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Amarin JZ, Dulek DE, Simmons J, Hayek H, Chappell JD, Nochowicz CH, Kitko CL, Schuster JE, Muñoz FM, Bocchini CE, Moulton EA, Coffin SE, Freedman JL, Ardura MI, Wattier RL, Maron G, Grimley M, Paulsen G, Danziger-Isakov L, Carpenter PA, Englund JA, Halasa NB, Spieker AJ, Kalams SA. Immunophenotypic predictors of influenza vaccine immunogenicity in pediatric hematopoietic cell transplant recipients. Blood Adv 2024; 8:1880-1892. [PMID: 38386973 PMCID: PMC11007439 DOI: 10.1182/bloodadvances.2023012118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
ABSTRACT Pediatric hematopoietic cell transplant (HCT) recipients exhibit poor serologic responses to influenza vaccination early after transplant. To facilitate the optimization of influenza vaccination timing, we sought to identify B- and T-cell subpopulations associated with influenza vaccine immunogenicity in this population. We used mass cytometry to phenotype peripheral blood mononuclear cells collected from pediatric HCT recipients enrolled in a multicenter influenza vaccine trial comparing high- and standard-dose formulations over 3 influenza seasons (2016-2019). We fit linear regression models to estimate relationships between immune cell subpopulation numbers before vaccination and prevaccination to postvaccination geometric mean fold rises in antigen-specific (A/H3N2, A/H1N1, and B/Victoria) serum hemagglutination inhibition antibody titers (28-42 days, and ∼6 months after 2 doses). For cell subpopulations identified as predictive of a response to all 3 antigens, we conducted a sensitivity analysis including time after transplant as an additional covariate. Among 156 HCT recipients, we identified 33 distinct immune cell subpopulations; 7 significantly predicted responses to all 3 antigens 28 to 42 days after a 2-dose vaccine series, irrespective of vaccine dose. We also found evidence that baseline absolute numbers of naïve B cells, naïve CD4+ T cells, and circulating T follicular helper cells predicted peak and sustained vaccine-induced titers irrespective of dose or timing of posttransplant vaccine administration. In conclusion, several B- and T-cell subpopulations predicted influenza vaccine immunogenicity in pediatric HCT recipients. This study provides insights into the immune determinants of vaccine responses and may help guide the development of tailored vaccination strategies for this vulnerable population.
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Affiliation(s)
- Justin Z. Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Epidemiology Doctoral Program, School of Medicine, Vanderbilt University, Nashville, TN
| | - Daniel E. Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua Simmons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Haya Hayek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Carrie L. Kitko
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Flor M. Muñoz
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
- Department of Molecular Virology and Microbiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | - Claire E. Bocchini
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | - Elizabeth A. Moulton
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | - Susan E. Coffin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jason L. Freedman
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Monica I. Ardura
- Division of Infectious Diseases and Host Defense Program, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Rachel L. Wattier
- Department of Pediatrics, University of California San Francisco and Benioff Children’s Hospital, San Francisco, CA
| | - Gabriela Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN
| | - Michael Grimley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Grant Paulsen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Lara Danziger-Isakov
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Paul A. Carpenter
- Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, WA
| | - Janet A. Englund
- Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, WA
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Spyros A. Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN
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LaCourse SM, Wetzler EA, Aurelio MC, Escudero JN, Selke SS, Greninger AL, Goecker EA, Barnes SR, Arnould IS, Pérez-Osorio AC, Richardson BA, Kachikis A, Englund JA, Drake AL. Hybrid Immunity to Severe Acute Respiratory Syndrome Coronavirus 2 During Pregnancy Provides More Durable Infant Antibody Responses Compared to Natural Infection or Vaccination Alone. J Infect Dis 2024; 229:1241-1243. [PMID: 38285008 DOI: 10.1093/infdis/jiae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 01/30/2024] Open
Affiliation(s)
- Sylvia M LaCourse
- Division of Allergy and Infectious Diseases, Department of Medicine
- Department of Global Health
- Department of Epidemiology
| | | | | | | | | | | | | | | | | | | | | | | | - Janet A Englund
- Department of Pediatrics, University of Washington
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington
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Antoon JW, Stopczynski T, Amarin JZ, Stewart LS, Boom JA, Sahni LC, Michaels MG, Williams JV, Englund JA, Klein EJ, Staat MA, Schlaudecker EP, Selvarangan R, Schuster JE, Weinberg GA, Szilagyi PG, Perez A, Moline HL, Spieker AJ, Grijalva CG, Olson SM, Halasa NB. Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children. JAMA Netw Open 2024; 7:e248255. [PMID: 38656577 PMCID: PMC11043895 DOI: 10.1001/jamanetworkopen.2024.8255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Importance Studies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown. Objective To determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings. Design, Setting, and Participants Children younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 US pediatric medical centers affiliated with the Centers for Disease Control and Prevention-sponsored New Vaccine Surveillance Network from December 1, 2016, to March 31, 2020, were included in this cohort study. Nasal and/or throat swabs were collected for research molecular testing for influenza, regardless of clinical testing. Data, including ICD-10 discharge diagnoses and clinical testing for influenza, were obtained through medical record review. Data analysis was performed in August 2023. Main Outcomes and Measures The accuracy of ICD-10-coded discharge diagnoses was characterized using molecular clinical or research laboratory test results as reference. Measures included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Estimates were stratified by setting (ED vs inpatient) and age (0-1, 2-4, and 5-17 years). Results A total of 16 867 children in the ED (median [IQR] age, 2.0 [0.0-4.0] years; 9304 boys [55.2%]) and 17 060 inpatients (median [IQR] age, 1.0 [0.0-4.0] years; 9798 boys [57.4%]) were included. In the ED, ICD-10 influenza diagnoses were highly specific (98.0%; 95% CI, 97.8%-98.3%), with high PPV (88.6%; 95% CI, 88.0%-89.2%) and high NPV (85.9%; 95% CI, 85.3%-86.6%), but sensitivity was lower (48.6%; 95% CI, 47.6%-49.5%). Among inpatients, specificity was 98.2% (95% CI, 98.0%-98.5%), PPV was 82.8% (95% CI, 82.1%-83.5%), sensitivity was 70.7% (95% CI, 69.8%-71.5%), and NPV was 96.5% (95% CI, 96.2%-96.9%). Accuracy of ICD-10 diagnoses varied by patient age, influenza season definition, time between disease onset and testing, and clinical setting. Conclusions and Relevance In this large cohort study, influenza ICD-10 discharge diagnoses were highly specific but moderately sensitive in identifying laboratory-confirmed influenza; the accuracy of influenza diagnoses varied by clinical and epidemiological factors. In the ED and inpatient settings, an ICD-10 diagnosis likely represents a true-positive influenza case.
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Affiliation(s)
- James W Antoon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tess Stopczynski
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin Z Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Leila C Sahni
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Marian G Michaels
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John V Williams
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, Washington
| | - Eileen J Klein
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, Washington
| | - Mary A Staat
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth P Schlaudecker
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Jennifer E Schuster
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Ariana Perez
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi L Moline
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samantha M Olson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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4
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Clopper BR, Zhou Y, Tannis A, Staat MA, Rice M, Boom JA, Sahni LC, Selvarangan R, Harrison CJ, Halasa NB, Stewart LS, Weinberg GA, Szilagyi PG, Klein EJ, Englund JA, Rha B, Lively JY, Ortega-Sanchez IR, McMorrow ML, Moline HL. Medical Costs of RSV-associated Hospitalizations and Emergency Department Visits in Children Aged <5 years: Observational Findings from the New Vaccine Surveillance Network (NVSN), 2016-2019. J Pediatr 2024:114045. [PMID: 38561048 DOI: 10.1016/j.jpeds.2024.114045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To assess medical costs of hospitalizations and emergency department (ED) care associated with respiratory syncytial virus (RSV) disease in children enrolled in the New Vaccine Surveillance Network. STUDY DESIGN We used accounting and prospective surveillance data from six pediatric health systems to assess direct medical costs from laboratory-confirmed RSV-associated hospitalizations (n=2,007) and ED visits (n=1,267) from 2016 through 2019 among children aged <5 years. We grouped costs into categories relevant to clinical care and administrative billing practices. We examined RSV-associated medical costs by care setting using descriptive and bivariate analyses. We assessed associations between known RSV risk factors and hospitalization costs and length of stay (LOS) using chi-square tests of association. RESULTS The median cost was $7,100 (IQR: $4,006-$13,355) per hospitalized child and $503 (IQR: $387-$930) per ED visit. Eighty percent (n=2,628) of our final sample were children aged <2 years. Fewer weeks' gestational age (GA) was associated with higher median costs in hospitalized children [p<0.001, ≥37 weeks' GA: $6,840 ($3,905-$12,450); 29-36 weeks' GA: $7,721 ($4,362-$15,274); <29 w weeks' GA: $9,131 ($4,518-$19,924)]. Full-term infants accounted for 70% of the total expenditures in our sample. Almost three quarters of the healthcare dollars spent originated in children under 12 months of age; the primary age group targeted by recommended RSV prophylactics. CONCLUSIONS Reducing the cost burden for RSV-associated medical care in young children will require prevention of RSV in all young children, not just high-risk infants. Newly available maternal vaccine and immunoprophylaxis products could substantially reduce RSV-associated medical costs.
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Affiliation(s)
- Benjamin R Clopper
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
| | - Yingtao Zhou
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Ayzsa Tannis
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mary Allen Staat
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marilyn Rice
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Julie A Boom
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Leila C Sahni
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | | | | | | | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Joana Y Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Ismael R Ortega-Sanchez
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; U.S. Public Health Service, Rockville, Maryland
| | - Heidi L Moline
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; U.S. Public Health Service, Rockville, Maryland
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5
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Kim AE, Bennett JC, Luiten K, O'Hanlon JA, Wolf CR, Magedson A, Han PD, Acker Z, Regelbrugge L, McCaffrey KM, Stone J, Reinhart D, Capodanno BJ, Morse SS, Bedford T, Englund JA, Boeckh M, Starita LM, Uyeki TM, Carone M, Weil A, Chu HY. Comparative diagnostic utility of SARS-CoV-2 rapid antigen and molecular testing in a community setting. J Infect Dis 2024:jiae150. [PMID: 38531685 DOI: 10.1093/infdis/jiae150] [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: 12/08/2023] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND SARS-CoV-2 antigen-detection rapid diagnostic tests (Ag-RDTs) have become widely utilized but longitudinal characterization of their community-based performance remains incompletely understood. METHODS This prospective longitudinal study at a large public university in Seattle, WA utilized remote enrollment, online surveys, and self-collected nasal swab specimens to evaluate Ag-RDT performance against real-time reverse transcription polymerase chain reaction (rRT-PCR) in the context of SARS-CoV-2 Omicron. Ag-RDT sensitivity and specificity within 1 day of rRT-PCR were evaluated by symptom status throughout the illness episode and Orf1b cycle threshold (Ct). RESULTS From February to December 2022, 5,757 participants reported 17,572 Ag-RDT results and completed 12,674 rRT-PCR tests, of which 995 (7.9%) were rRT-PCR-positive. Overall sensitivity and specificity were 53.0% (95% CI: 49.6-56.4%) and 98.8% (98.5-99.0%), respectively. Sensitivity was comparatively higher for Ag-RDTs used 1 day after rRT-PCR (69.0%), 4 to 7 days post-symptom onset (70.1%), and Orf1b Ct ≤20 (82.7%). Serial Ag-RDT sensitivity increased with repeat testing ≥2 (68.5%) and ≥4 (75.8%) days after an initial Ag-RDT-negative result. CONCLUSION Ag-RDT performance varied by clinical characteristics and temporal testing patterns. Our findings support recommendations for serial testing following an initial Ag-RDT-negative result, especially among recently symptomatic persons or those at high-risk for SARS-CoV-2 infection.
