using purposive sampling, we then generated a blinded list of five positive outliers and five negative comparators.Using rapid qualitative inquiry (RQI), blinded interdisciplinary site visit teams will conduct interviews and observations using a team ethnography approach. After data collection is completed, the data will be unblinded and analysed using a cross-case method to identify themes, patterns and innovations using a constant comparative grounded theory approach. This process detects the innovations in intensive care and supports an evaluation of how positive deviance and RQI methods can be adapted to healthcare. ETHICS AND DISSEMINATION The study protocol was approved by the Stanford University Institutional Review Board (reference: 39509). We plan on publishing study findings and methodological guidance in peer-reviewed academic journals, white papers and presentations at conferences.
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Affiliation(s)
- Howard Chiou
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
- Emory University School of Medicine Medical Scientist Training Program and Department of Anthropology, Emory University, Atlanta, USA
| | - Jeffrey K Jopling
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
- Gordon and Betty Moore Foundation, Palo Alto, USA
| | - Jennifer Yang Scott
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Meghan Ramsey
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Kelly Vranas
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Todd H Wagner
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
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Chen Y, Hsieh F, Hsieh Y, Jeng J, Lien L, Lin H, Hu C, Peng G, Chern C, Chen C, Tang S, Chi N, Sung Y, Chiou H. Significant association between genetic polymorphisms of gckr and glut1, and ischemic stroke. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Liao P, Chiou H, Chen C, Hsu K. 983: Hypermethylation biomarkers associated with inorganic arsenic metabolism are predictors to the occurrence of internal organ cancers among arseniasis residents. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chiou H, Yang S, Hsieh M. 160: Pterostilbene inhibit hepatocellular carcinoma cells proliferation by induce autophagy and apoptosis in vitro. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tang P, Chan HK, Chiou H, Ogawa K, Jones MD, Adi H, Buckton G, Prud'homme RK, Raper JA. Characterisation and aerosolisation of mannitol particles produced via confined liquid impinging jets. Int J Pharm 2008; 367:51-7. [PMID: 18848874 DOI: 10.1016/j.ijpharm.2008.09.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 09/12/2008] [Accepted: 09/12/2008] [Indexed: 10/21/2022]
Abstract
Mannitol particles, produced by spray drying (SD), have been used commercially (Aridol) in bronchial provocation test. In this study, we propose an alternative method to produce inhalable mannitol powders. The elongated mannitol particles (number median length 4.0microm, and axial ratio of 3.5) were prepared using a confined liquid impinging jets (CLIJs) followed by jet milling (JM). Spray dried and jet milled raw mannitol particles were compared in an attempt to assess the performance of the particles produced by the new method. Aerosol performance of the three different powders (CLIJ, SD, and JM) was relatively poor (fine particle fraction or FPF(loaded) below 15%) when dispersed by the Rotahaler. Dispersion through the Aeroliser led to better aerosol performance of the CLIJ mannitol (FPF(loaded) 20.3%), which is worse than the JM (FPF(loaded) 30.3%) and SD mannitol particles (FPF(loaded) 45.7%) at 60 L/min, but comparable (FPF(loaded) 40.0%) with those of the JM (FPF(loaded) 40.7%) and SD (FPF(loaded) 45.5%) powders at 100L/min. Hence, the optimum use of these elongated mannitol particles can be achieved at increased air flow with a more efficient inhaler. In addition to crystallinity, morphology, and particle size distribution, the surface energies of these powders were measured to explain the differences in aerosol performance. A major advantage of using the CLIJ method is that it can be scaled up with a good yield as the precipitate can be largely collected and recovered on a filter, compared with spray drying which has a low collection efficiency for fine particles below 2microm.
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Affiliation(s)
- P Tang
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, New South Wales 2006, Australia.
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