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Affiliation(s)
- Ashley E Kim
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Julia C Bennett
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kyle Luiten
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jessica A O'Hanlon
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Caitlin R Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ariana Magedson
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Peter D Han
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Zack Acker
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Lani Regelbrugge
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Jeremey Stone
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - David Reinhart
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Benjamin J Capodanno
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Stephen S Morse
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Trevor Bedford
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Howard Hughes Medical Institute, Seattle, WA, USA
| | | | - Michael Boeckh
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lea M Starita
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Ana Weil
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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6
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Hayden MK, El Mikati IK, Hanson KE, Englund JA, Humphries RM, Lee F, Loeb M, Morgan DJ, Patel R, Al Ta'ani O, Nazzal J, Iqneibi S, Amarin JZ, Sultan S, Falck-Ytter Y, Morgan RL, Murad MH, Bhimraj A, Mustafa RA. Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Serologic Testing. Clin Infect Dis 2024:ciae121. [PMID: 38489670 DOI: 10.1093/cid/ciae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The role of serologic testing for SARS-CoV-2 has evolved during the pandemic as seroprevalence in global populations has increased. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the coronavirus disease 2019 (COVID-19) serology literature and construct updated best practice guidance related to SARS-CoV-2 serologic testing. This guideline is an update to the fourth in a series of rapid, frequently updated COVID-19 guidelines developed by IDSA. OBJECTIVE To develop evidence-based recommendations and identify unmet research needs pertaining to the use of anti-SARS-CoV-2 antibody tests for diagnosis, decisions related to vaccination and administration of monoclonal antibodies or convalescent plasma in immunocompromised patients, and identification of a serologic correlate of immunity. METHODS A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists and experts in systematic literature reviewed, identified, and prioritized clinical questions related to the use of SARS-CoV-2 serologic tests. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. RESULTS The panel recommends against serologic testing to diagnose SARS-CoV-2 infection in the first two weeks after symptom onset (strong recommendations, low certainty of evidence). Serologic testing should not be used to provide evidence of COVID-19 in symptomatic patients with a high clinical suspicion and repeatedly negative nucleic acid amplification test results (strong recommendation, very low certainty of evidence). Serologic testing may assist with the diagnosis of multisystem inflammatory syndrome in children (strong recommendation, very low certainty of evidence). To seek evidence for prior SARS-CoV-2 infection, the panel suggests testing for IgG, IgG/IgM, or total antibodies to nucleocapsid protein three to five weeks after symptom onset (conditional recommendation, low certainty of evidence). In individuals with previous SARS-CoV-2 infection or vaccination, we suggest against routine serologic testing given no demonstrated benefit to improving patient outcomes (conditional recommendation, very low certainty of evidence.) The panel acknowledges further that a negative spike antibody test may be a useful metric to identify immunocompromised patients who are candidates for immune therapy. CONCLUSIONS The high seroprevalence of antibodies against SARS-CoV-2 worldwide limits the utility of detecting anti-SARS CoV-2 antibody. The certainty of available evidence supporting the use of serology for diagnosis was graded as very low to low. Future studies should use serologic assays calibrated to a common reference standard.
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Affiliation(s)
- Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois; Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Kimberly E Hanson
- Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Romney M Humphries
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robin Patel
- Division of Clinical Microbiology, Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Al Ta'ani
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Jamil Nazzal
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Shahad Iqneibi
- Department of Pathology & Laboratory Medicine - Emory University, Atlanta, Georgia, USA
| | - Justin Z Amarin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adarsh Bhimraj
- Houston Methodist, Director, Infectious Diseases Fellowship and Education, Division of Infectious Diseases, Houston Methodist Hospital, Center of Excellence for Infectious Diseases Houston Methodist Research Institute, Houston, Texas, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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7
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Emanuels A, Casto AM, Heimonen J, O'Hanlon J, Chow EJ, Ogokeh C, Rolfes MA, Han PD, Hughes JP, Uyeki TM, Frazar C, Chung E, Starita LM, Englund JA, Chu HY. Remote surveillance and detection of SARS-CoV-2 transmission among household members in King County, Washington. BMC Infect Dis 2024; 24:309. [PMID: 38481147 PMCID: PMC10936024 DOI: 10.1186/s12879-024-09160-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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Early during the COVID-19 pandemic, it was important to better understand transmission dynamics of SARS-CoV-2, the virus that causes COVID-19. Household contacts of infected individuals are particularly at risk for infection, but delays in contact tracing, delays in testing contacts, and isolation and quarantine posed challenges to accurately capturing secondary household cases. METHODS In this study, 346 households in the Seattle region were provided with respiratory specimen collection kits and remotely monitored using web-based surveys for respiratory illness symptoms weekly between October 1, 2020, and June 20, 2021. Symptomatic participants collected respiratory specimens at symptom onset and mailed specimens to the central laboratory in Seattle. Specimens were tested for SARS-CoV-2 using RT-PCR with whole genome sequencing attempted when positive. SARS-CoV-2-infected individuals were notified, and their household contacts submitted specimens every 2 days for 14 days. RESULTS In total, 1371 participants collected 2029 specimens that were tested; 16 individuals (1.2%) within 6 households tested positive for SARS-CoV-2 during the study period. Full genome sequences were generated from 11 individuals within 4 households. Very little genetic variation was found among SARS-CoV-2 viruses sequenced from different individuals in the same household, supporting transmission within the household. CONCLUSIONS This study indicates web-based surveillance of respiratory symptoms, combined with rapid and longitudinal specimen collection and remote contact tracing, provides a viable strategy to monitor households and detect household transmission of SARS-CoV-2. TRIAL REGISTRATION IDENTIFIER NCT04141930, Date of registration 28/10/2019.
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Affiliation(s)
- Anne Emanuels
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA
| | - Amanda M Casto
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jessica Heimonen
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA
| | - Jessica O'Hanlon
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA
| | - Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA
| | - Constance Ogokeh
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter D Han
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christian Frazar
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Erin Chung
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA
| | - Lea M Starita
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA.
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8
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Moline HL, Tannis A, Toepfer AP, Williams JV, Boom JA, Englund JA, Halasa NB, Staat MA, Weinberg GA, Selvarangan R, Michaels MG, Sahni LC, Klein EJ, Stewart LS, Schlaudecker EP, Szilagyi PG, Schuster JE, Goldstein L, Musa S, Piedra PA, Zerr DM, Betters KA, Rohlfs C, Albertin C, Banerjee D, McKeever ER, Kalman C, Clopper BR, McMorrow ML, Dawood FS. Early Estimate of Nirsevimab Effectiveness for Prevention of Respiratory Syncytial Virus-Associated Hospitalization Among Infants Entering Their First Respiratory Syncytial Virus Season - New Vaccine Surveillance Network, October 2023-February 2024. MMWR Morb Mortal Wkly Rep 2024; 73:209-214. [PMID: 38457312 PMCID: PMC10932582 DOI: 10.15585/mmwr.mm7309a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Respiratory syncytial virus (RSV) is the leading cause of hospitalization among infants in the United States. In August 2023, CDC's Advisory Committee on Immunization Practices recommended nirsevimab, a long-acting monoclonal antibody, for infants aged <8 months to protect against RSV-associated lower respiratory tract infection during their first RSV season and for children aged 8-19 months at increased risk for severe RSV disease. In phase 3 clinical trials, nirsevimab efficacy against RSV-associated lower respiratory tract infection with hospitalization was 81% (95% CI = 62%-90%) through 150 days after receipt; post-introduction effectiveness has not been assessed in the United States. In this analysis, the New Vaccine Surveillance Network evaluated nirsevimab effectiveness against RSV-associated hospitalization among infants in their first RSV season during October 1, 2023-February 29, 2024. Among 699 infants hospitalized with acute respiratory illness, 59 (8%) received nirsevimab ≥7 days before symptom onset. Nirsevimab effectiveness was 90% (95% CI = 75%-96%) against RSV-associated hospitalization with a median time from receipt to symptom onset of 45 days (IQR = 19-76 days). The number of infants who received nirsevimab was too low to stratify by duration from receipt; however, nirsevimab effectiveness is expected to decrease with increasing time after receipt because of antibody decay. Although nirsevimab uptake and the interval from receipt of nirsevimab were limited in this analysis, this early estimate supports the current nirsevimab recommendation for the prevention of severe RSV disease in infants. Infants should be protected by maternal RSV vaccination or infant receipt of nirsevimab.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - New Vaccine Surveillance Network Product Effectiveness Collaborators
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Texas Children’s Hospital, Houston, Texas; Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, University of Rochester Medical Center and University of Rochester–Golisano Children’s Hospital, Rochester, New York; Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, Missouri; Department of Pediatrics Children’s Mercy Hospital, Kansas City, Missouri
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9
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Curns AT, Rha B, Lively JY, Sahni LC, Englund JA, Weinberg GA, Halasa NB, Staat MA, Selvarangan R, Michaels M, Moline H, Zhou Y, Perez A, Rohlfs C, Hickey R, Lacombe K, McHenry R, Whitaker B, Schuster J, Pulido CG, Strelitz B, Quigley C, Dnp GW, Avadhanula V, Harrison CJ, Stewart LS, Schlaudecker E, Szilagyi PG, Klein EJ, Boom J, Williams JV, Langley G, Gerber SI, Hall AJ, McMorrow ML. Respiratory Syncytial Virus-Associated Hospitalizations Among Children <5 Years Old: 2016 to 2020. Pediatrics 2024; 153:e2023062574. [PMID: 38298053 DOI: 10.1542/peds.2023-062574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention. METHODS We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates. RESULTS Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]). CONCLUSIONS Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants.
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Affiliation(s)
- Aaron T Curns
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joana Y Lively
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leila C Sahni
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Mary A Staat
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Marian Michaels
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heidi Moline
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yingtao Zhou
- Centers for Disease Control and Prevention, Atlanta, Georgia
- TDB Communications, Inc, Atlanta, Georgia
| | - Ariana Perez
- Centers for Disease Control and Prevention, Atlanta, Georgia
- GDIT, Atlanta, Georgia
| | - Chelsea Rohlfs
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert Hickey
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rendie McHenry
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brett Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Christina Quigley
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Vasanthi Avadhanula
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | - Elizabeth Schlaudecker
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Peter G Szilagyi
- UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California
| | | | - Julie Boom
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - John V Williams
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gayle Langley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I Gerber
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aron J Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Bennett JC, Luiten KG, O'Hanlon J, Han PD, McDonald D, Wright T, Wolf CR, Lo NK, Acker Z, Regelbrugge L, McCaffrey KM, Pfau B, Stone J, Schwabe-Fry K, Lockwood CM, Guthrie BL, Gottlieb GS, Englund JA, Uyeki TM, Carone M, Starita LM, Weil AA, Chu HY. Utilizing a university testing program to estimate relative effectiveness of monovalent COVID-19 mRNA booster vaccine versus two-dose primary series against symptomatic SARS-CoV-2 infection. Vaccine 2024; 42:1332-1341. [PMID: 38307746 DOI: 10.1016/j.vaccine.2024.01.080] [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: 12/04/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Vaccine effectiveness (VE) studies utilizing the test-negative design are typically conducted in clinical settings, rather than community populations, leading to bias in VE estimates against mild disease and limited information on VE in healthy young adults. In a community-based university population, we utilized data from a large SARS-CoV-2 testing program to estimate relative VE of COVID-19 mRNA vaccine primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection from September 2021 to July 2022. We used the test-negative design and logistic regression implemented via generalized estimating equations adjusted for age, calendar time, prior SARS-CoV-2 infection, and testing frequency (proxy for test-seeking behavior) to estimate relative VE. Analyses included 2,218 test-positive cases (59 % received monovalent booster dose) and 9,615 test-negative controls (62 %) from 9,066 individuals, with median age of 21 years, mostly students (71 %), White (56 %) or Asian (28 %), and with few comorbidities (3 %). More cases (23 %) than controls (6 %) had COVID-19-like illness. Estimated adjusted relative VE of primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection was 40 % (95 % CI: 33-47 %) during the overall analysis period and 46 % (39-52 %) during the period of Omicron circulation. Relative VE was greater for those without versus those with prior SARS-CoV-2 infection (41 %, 34-48 % versus 33 %, 9 %-52 %, P < 0.001). Relative VE was also greater in the six months after receiving a booster dose (41 %, 33-47 %) compared to more than six months (27 %, 8-42 %), but this difference was not statistically significant (P = 0.06). In this relatively young and healthy adult population, an mRNA monovalent booster dose provided increased protection against symptomatic SARS-CoV-2 infection, overall and with the Omicron variant. University testing programs may be utilized for estimating VE in healthy young adults, a population that is not well-represented by routine VE studies.
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Affiliation(s)
- Julia C Bennett
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Kyle G Luiten
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jessica O'Hanlon
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Peter D Han
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Devon McDonald
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tessa Wright
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Caitlin R Wolf
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Natalie K Lo
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Zack Acker
- Brotman Baty Institute, Seattle, WA, USA
| | | | | | - Brian Pfau
- Brotman Baty Institute, Seattle, WA, USA
| | - Jeremey Stone
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Christina M Lockwood
- Brotman Baty Institute, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Brandon L Guthrie
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA; Environmental Health & Safety Department, University of Washington, Seattle, WA, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Lea M Starita
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Ana A Weil
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA
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11
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Edens C, Clopper BR, DeVies J, Benitez A, McKeever ER, Johns D, Wolff B, Selvarangan R, Schuster JE, Weinberg GA, Szilagyi PG, Dawood FS, Radhakrishnan L, Quigley C, Sahni LC, Halasa N, Stewart LS, McMorrow ML, Whitaker B, Zerr DM, Avadhanula V, Williams JV, Michaels MG, Kite-Powell A, Englund JA, Staat MA, Hartnett K, Moline HL, Cohen AL, Diaz M. Notes from the Field: Reemergence of Mycoplasma pneumoniae Infections in Children and Adolescents After the COVID-19 Pandemic, United States, 2018-2024. MMWR Morb Mortal Wkly Rep 2024; 73:149-151. [PMID: 38386615 PMCID: PMC10899077 DOI: 10.15585/mmwr.mm7307a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
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12
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Toepfer AP, Amarin JZ, Spieker AJ, Stewart LS, Staat MA, Schlaudecker EP, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Michaels MG, Williams JV, Selvarangan R, Harrison CJ, Lively JY, Piedra PA, Avadhanula V, Rha B, Chappell J, McMorrow M, Moline H, Halasa NB. Seasonality, clinical characteristics, and outcomes of respiratory syncytial virus disease by subtype among children less than five years old, New Vaccine Surveillance Network, United States, 2016-2020. Clin Infect Dis 2024:ciae085. [PMID: 38366649 DOI: 10.1093/cid/ciae085] [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: 12/14/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illnesses (ARI) in children. RSV can be broadly categorized into two major subtypes (A and B). RSV subtypes have been known to co-circulate with variability in different regions of the world. Clinical associations with viral subtype have been studied among children with conflicting findings such that no conclusive relationships between RSV subtype and severity have been established. METHODS During 2016-2020, children <5 years old were enrolled in prospective surveillance in the emergency department (ED) or inpatient (IP) settings from seven U.S. pediatric medical centers. Surveillance data collection included parent/guardian interviews, chart reviews, and collection of mid-turbinate nasal +/- throat swabs for RSV (RSV-A, RSV-B, and Untyped) by reverse transcription polymerase chain reaction (RT-PCR). RESULTS Among 6398 RSV-positive children <5 years old, 3424 (54%) had subtype RSV-A infections, 2602 (41%) had subtype RSV-B infections, and 272 (5%) were not typed, inconclusive, or mixed infections. In both adjusted and unadjusted analyses, RSV-A-positive children were more likely to be hospitalized, as well as when restricted to <1 year. By season, RSV-A and RSV-B co-circulated in varying levels, with one subtype dominating proportionally. CONCLUSION Findings indicate that RSV-A and RSV-B may only be marginally clinically distinguishable but both subtypes are associated with medically attended illness in children <5 years old. Furthermore, circulation of RSV subtypes varies substantially each year, seasonally and geographically. With introduction of new RSV prevention products, this highlights the importance of continued monitoring of RSV-A and RSV-B subtypes.
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Affiliation(s)
- Ariana P Toepfer
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Justin Z Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Allen Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Eileen J Klein
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Marian G Michaels
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John V Williams
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Christopher J Harrison
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Joana Y Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | | | | | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meredith McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
- U.S. Public Health Service, Rockville, Maryland, USA
| | - Heidi Moline
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
- U.S. Public Health Service, Rockville, Maryland, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Heimonen J, Chow EJ, Wang Y, Hughes JP, Rogers J, Emanuels A, O’Hanlon J, Han PD, Wolf CR, Logue JK, Ogokeh CE, Rolfes MA, Uyeki TM, Starita L, Englund JA, Chu HY. Risk of Subsequent Respiratory Virus Detection After Primary Virus Detection in a Community Household Study-King County, Washington, 2019-2021. J Infect Dis 2024; 229:422-431. [PMID: 37531658 PMCID: PMC10873185 DOI: 10.1093/infdis/jiad305] [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: 03/31/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The epidemiology of respiratory viral infections is complex. How infection with one respiratory virus affects risk of subsequent infection with the same or another respiratory virus is not well described. METHODS From October 2019 to June 2021, enrolled households completed active surveillance for acute respiratory illness (ARI), and participants with ARI self-collected nasal swab specimens; after April 2020, participants with ARI or laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and their household members self-collected nasal swab specimens. Specimens were tested using multiplex reverse-transcription polymerase chain reaction for respiratory viruses. A Cox regression model with a time-dependent covariate examined risk of subsequent detections following a specific primary viral detection. RESULTS Rhinovirus was the most frequently detected pathogen in study specimens (406 [9.5%]). Among 51 participants with multiple viral detections, rhinovirus to seasonal coronavirus (8 [14.8%]) was the most common viral detection pairing. Relative to no primary detection, there was a 1.03-2.06-fold increase in risk of subsequent virus detection in the 90 days after primary detection; risk varied by primary virus: human parainfluenza virus, rhinovirus, and respiratory syncytial virus were statistically significant. CONCLUSIONS Primary virus detection was associated with higher risk of subsequent virus detection within the first 90 days after primary detection.
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Affiliation(s)
- Jessica Heimonen
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Prevention Division, Public Health—Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Yongzhe Wang
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Julia Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anne Emanuels
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jessica O’Hanlon
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Peter D Han
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Caitlin R Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer K Logue
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Constance E Ogokeh
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Military and Health Research Foundation, Laurel, Maryland, USA
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lea Starita
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Janet A Englund
- Division of Pediatric Infectious Diseases, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
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14
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Pfau B, Opsahl J, Crew R, Best S, Han PD, Heidl S, McDermot E, Stone J, Schwabe-Fry K, MacMillan MP, O'Hanlon J, Sohlberg S, Acker Z, Ehmen B, Englund JA, Konnick EQ, Chu HY, Weil AA, Lockwood CM, Starita LM. Tiny swabs: nasal swabs integrated into tube caps facilitate large-scale self-collected SARS-CoV-2 testing. J Clin Microbiol 2024; 62:e0128523. [PMID: 38131692 PMCID: PMC10865831 DOI: 10.1128/jcm.01285-23] [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: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
The COVID-19 pandemic spurred the development of innovative solutions for specimen collection and molecular detection for large-scale community testing. Among these developments is the RHINOstic nasal swab, a plastic anterior nares swab built into the cap of a standard matrix tube that facilitates automated processing of up to 96 specimens at a time. In a study of unsupervised self-collection utilizing these swabs, we demonstrate comparable analytic performance and shipping stability compared to traditional anterior nares swabs, as well as significant improvements in laboratory processing efficiency. The use of these swabs may allow laboratories to accommodate large numbers of sample collections during periods of high testing demand. Automation-friendly nasal swabs are an important tool for high-throughput processing of samples that may be adopted in response to future respiratory viral pandemics.
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Affiliation(s)
- Brian Pfau
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Jordan Opsahl
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Ruben Crew
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Sabrina Best
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Peter D. Han
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Sarah Heidl
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Evan McDermot
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Jeremy Stone
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | | | | | - Jessica O'Hanlon
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah Sohlberg
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Zack Acker
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Brenna Ehmen
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Janet A. Englund
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Eric Q. Konnick
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Helen Y. Chu
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Ana A. Weil
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Christina M. Lockwood
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Lea M. Starita
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - The Seattle Flu Alliance InvestigatorsBedfordTrevorBoeckhMichaelChuHelen Y.EnglundJanet A.LockwoodChristina M.LutzBarry R.PrenticeRobinShendureJayStaritaLea M.WaghmereAlpanaWeilAna A.
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
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15
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Feldstein LR, Britton A, Grant L, Wiegand R, Ruffin J, Babu TM, Briggs Hagen M, Burgess JL, Caban-Martinez AJ, Chu HY, Ellingson KD, Englund JA, Hegmann KT, Jeddy Z, Lauring AS, Lutrick K, Martin ET, Mathenge C, Meece J, Midgley CM, Monto AS, Newes-Adeyi G, Odame-Bamfo L, Olsho LEW, Phillips AL, Rai RP, Saydah S, Smith N, Steinhardt L, Tyner H, Vandermeer M, Vaughan M, Yoon SK, Gaglani M, Naleway AL. Effectiveness of Bivalent mRNA COVID-19 Vaccines in Preventing SARS-CoV-2 Infection in Children and Adolescents Aged 5 to 17 Years. JAMA 2024; 331:408-416. [PMID: 38319331 PMCID: PMC10848053 DOI: 10.1001/jama.2023.27022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024]
Abstract
Importance Bivalent mRNA COVID-19 vaccines were recommended in the US for children and adolescents aged 12 years or older on September 1, 2022, and for children aged 5 to 11 years on October 12, 2022; however, data demonstrating the effectiveness of bivalent COVID-19 vaccines are limited. Objective To assess the effectiveness of bivalent COVID-19 vaccines against SARS-CoV-2 infection and symptomatic COVID-19 among children and adolescents. Design, Setting, and Participants Data for the period September 4, 2022, to January 31, 2023, were combined from 3 prospective US cohort studies (6 sites total) and used to estimate COVID-19 vaccine effectiveness among children and adolescents aged 5 to 17 years. A total of 2959 participants completed periodic surveys (demographics, household characteristics, chronic medical conditions, and COVID-19 symptoms) and submitted weekly self-collected nasal swabs (irrespective of symptoms); participants submitted additional nasal swabs at the onset of any symptoms. Exposure Vaccination status was captured from the periodic surveys and supplemented with data from state immunization information systems and electronic medical records. Main Outcome and Measures Respiratory swabs were tested for the presence of the SARS-CoV-2 virus using reverse transcriptase-polymerase chain reaction. SARS-CoV-2 infection was defined as a positive test regardless of symptoms. Symptomatic COVID-19 was defined as a positive test and 2 or more COVID-19 symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios for SARS-CoV-2 infection and symptomatic COVID-19 among participants who received a bivalent COVID-19 vaccine dose vs participants who received no vaccine or monovalent vaccine doses only. Models were adjusted for age, sex, race, ethnicity, underlying health conditions, prior SARS-CoV-2 infection status, geographic site, proportion of circulating variants by site, and local virus prevalence. Results Of the 2959 participants (47.8% were female; median age, 10.6 years [IQR, 8.0-13.2 years]; 64.6% were non-Hispanic White) included in this analysis, 25.4% received a bivalent COVID-19 vaccine dose. During the study period, 426 participants (14.4%) had laboratory-confirmed SARS-CoV-2 infection. Among these 426 participants, 184 (43.2%) had symptomatic COVID-19, 383 (89.9%) were not vaccinated or had received only monovalent COVID-19 vaccine doses (1.38 SARS-CoV-2 infections per 1000 person-days), and 43 (10.1%) had received a bivalent COVID-19 vaccine dose (0.84 SARS-CoV-2 infections per 1000 person-days). Bivalent vaccine effectiveness against SARS-CoV-2 infection was 54.0% (95% CI, 36.6%-69.1%) and vaccine effectiveness against symptomatic COVID-19 was 49.4% (95% CI, 22.2%-70.7%). The median observation time after vaccination was 276 days (IQR, 142-350 days) for participants who received only monovalent COVID-19 vaccine doses vs 50 days (IQR, 27-74 days) for those who received a bivalent COVID-19 vaccine dose. Conclusion and Relevance The bivalent COVID-19 vaccines protected children and adolescents against SARS-CoV-2 infection and symptomatic COVID-19. These data demonstrate the benefit of COVID-19 vaccine in children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.
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Affiliation(s)
- Leora R. Feldstein
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Grant
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Wiegand
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jasmine Ruffin
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara M. Babu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | - Melissa Briggs Hagen
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | | | | | | | | | - Adam S. Lauring
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | - Emily T. Martin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Claire M. Midgley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arnold S. Monto
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | | | | | | | | | - Sharon Saydah
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Laura Steinhardt
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Harmony Tyner
- St Luke’s Regional Health Care System, Duluth, Minnesota
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16
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Sahni LC, Olson SM, Halasa NB, Stewart LS, Michaels MG, Williams JV, Englund JA, Klein EJ, Staat MA, Schlaudecker EP, Selvarangan R, Schuster JE, Weinberg GA, Szilagyi PG, Boom JA, Patel MM, Muñoz FM. Maternal Vaccine Effectiveness Against Influenza-Associated Hospitalizations and Emergency Department Visits in Infants. JAMA Pediatr 2024; 178:176-184. [PMID: 38109102 PMCID: PMC10728798 DOI: 10.1001/jamapediatrics.2023.5639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023]
Abstract
Importance Influenza virus infection during pregnancy is associated with severe maternal disease and may be associated with adverse birth outcomes. Inactivated influenza vaccine during pregnancy is safe and effective and can protect young infants, but recent evidence, particularly after the 2009 novel influenza A (H1N1) pandemic, is limited. Objective To evaluate the effectiveness of influenza vaccination during pregnancy against laboratory-confirmed influenza-associated hospitalizations and emergency department (ED) visits in infants younger than 6 months. Design, Setting, and Participants This was a prospective, test-negative case-control study using data from the New Vaccine Surveillance Network from the 2016 to 2017 through 2019 to 2020 influenza seasons. Infants younger than 6 months with an ED visit or hospitalization for acute respiratory illness were included from 7 pediatric medical institutions in US cities. Control infants with an influenza-negative molecular test were included for comparison. Data were analyzed from June 2022 to September 2023. Exposure Maternal influenza vaccination during pregnancy. Main Outcomes and Measures We estimated maternal vaccine effectiveness against hospitalizations or ED visits in infants younger than 6 months, those younger than 3 months, and by trimester of vaccination. Maternal vaccination status was determined using immunization information systems, medical records, or self-report. Vaccine effectiveness was estimated by comparing the odds of maternal influenza vaccination 14 days or more before delivery in infants with influenza vs those without. Results Of 3764 infants (223 with influenza and 3541 control infants), 2007 (53%) were born to mothers who were vaccinated during pregnancy. Overall vaccine effectiveness in infants was 34% (95% CI, 12 to 50), 39% (95% CI, 12 to 58) against influenza-associated hospitalizations, and 19% (95% CI, -24 to 48) against ED visits. Among infants younger than 3 months, effectiveness was 53% (95% CI, 30 to 68). Effectiveness was 52% (95% CI, 30 to 68) among infants with mothers who were vaccinated during the third trimester and 17% (95% CI, -15 to 40) among those with mothers who were vaccinated during the first or second trimesters. Conclusions and Relevance Maternal vaccination was associated with reduced odds of influenza-associated hospitalizations and ED visits in infants younger than 6 months. Effectiveness was greatest among infants younger than 3 months, for those born to mothers vaccinated during the third trimester, and against influenza-associated hospitalizations.
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Affiliation(s)
- Leila C. Sahni
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Samantha M. Olson
- Influenza Division, National Center for Immunization and Respiratory Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Marian G. Michaels
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John V. Williams
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Mary A. Staat
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth P. Schlaudecker
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rangaraj Selvarangan
- University of Missouri, Kansas City School of Medicine, Children’s Mercy Kansas City, Kansas City
| | - Jennifer E. Schuster
- University of Missouri, Kansas City School of Medicine, Children’s Mercy Kansas City, Kansas City
| | | | - Peter G. Szilagyi
- University of California Los Angeles Mattel Children’s Hospital, Los Angeles
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Manish M. Patel
- Influenza Division, National Center for Immunization and Respiratory Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Flor M. Muñoz
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
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17
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Brothers AW, Pak DJ, Poole NM, Kronman MP, Bettinger B, Wilkes JJ, Carpenter PA, Englund JA, Weissman SJ. Individualized Antibiotic Plans as a Quality Improvement Initiative to Reduce Carbapenem Use for Hematopoietic Cell Transplant Patients at a Freestanding Pediatric Hospital. Clin Infect Dis 2024; 78:15-23. [PMID: 37647637 DOI: 10.1093/cid/ciad518] [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: 06/08/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Providers must balance effective empiric therapy against toxicity risks and collateral damage when selecting antibiotic therapy for patients receiving hematopoietic cell transplant (HCT). Antimicrobial stewardship interventions during HCT are often challenging due to concern for undertreating potential infections. METHODS In an effort to decrease unnecessary carbapenem exposure for patients undergoing HCT at our pediatric center, we implemented individualized antibiotic plans (IAPs) to provide recommendations for preengraftment neutropenia prophylaxis, empiric treatment of febrile neutropenia, and empiric treatment for hemodynamic instability. We compared monthly antibiotic days of therapy (DOT) adjusted per 1000 patient-days for carbapenems, antipseudomonal cephalosporins, and all antibiotics during two 3-year periods immediately before and after the implementation of IAPs to measure the impact of IAP on prescribing behavior. Bloodstream infection (BSIs) and Clostridioides difficile (CD) positivity test rates were also compared between cohorts. Last, providers were surveyed to assess their experience of using IAPs in antibiotic decision making. RESULTS Overall antibiotic use decreased after the implementation of IAPs (monthly reduction of 19.6 DOT/1000 patient-days; P = .004), with carbapenems showing a continuing decline after IAP implementation. BSI and CD positivity rates were unchanged. More than 90% of providers found IAPs to be either extremely or very valuable for their practice. CONCLUSIONS Implementation of IAPs in this high-risk HCT population led to reduction in overall antibiotic use without increase in rate of BSI or CD test positivity. The program was well received by providers.
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Affiliation(s)
- Adam W Brothers
- Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA
| | - Daniel J Pak
- Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nicole M Poole
- Departments of Pediatrics, Section of Pediatric Infectious Diseases, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew P Kronman
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Brendan Bettinger
- Department of Clinical Analytics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jennifer J Wilkes
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle, Washington, USA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Paul A Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Scott J Weissman
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA
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18
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Schuster JE, Hamdan L, Dulek DE, Kitko CL, Batarseh E, Haddadin Z, Stewart LS, Stahl A, Potter M, Rahman H, Kalams SA, Bocchini CE, Moulton EA, Coffin SE, Ardura MI, Wattier RL, Maron G, Grimley M, Paulsen G, Harrison CJ, Freedman JL, Carpenter PA, Englund JA, Munoz FM, Danziger-Isakov L, Spieker AJ, Halasa NB. The Durability of Antibody Responses of Two Doses of High-Dose Relative to Two Doses of Standard-Dose Inactivated Influenza Vaccine in Pediatric Hematopoietic Cell Transplant Recipients: A Multi-Center Randomized Controlled Trial. Clin Infect Dis 2024; 78:217-226. [PMID: 37800415 PMCID: PMC10810702 DOI: 10.1093/cid/ciad534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Our previous study established a 2-dose regimen of high-dose trivalent influenza vaccine (HD-TIV) to be immunogenically superior compared to a 2-dose regimen of standard-dose quadrivalent influenza vaccine (SD-QIV) in pediatric allogeneic hematopoietic cell transplant (HCT) recipients. However, the durability of immunogenicity and the role of time post-HCT at immunization as an effect modifier are unknown. METHODS This phase II, multi-center, double-blinded, randomized controlled trial compared HD-TIV to SD-QIV in children 3-17 years old who were 3-35 months post-allogeneic HCT, with each formulation administered twice, 28-42 days apart. Hemagglutination inhibition (HAI) titers were measured at baseline, 28-42 days following each dose, and 138-222 days after the second dose. Using linear mixed effects models, we estimated adjusted geometric mean HAI titer ratios (aGMR: HD-TIV/SD-QIV) to influenza antigens. Early and late periods were defined as 3-5 and 6-35 months post-HCT, respectively. RESULTS During 3 influenza seasons (2016-2019), 170 participants were randomized to receive HD-TIV (n = 85) or SD-QIV (n = 85). HAI titers maintained significant elevations above baseline for both vaccine formulations, although the relative immunogenic benefit of HD-TIV to SD-QIV waned during the study. A 2-dose series of HD-TIV administered late post-HCT was associated with higher GMTs compared to the early post-HCT period (late group: A/H1N1 aGMR = 2.16, 95% confidence interval [CI] = [1.14-4.08]; A/H3N2 aGMR = 3.20, 95% CI = [1.60-6.39]; B/Victoria aGMR = 1.91, 95% CI = [1.01-3.60]; early group: A/H1N1 aGMR = 1.03, 95% CI = [0.59-1.80]; A/H3N2 aGMR = 1.23, 95% CI = [0.68-2.25]; B/Victoria aGMR = 1.06, 95% CI = [0.56-2.03]). CONCLUSIONS Two doses of HD-TIV were more immunogenic than SD-QIV, especially when administered ≥6 months post-HCT. Both groups maintained higher titers compared to baseline throughout the season. CLINICAL TRIALS REGISTRATION NCT02860039.
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Affiliation(s)
- Jennifer E Schuster
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Lubna Hamdan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie L Kitko
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Einas Batarseh
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anna Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Molly Potter
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spyros A Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claire E Bocchini
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth A Moulton
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
| | - Susan E Coffin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica I Ardura
- Department of Pediatrics, Division of Infectious Diseases & Host Defense, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Rachel L Wattier
- Department of Pediatrics, University of California San Francisco and Benioff Children's Hospital – San Francisco, San Francisco, California, USA
| | - Gabriela Maron
- Department of Infectious Diseases, Children's, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael Grimley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Grant Paulsen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher J Harrison
- Department of Infectious Diseases, University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Jason L Freedman
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Carpenter
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Flor M Munoz
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Lara Danziger-Isakov
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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19
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Kachikis A, Pike M, Eckert LO, Roberts E, Frank Y, Young AL, Goecker E, Gravett MG, Greninger AL, Englund JA. Timing of Maternal COVID-19 Vaccine and Antibody Concentrations in Infants Born Preterm. JAMA Netw Open 2024; 7:e2352387. [PMID: 38241046 PMCID: PMC10799259 DOI: 10.1001/jamanetworkopen.2023.52387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Importance COVID-19 vaccine-derived antibodies in pregnant people may protect infants from severe infection in the first 6 months of life via transplacental antibody transfer. Few data exist on maternally derived SARS-CoV-2 antibodies in preterm compared with full-term infants in association with vaccination timing. Objective To compare SARS-CoV-2 anti-Spike (anti-S) antibody levels in preterm and full-term infants in the context of vaccine dose timing before delivery. Design, Setting, and Participants This prospective cohort study enrolled pregnant individuals and collected paired maternal and cord blood samples at delivery at the University of Washington between February 1, 2021, and January 31, 2023. Participants who had received at least 2 doses of a messenger RNA COVID-19 vaccine before delivery and did not have a history of prior COVID-19 infection or detectable anti-SARS-CoV-2 nucleocapsid antibodies were included. Exposures Timing of the last vaccine dose and preterm or full-term gestational age at delivery. Main Outcomes and Measures Paired maternal and cord samples were tested for anti-S antibody, and linear regression was used to evaluate associations between preterm delivery and anti-S antibody levels. Covariates included timing of last dose, number of doses, insurance status, and immunosuppressing medications. Results A total of 220 participants (median [IQR] age, 34 [32-37] years; 212 [96.4%] female) with 36 preterm and 184 full-term deliveries were studied. Before delivery, 121 persons received 2 vaccine doses and 99 persons received 3 or more vaccine doses. The geometric mean concentration of maternal anti-S antibodies was 674 (95% CI, 577-787) after 2 doses and 8159 (95% CI, 6636-10 032) after 3 or more doses (P < .001). The cord anti-S antibody geometric mean concentration was 1000 (95% CI, 874-1144) after 2 doses and 9992 (95% CI, 8381-11 914) after 3 or more doses (P < .001). After adjustment for vaccine timing and number of doses before delivery, no association was found between preterm delivery and cord anti-S antibody levels (β = 0.44; 95% CI, -0.06 to 0.94). Conclusions and Relevance In this prospective cohort study of pregnant individuals with preterm and full-term deliveries, receipt of 3 or more compared with 2 doses of COVID-19 vaccine before delivery resulted in 10-fold higher cord anti-S antibody levels. Maternal antibody concentration appeared more important than delivery gestational age in determining cord anti-S antibody levels. The number of doses and timing considerations for COVID-19 vaccine in pregnancy should include individuals at risk for preterm delivery.
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Affiliation(s)
- Alisa Kachikis
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Mindy Pike
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Linda O. Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Emma Roberts
- Department of Obstetrics and Gynecology, University of California, San Diego
| | - Yael Frank
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amber L. Young
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Erin Goecker
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Michael G. Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | | | - Janet A. Englund
- Seattle Children’s Hospital Research Institute, Department of Pediatrics, University of Washington, Seattle
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20
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LaCourse SM, Wetzler EA, Aurelio MC, Escudero JN, Selke SS, Greninger AL, Goecker EA, Barnes SR, Arnould IS, Pérez-Osorio AC, Richardson BA, Kachikis A, Englund JA, Drake AL. Hybrid immunity to SARS-CoV-2 during pregnancy provides more durable infant antibody responses compared to natural infection alone. J Infect Dis 2023:jiad592. [PMID: 38128542 DOI: 10.1093/infdis/jiad592] [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: 08/14/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Hybrid immunity (infection plus vaccination) may increase maternally-derived SARS-CoV-2 antibody responses and durability vs. infection alone. METHODS Prospective cohort of pregnant participants with prior SARS-CoV-2 infection (anti-nucleocapsid IgG+, RT-PCR + or antigen+) and their infants had blood collected in pregnancy, delivery/birth, and postpartum tested for anti-spike (anti-S) IgG and neutralizing antibodies (neutAb). RESULTS Among 107 participants at enrollment, 40% were unvaccinated and 60% were vaccinated (received ≥1 dose); 102 had previous SARS-CoV-2 infection in pregnancy (median 19 weeks gestation); 5 were diagnosed just prior to prior to pregnancy (median 8 weeks). At delivery, fewer unvaccinated participants (87% anti-S IgG+, 86% neutAb) and their infants (86% anti-S IgG+, 75% neutAb) had anti-S IgG + or neutAb compared to vaccinated participants and their infants (100%, p ≤ 0.01 for all). By 3-6 months postpartum, 50% of infants of unvaccinated participants were anti-S IgG + and 14% had neutAb, vs. 100% among infants of vaccinated participants (all p < 0.01), with lower median antibody responses (anti-S IgG log10 1.95 vs. 3.84 AU/ml, p < 0.01; neutAb log10 1:1.34 vs. 1:3.20, p = 0.11). CONCLUSIONS In pregnant people with prior SARS-CoV-2, vaccination before delivery provided more durable maternally-derived antibody responses than infection alone in infants through 6 months.
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Affiliation(s)
- Sylvia M LaCourse
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Erica A Wetzler
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Morgan C Aurelio
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jaclyn N Escudero
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Stacy S Selke
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Erin A Goecker
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Sarina R Barnes
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Isabel S Arnould
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Ailyn C Pérez-Osorio
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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21
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Hayden MK, Hanson KE, Englund JA, Lee MJ, Loeb M, Lee F, Morgan DJ, Patel R, El Mikati IK, Iqneibi S, Alabed F, Amarin JZ, Mansour R, Patel P, Falck-Ytter Y, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of Coronavirus Disease 2019 (COVID-19): Molecular Diagnostic Testing. Clin Infect Dis 2023:ciad646. [PMID: 38112284 DOI: 10.1093/cid/ciad646] [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: 09/12/2023] [Indexed: 12/21/2023] Open
Abstract
Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches.
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Affiliation(s)
- Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kimberly E Hanson
- Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robin Patel
- Division of Clinical Microbiology and Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shahad Iqneibi
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Farouk Alabed
- School of Medicine, The University of Kansas, Kansas City, Kansas, USA
| | - Justin Z Amarin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Razan Mansour
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
| | - Adarsh Bhimraj
- Houston Methodist Hospital, Center of Excellence for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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22
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Welsh FC, Eguia RT, Lee JM, Haddox HK, Galloway J, Chau NVV, Loes AN, Huddleston J, Yu TC, Le MQ, Nhat NTD, Thanh NTL, Greninger AL, Chu HY, Englund JA, Bedford T, Matsen FA, Boni MF, Bloom JD. Age-dependent heterogeneity in the antigenic effects of mutations to influenza hemagglutinin. bioRxiv 2023:2023.12.12.571235. [PMID: 38168237 PMCID: PMC10760046 DOI: 10.1101/2023.12.12.571235] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Human influenza virus evolves to escape neutralization by polyclonal antibodies. However, we have a limited understanding of how the antigenic effects of viral mutations vary across the human population, and how this heterogeneity affects virus evolution. Here we use deep mutational scanning to map how mutations to the hemagglutinin (HA) proteins of the A/Hong Kong/45/2019 (H3N2) and A/Perth/16/2009 (H3N2) strains affect neutralization by serum from individuals of a variety of ages. The effects of HA mutations on serum neutralization differ across age groups in ways that can be partially rationalized in terms of exposure histories. Mutations that fixed in influenza variants after 2020 cause the greatest escape from sera from younger individuals. Overall, these results demonstrate that influenza faces distinct antigenic selection regimes from different age groups, and suggest approaches to understand how this heterogeneous selection shapes viral evolution.
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Affiliation(s)
- Frances C Welsh
- Molecular and Cellular Biology Graduate Program, University of Washington, and Basic Sciences Division, Fred Hutch Cancer Center, Seattle, WA, 98109, USA
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Rachel T Eguia
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- Howard Hughes Medical Institute, Seattle, WA, 98109, USA
| | - Juhye M Lee
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- Howard Hughes Medical Institute, Seattle, WA, 98109, USA
| | - Hugh K Haddox
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Jared Galloway
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Nguyen Van Vinh Chau
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Andrea N Loes
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- Howard Hughes Medical Institute, Seattle, WA, 98109, USA
| | - John Huddleston
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Timothy C Yu
- Molecular and Cellular Biology Graduate Program, University of Washington, and Basic Sciences Division, Fred Hutch Cancer Center, Seattle, WA, 98109, USA
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Mai Quynh Le
- National Institutes for Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nguyen T D Nhat
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Nguyen Thi Le Thanh
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, 98195, USA
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Seattle, WA, 98109, USA
| | - Trevor Bedford
- Howard Hughes Medical Institute, Seattle, WA, 98109, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Frederick A Matsen
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- Howard Hughes Medical Institute, Seattle, WA, 98109, USA
| | - Maciej F Boni
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA, 16802, USA
| | - Jesse D Bloom
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- Howard Hughes Medical Institute, Seattle, WA, 98109, USA
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23
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El Chaer F, Kaul DR, Englund JA, Boeckh M, Batista MV, Seo SK, Carpenter PA, Navarro D, Hirsch HH, Ison MG, Papanicolaou GA, Chemaly RF. American Society of Transplantation and Cellular Therapy Series: #7 - Management of Respiratory Syncytial Virus Infections in Hematopoietic Cell Transplant Recipients. Transplant Cell Ther 2023; 29:730-738. [PMID: 37783338 DOI: 10.1016/j.jtct.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy (ASTCT) partnered with its Transplant Infectious Disease Special Interest Group (TID-SIG) to update the 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A new approach was adopted to better serve clinical providers by publishing each standalone topic in the infectious disease series in a concise format of frequently asked questions (FAQ), tables, and figures. Experts in HCT and infectious diseases identified FAQs and then provided answers based on the strength of the recommendation and the level of supporting evidence. In the seventh guideline in the series, we focus on the respiratory syncytial virus (RSV) with FAQs addressing epidemiology, clinical diagnosis, prophylaxis, and treatment. Special consideration was given to RSV in pediatric, cord blood, haploidentical, and T cell-depleted HCT and chimeric antigen receptor T cell therapy recipients, as well as to identify future research directions.
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Affiliation(s)
- Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia.
| | - Daniel R Kaul
- Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington
| | - Michael Boeckh
- Clinical Research and Vaccine and Infectious Disease Divisions, Fred Hutchinson Cancer Center and Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Marjorie V Batista
- Department of Infectious Diseases, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Susan K Seo
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, and Department of Microbiology, School of Medicine, University of Valencia, Valencia & Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans H Hirsch
- Clinical Virology Laboratory, Laboratory Medicine, University Hospital Basel, Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Michael G Ison
- Respiratory Disease Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Genovefa A Papanicolaou
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Tannis A, Englund JA, Perez A, Harker EJ, Staat MA, Schlaudecker EP, Halasa NB, Stewart LS, Williams JV, Michaels MG, Selvarangan R, Schuster JE, Sahni LC, Boom JA, Weinberg GA, Szilagyi PG, Clopper BR, Zhou Y, McMorrow ML, Klein EJ, Moline HL. SARS-CoV-2 Epidemiology and COVID-19 mRNA Vaccine Effectiveness Among Infants and Children Aged 6 Months-4 Years - New Vaccine Surveillance Network, United States, July 2022-September 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1300-1306. [PMID: 38032834 PMCID: PMC10718202 DOI: 10.15585/mmwr.mm7248a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
SARS-CoV-2 infection in young children is often mild or asymptomatic; however, some children are at risk for severe disease. Data describing the protective effectiveness of COVID-19 mRNA vaccines against COVID-19-associated emergency department (ED) visits and hospitalization in this population are limited. Data from the New Vaccine Surveillance Network, a prospective population-based surveillance system, were used to estimate vaccine effectiveness using a test-negative, case-control design and describe the epidemiology of SARS-CoV-2 in infants and children aged 6 months-4 years during July 1, 2022-September 30, 2023. Among 7,434 children included, 5% received a positive SARS-CoV-2 test result, and 95% received a negative test result; 86% were unvaccinated, 4% had received 1 dose of any vaccine product, and 10% had received ≥2 doses. When compared with receipt of no vaccines among children, receipt of ≥2 COVID-19 mRNA vaccine doses was 40% effective (95% CI = 8%-60%) in preventing ED visits and hospitalization. These findings support existing recommendations for COVID-19 vaccination of young children to reduce COVID-19-associated ED visits and hospitalization.
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25
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Lee K, Williams KV, Englund JA, Sullivan SG. The potential benefits of delaying seasonal influenza vaccine selections for the Northern Hemisphere: a retrospective modeling study in the United States. J Infect Dis 2023:jiad541. [PMID: 38019883 DOI: 10.1093/infdis/jiad541] [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: 08/08/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUNDS Antigenic similarity between vaccine viruses and circulating viruses is crucial for achieving high vaccine effectiveness against seasonal influenza. New non-egg-based vaccine production technologies could revise current vaccine formulation schedules. We aim to assess the potential benefit of delaying seasonal influenza vaccine virus selection decisions. METHODS We identified seasons where season-dominant viruses presented increasing prevalence after vaccine formulation had been decided in February for the Northern Hemisphere, contributing to their antigenic discrepancy with vaccine viruses. Using a SEIR model of seasonal influenza in the United States, we evaluated the impact of updating vaccine decisions with more antigenically-similar vaccine viruses on the influenza burden in the United States. RESULTS In 2014/15 and 2019/20, the season-dominant A(H3N2) subclade and B/Victoria clade respectively presented increasing prevalence after vaccine decisions were already made for the Northern Hemisphere. Our model showed that the updated A(H3N2) vaccine could have averted 5,000-65,000 influenza hospitalizations in the United States in 2014/15, whereas updating the B/Victoria vaccine component did not substantially change influenza burden in 2019/20 season. CONCLUSIONS With rapid vaccine production, revising current timelines for vaccine selection could result in substantial epidemiological benefits, particularly when additional data could help improve the antigenic match between vaccine and circulating viruses.
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Affiliation(s)
- Kyueun Lee
- The Comparative Health Outcomes Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Katherine V Williams
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, 3000, Australia
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26
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Margolis EB, Maron G, Sun Y, Dallas RH, Allison KJ, Ferrolino J, Ross HS, Davis AE, Jia Q, Turner P, Mackay V, Morin CE, Triplett BM, Klein EJ, Englund JA, Tang L, Hayden RT. Microbiota Predict Infections and Acute Graft-Versus-Host Disease After Pediatric Allogeneic Hematopoietic Stem Cell Transplantation. J Infect Dis 2023; 228:627-636. [PMID: 37249910 PMCID: PMC10469318 DOI: 10.1093/infdis/jiad190] [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: 11/16/2022] [Revised: 04/19/2023] [Accepted: 05/27/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Despite preventive measures, infections continue to pose significant risks to pediatric allogeneic hematopoietic cell transplantation (allo-HCT) recipients. The gut microbiota has been linked to clinical outcomes following adult allo-HCT. This study evaluated whether similar disruptions or differing microbiota patterns were associated with infection risk in pediatric allo-HCT. METHODS In a prospective observational study, fecal samples were obtained from 74 children before conditioning and upon neutrophil recovery. Microbiome signatures identified through sequencing were examined for their associations with infections or acute graft-versus-host disease (aGVHD) in the first-year post-HCT using Cox proportional hazards analysis. RESULTS Microbiome disruption in adults, did not predict infection risk in pediatric allo-HCT. Unique microbiota signatures were associated with different infections or aGVHD. A ratio of strict and facultative anaerobes (eg, Lachnoclostridium, Parabacteroides) prior to conditioning predicted bacteremia risk (Cox hazard ratio [HR], 3.89). A distinct ratio of oral (eg, Rothia, Veillonella) to intestinal anaerobes (eg, Anaerobutyricum, Romboutsia) at neutrophil recovery predicted likelihood of bacterial infections (Cox HR, 1.81) and viral enterocolitis (Cox HR, 1.96). CONCLUSIONS Interactions between medical interventions, pediatric hosts, and microbial communities contribute to microbiota signatures that predict infections. Further multicenter study is necessary to validate the generalizability of these ratios as biomarkers.
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Affiliation(s)
- Elisa B Margolis
- Department of Infectious Diseases, St Jude Children’s Research Hospital
- Department of Pediatrics, University of Tennessee Health Sciences Center
| | - Gabriela Maron
- Department of Infectious Diseases, St Jude Children’s Research Hospital
- Department of Pediatrics, University of Tennessee Health Sciences Center
| | - Yilun Sun
- Department of Biostatistics, St Jude Children’s Research Hospital
| | - Ronald H Dallas
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Kim J Allison
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Jose Ferrolino
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Hailey S Ross
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Amy E Davis
- Department of Infectious Diseases, St Jude Children’s Research Hospital
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Sciences Center, Memphis
| | - Qidong Jia
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Paige Turner
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Victoria Mackay
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Cara E Morin
- Division of Radiology and Medical Imaging, Cincinnati Children's Hospital, Ohio
| | - Brandon M Triplett
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | | | - Li Tang
- Department of Biostatistics, St Jude Children’s Research Hospital
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27
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Clark JD, Albers EL, Albert JE, Berkman ER, Englund JA, Farris RWD, Johnson BA, Lewis‐Newby M, McGuire J, Rogers M, Thompson HM, Wagner TA, Wells C, Yanay O, Zerr DM, Limaye AP. SARS-CoV-2 RNA positive pediatric organ donors: A case report. Pediatr Transplant 2023; 27:e14452. [PMID: 36518025 PMCID: PMC9878170 DOI: 10.1111/petr.14452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/23/2022] [Accepted: 10/24/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preliminary evidence suggests that non-lung organ donation from resolved, asymptomatic or mildly symptomatic SARS-CoV-2 infected adults may be safe. However, several biological aspects of SARS-CoV-2 infection differ in children and the risk for transmission and outcomes of recipients from pediatric donors with SARS-CoV-2 infection are not well described. METHODS We report two unvaccinated asymptomatic pediatric non-lung organ deceased donors who tested positive for SARS-CoV-2 RNA by RT-PCR. Donor One unexpectedly had SARS-CoV-2 RNA detected in nasopharyngeal swab and plasma specimens at autopsy despite several negative tests (upper and lower respiratory tract) in the days prior to organ recovery. Donor Two had SARS-CoV- 2 RNA detected in multiple nasopharyngeal swabs but not lower respiratory tract specimens (endotracheal aspirate and bronchoalveolar lavage) during routine surveillance prior to organ recovery and was managed with remdesivir and monoclonal antibodies prior to organ recovery. RESULTS Two hearts, two livers and four kidneys were successfully transplanted into seven recipients. No donor to recipient transmission of SARS-CoV-2 was observed and graft function of all organs has remained excellent for up to 7 months of followup. CONCLUSIONS Due to the persistent gap between organ availability and the number of children waiting for transplants, deceased pediatric patients with non-disseminated SARS-CoV-2 infection, isolated to upper and/or lower respiratory tract, should be considered as potential non-lung organ donors.
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Affiliation(s)
- Jonna D. Clark
- Division of Bioethics and Palliative Care, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashingtonUSA
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Erin L. Albers
- Division of Pediatric CardiologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jesselle E. Albert
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Emily R. Berkman
- Division of Bioethics and Palliative Care, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashingtonUSA
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Janet A. Englund
- Division of Pediatric Infectious DiseasesUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Reid W. D. Farris
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | | | - Mithya Lewis‐Newby
- Division of Bioethics and Palliative Care, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashingtonUSA
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - John McGuire
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | | | | | - Thor A. Wagner
- Division of Pediatric Infectious DiseasesUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | | | - Ofer Yanay
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Danielle M. Zerr
- Division of Pediatric Infectious DiseasesUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Ajit P. Limaye
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
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Babu TM, Feldstein LR, Saydah S, Acker Z, Boisvert CL, Briggs-Hagen M, Carone M, Casto A, Cox SN, Ehmen B, Englund JA, Fortmann SP, Frivold CJ, Groom H, Han PD, Kuntz JL, Lockwood T, Midgley CM, Mularski RA, Ogilvie T, Reich SL, Schmidt MA, Smith N, Starita L, Stone J, Vandermeer M, Weil AA, Wolf CR, Chu HY, Naleway AL. CASCADIA: a prospective community-based study protocol for assessing SARS-CoV-2 vaccine effectiveness in children and adults using a remote nasal swab collection and web-based survey design. BMJ Open 2023; 13:e071446. [PMID: 37451722 PMCID: PMC10350906 DOI: 10.1136/bmjopen-2022-071446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Although SARS-CoV-2 vaccines were first approved under Emergency Use Authorization by the Food and Drug Administration in late 2020 for adults, authorisation for young children 6 months to <5 years of age did not occur until 2022. These authorisations were based on clinical trials, understanding real-world vaccine effectiveness (VE) in the setting of emerging variants is critical. The primary goal of this study is to evaluate SARS-CoV-2 VE against infection among children aged >6 months and adults aged <50 years. METHODS CASCADIA is a 4-year community-based prospective study of SARS-CoV-2 VE among 3500 adults and paediatric populations aged 6 months to 49 years in Oregon and Washington, USA. At enrolment and regular intervals, participants complete a sociodemographic questionnaire. Individuals provide a blood sample at enrolment and annually thereafter, with optional blood draws every 6 months and after infection and vaccination. Participants complete weekly self-collection of anterior nasal swabs and symptom questionnaires. Swabs are tested for SARS-CoV-2 and other respiratory pathogens by reverse transcription-PCR, with results of selected pathogens returned to participants; nasal swabs with SARS-CoV-2 detected will undergo whole genome sequencing. Participants who test positive for SARS-CoV-2 undergo serial swab collection every 3 days for 21 days. Serum samples are tested for SARS-CoV-2 antibody by binding and neutralisation assays. ANALYSIS The primary outcome is SARS-CoV-2 infection. Cox regression models will be used to estimate the incidence rate ratio associated with SARS-CoV-2 vaccination among the paediatric and adult population, controlling for demographic factors and other potential confounders. ETHICS AND DISSEMINATION All study materials including the protocol, consent forms, data collection instruments, participant communication and recruitment materials, were approved by the Kaiser Permanente Interregional Institutional Review Board, the IRB of record for the study. Results will be disseminated through peer-reviewed publications, presentations, participant newsletters and appropriate general news media.
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Affiliation(s)
- Tara M Babu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Leora R Feldstein
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Saydah
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary Acker
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | | | - Melissa Briggs-Hagen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Amanda Casto
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sarah N Cox
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Brenna Ehmen
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Stephen P Fortmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Collrane J Frivold
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Holly Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Peter D Han
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer L Kuntz
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Tina Lockwood
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Claire M Midgley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard A Mularski
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Tara Ogilvie
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sacha L Reich
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Lea Starita
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
- Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Jeremy Stone
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Meredith Vandermeer
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Ana A Weil
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Caitlin R Wolf
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Helen Y Chu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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Rogers JH, Cox SN, Link AC, Nwanne G, Han PD, Pfau B, Chow EJ, Wolf CR, Boeckh M, Hughes JP, Halloran ME, Uyeki TM, Shim MM, Duchin J, Englund JA, Mosites E, Rolfes MA, Starita LA, Chu HY. Incidence of SARS-CoV-2 infection and associated risk factors among staff and residents at homeless shelters in King County, Washington: an active surveillance study. Epidemiol Infect 2023; 151:e129. [PMID: 37424310 PMCID: PMC10540173 DOI: 10.1017/s0950268823001036] [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: 03/16/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Homeless shelter residents and staff may be at higher risk of SARS-CoV-2 infection. However, SARS-CoV-2 infection estimates in this population have been reliant on cross-sectional or outbreak investigation data. We conducted routine surveillance and outbreak testing in 23 homeless shelters in King County, Washington, to estimate the occurrence of laboratory-confirmed SARS-CoV-2 infection and risk factors during 1 January 2020-31 May 2021. Symptom surveys and nasal swabs were collected for SARS-CoV-2 testing by RT-PCR for residents aged ≥3 months and staff. We collected 12,915 specimens from 2,930 unique participants. We identified 4.74 (95% CI 4.00-5.58) SARS-CoV-2 infections per 100 individuals (residents: 4.96, 95% CI 4.12-5.91; staff: 3.86, 95% CI 2.43-5.79). Most infections were asymptomatic at the time of detection (74%) and detected during routine surveillance (73%). Outbreak testing yielded higher test positivity than routine surveillance (2.7% versus 0.9%). Among those infected, residents were less likely to report symptoms than staff. Participants who were vaccinated against seasonal influenza and were current smokers had lower odds of having an infection detected. Active surveillance that includes SARS-CoV-2 testing of all persons is essential in ascertaining the true burden of SARS-CoV-2 infections among residents and staff of congregate settings.
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Affiliation(s)
- Julia H. Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Sarah N. Cox
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Amy C. Link
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gift Nwanne
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Peter D. Han
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Brian Pfau
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Eric J. Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael Boeckh
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - James P. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Mia Shim
- Public Health – Seattle & King County, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jeffrey Duchin
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, Seattle, WA, USA
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa A. Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lea A. Starita
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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30
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Bennett JC, Emanuels A, Heimonen J, O'Hanlon J, Hughes JP, Han PD, Chow EJ, Ogokeh CE, Rolfes MA, Lockwood CM, Pfau B, Uyeki TM, Shendure J, Hoag S, Fay K, Lee J, Sibley TR, Rogers JH, Starita LM, Englund JA, Chu HY. Streptococcus pneumoniae nasal carriage patterns with and without common respiratory virus detections in households in Seattle, WA, USA before and during the COVID-19 pandemic. Front Pediatr 2023; 11:1198278. [PMID: 37484765 PMCID: PMC10361771 DOI: 10.3389/fped.2023.1198278] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background Respiratory viruses might influence Streptococcus pneumoniae nasal carriage and subsequent disease risk. We estimated the association between common respiratory viruses and semiquantitative S. pneumoniae nasal carriage density in a household setting before and during the COVID-19 pandemic. Methods From November 2019-June 2021, we enrolled participants in a remote household surveillance study of respiratory pathogens. Participants submitted weekly reports of acute respiratory illness (ARI) symptoms. Mid-turbinate or anterior nasal swabs were self-collected at enrollment, when ARI occurred, and, in the second year of the study only, from household contacts after SARS-CoV-2 was detected in a household member. Specimens were tested using multiplex reverse-transcription PCR for respiratory pathogens, including S. pneumoniae, rhinovirus, adenovirus, common human coronavirus, influenza A/B virus, respiratory syncytial virus (RSV) A/B, human metapneumovirus, enterovirus, and human parainfluenza virus. We estimated differences in semiquantitative S. pneumoniae nasal carriage density, estimated by the inverse of S. pneumoniae relative cycle threshold (Crt) values, with and without viral detection for any virus and for specific respiratory viruses using linear generalized estimating equations of S. pneumoniae Crt values on virus detection adjusted for age and swab type and accounting for clustering of swabs within households. Results We collected 346 swabs from 239 individuals in 151 households that tested positive for S. pneumoniae (n = 157 with and 189 without ≥1 viruses co-detected). Difficulty breathing, cough, and runny nose were more commonly reported among individuals with specimens with viral co-detection compared to without (15%, 80% and 93% vs. 8%, 57%, and 51%, respectively) and ear pain and headache were less commonly reported (3% and 26% vs. 16% and 41%, respectively). For specific viruses among all ages, semiquantitative S. pneumoniae nasal carriage density was greater with viral co-detection for enterovirus, RSV A/B, adenovirus, rhinovirus, and common human coronavirus (P < 0.01 for each). When stratified by age, semiquantitative S. pneumoniae nasal carriage density was significantly greater with viral co-detection among children aged <5 (P = 0.002) and 5-17 years (P = 0.005), but not among adults aged 18-64 years (P = 0.29). Conclusion Detection of common respiratory viruses was associated with greater concurrent S. pneumoniae semiquantitative nasal carriage density in a household setting among children, but not adults.
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Affiliation(s)
- Julia C. Bennett
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Anne Emanuels
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Jessica Heimonen
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Jessica O'Hanlon
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Peter D. Han
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, United States
- Military and Health Research Foundation, Laurel, MD, United States
| | - Eric J. Chow
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Communicable Disease Epidemiology and Immunizations Section, Prevention Division, Public Health – Seattle & King County, Seattle, WA, United States
| | - Constance E. Ogokeh
- Military and Health Research Foundation, Laurel, MD, United States
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Melissa A. Rolfes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Christine M. Lockwood
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Brian Pfau
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, United States
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Timothy M. Uyeki
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jay Shendure
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, United States
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Samara Hoag
- Student Health Services, Seattle Public Schools, Seattle, WA, United States
| | - Kairsten Fay
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Jover Lee
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Thomas R. Sibley
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Julia H. Rogers
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Lea M. Starita
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, United States
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Janet A. Englund
- Seattle Children’s Research Institute, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Helen Y. Chu
- Department of Medicine, University of Washington, Seattle, WA, United States
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Rogers JH, Hawes SE, Wolf CR, Hughes JP, Englund JA, Starita LM, Chu HY. Care-seeking correlates of acute respiratory illness among sheltered adults experiencing homelessness in Seattle, WA, 2019: a community-based cross-sectional study. Front Public Health 2023; 11:1090148. [PMID: 37408748 PMCID: PMC10319010 DOI: 10.3389/fpubh.2023.1090148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Multifarious barriers to accessing healthcare services among people experiencing homelessness (PEH) lead to delays in seeking care for acute infections, including those caused by respiratory viruses. PEH are at high risk of acute respiratory illness (ARI)-related complications, especially in shelter settings that may facilitate virus spread, yet data characterizing healthcare utilization for ARI episodes among sheltered PEH remained limited. Methods We conducted a cross-sectional study of viral respiratory infection among adult residents at two homeless shelters in Seattle, Washington between January and May 2019. We assessed factors associated with seeking medical care for ARI via self-report. We collected illness questionnaires and nasal swabs were tested for respiratory viruses by reverse transcription quantitative real-time PCR (RT-qPCR). Results We observed 825 encounters from 649 unique participants; 241 (29.2%) encounters reported seeking healthcare for their ARI episode. Seasonal influenza vaccine receipt (adjusted prevalence ratio [aPR] 1.39, 95% CI 1.02-1.88), having health insurance (aPR 2.77, 95% CI 1.27-6.02), chronic lung conditions (aPR 1.55, 95% CI 1.12-2.15), and experiencing influenza-like-illness symptoms (aPR 1.63, 95% CI 1.20 - 2.20) were associated with increased likelihood of seeking care. Smoking (aPR 0.65, 95% CI 0.45-0.92) was associated with decreased likelihood of seeking care. Discussion Findings suggest that care seeking for viral respiratory illness among PEH may be supported by prior engagement with primary healthcare services. Strategies to increase healthcare utilization may lead to earlier detection of respiratory viruses.
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Affiliation(s)
- Julia H. Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
| | - James P. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children’s Research Institute, University of Washington, Seattle, WA, United States
| | - Lea M. Starita
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
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Newman KL, Wolf CR, Logue JK, Englund JA, Boeckh M, Chu HY. Nausea, Vomiting, and Diarrhea Are Common in Community-Acquired Acute Viral Respiratory Illness. Dig Dis Sci 2023:10.1007/s10620-023-07976-4. [PMID: 37269371 PMCID: PMC10238766 DOI: 10.1007/s10620-023-07976-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are recognized sequelae of acute respiratory illness (ARI), but their prevalence is not well documented. Our study aim was to assess the incidence of GI symptoms in community ARI cases for persons of all ages and their association with clinical outcomes. METHODS We collected mid-nasal swabs, clinical, and symptom data from Seattle-area individuals during the 2018-2019 winter season as part of a large-scale prospective community surveillance study. Swabs were tested by polymerase chain reaction (PCR) for 26 respiratory pathogens. Likelihood of GI symptoms given demographic, clinical, and microbiological covariates were analyzed with Fisher's exact, Wilcoxon-rank-sum, and t-tests and multivariable logistic regression. RESULTS In 3183 ARI episodes, 29.4% had GI symptoms (n = 937). GI symptoms were significantly associated with pathogen detection, illness interfering with daily life, seeking care for the illness, and greater symptom burden (all p < 0.05). Controlling for age, > 3 symptoms, and month, influenza (p < 0.001), human metapneumovirus (p = 0.004), and enterovirus D68 (p = 0.05) were significantly more likely to be associated with GI symptoms than episodes with no pathogen detected. Seasonal coronaviruses (p = 0.005) and rhinovirus (p = 0.04) were significantly less likely to be associated with GI symptoms. CONCLUSION In this community-surveillance study of ARI, GI symptoms were common and associated with illness severity and respiratory pathogen detection. GI symptoms did not track with known GI tropism, suggesting GI symptoms may be nonspecific rather than pathogen-mediated. Patients presenting with GI and respiratory symptoms should have respiratory virus testing, even if the respiratory symptom is not the primary concern.
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Affiliation(s)
- Kira L Newman
- University of Michigan, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI, 48109-5362, USA.
| | | | | | - Janet A Englund
- University of Washington, Seattle, WA, USA
- Seattle Children's, Seattle, WA, USA
| | - Michael Boeckh
- University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Cappetto KD, Brown JC, Englund JA, Zerr DM, Dickerson JA, Wang X, Strelitz B, Klein EJ. Paediatric healthcare and hospital worker SARS-CoV-2 IgG antibody: A longitudinal cohort study. IJID Reg 2023; 7:281-286. [PMID: 37234562 PMCID: PMC10175074 DOI: 10.1016/j.ijregi.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Background This study sought to determine the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleocapsid (N) and spike (S) protein immunoglobulin G (IgG) antibodies in healthcare and hospital workers (HCHWs), and changes in IgG N antibody levels over time. Methods Longitudinal study of HCHWs at a freestanding, urban paediatric tertiary care hospital. Asymptomatic HCHWs aged ≥18 years working in clinical areas were eligible to enrol. Participants completed four surveys and blood draws over 12 months. Specimens were tested for IgG N at four timepoints and IgG S at 12 months. Results In total, 531 HCHWs enrolled in this study; of these, 481 (91%), 429 (81%) and 383 (72%) completed follow-up blood draws at 2, 6 and 12 months, respectively. Five of 531 (1%), 5/481 (1%), 6/429 (1%) and 5/383 (1.3%) participants were seropositive for IgG N at baseline, 2, 6 and 12 months, respectively. All (374/374; 100%) participants who received one or two doses of either mRNA COVID-19 vaccine were seropositive for IgG S. One of nine unvaccinated participants was seropositive for IgG S. Conclusions In this paediatric hospital, IgG N and IgG S were detected in 1.9% and 97.9% of HCHWs, respectively. This study demonstrated low transmission of SARS-CoV-2 among HCHWs with appropriate infection prevention measures.
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Affiliation(s)
| | - Julie C Brown
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Danielle M Zerr
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jane A Dickerson
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Xing Wang
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Eileen J Klein
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
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McCulloch DJ, Rogers JH, Wang Y, Chow EJ, Link AC, Wolf CR, Uyeki TM, Rolfes MA, Mosites E, Sereewit J, Duchin JS, Sugg NK, Greninger AL, Boeckh MJ, Englund JA, Shendure J, Hughes JP, Starita LM, Roychoudhury P, Chu HY. Respiratory syncytial virus and other respiratory virus infections in residents of homeless shelters - King County, Washington, 2019-2021. Influenza Other Respir Viruses 2023; 17:e13166. [PMID: 37346095 PMCID: PMC10279995 DOI: 10.1111/irv.13166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023] Open
Abstract
Respiratory syncytial virus (RSV) causes disproportionate morbidity and mortality in vulnerable populations. We tested residents of homeless shelters in Seattle, Washington for RSV in a repeated cross-sectional study as part of community surveillance for respiratory viruses. Of 15 364 specimens tested, 35 had RSV detected, compared to 77 with influenza. The most common symptoms for both RSV and influenza were cough and rhinorrhea. Many individuals with RSV (39%) and influenza (58%) reported that their illness significantly impacted their ability to perform their regular activities. RSV and influenza demonstrated similar clinical presentations and burden of illness in vulnerable populations living in congregate settings.
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Affiliation(s)
- Denise J. McCulloch
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Julia H. Rogers
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Yongzhe Wang
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
| | - Eric J. Chow
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
| | - Amy C. Link
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
| | - Caitlin R. Wolf
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
| | - Timothy M. Uyeki
- Division of InfluenzaNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Melissa A. Rolfes
- Division of InfluenzaNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Emily Mosites
- Office of the Deputy Director for Infectious DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Jaydee Sereewit
- Department of Laboratory Medicine and PathologyUniversity of WashingtonSeattleWashingtonUSA
| | - Jeffrey S. Duchin
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
- Public Health—Seattle & King CountySeattleWashingtonUSA
| | - Nancy K. Sugg
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, Division of VirologyUniversity of WashingtonSeattleWashingtonUSA
| | - Michael J. Boeckh
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | | | - Jay Shendure
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
- Allen Discovery Center for Cell Lineage TracingSeattleWashingtonUSA
- Howard Hughes Medical InstituteSeattleWashingtonUSA
| | - James P. Hughes
- Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - Lea M. Starita
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
| | - Pavitra Roychoudhury
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
- Department of Laboratory Medicine and Pathology, Division of VirologyUniversity of WashingtonSeattleWashingtonUSA
| | - Helen Y. Chu
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
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35
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Abstract
Respiratory syncytial virus (RSV) infection is a significant cause of morbidity and mortality among infants aged younger than 1 year, adults aged 65 years or older, and immunocompromised persons. Limited data exist on RSV infection in pregnancy and further research is needed. Strides are being made to develop vaccines, including vaccines for maternal immunization, as well as monoclonal antibodies for disease prevention.
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Affiliation(s)
- Alisa B Kachikis
- Department of Obstetrics & Gynecology, University of Washington, 1959 Northeast Pacific Street, Box 356460, Seattle, WA 98195, USA.
| | - Hye Cho
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital Pediatric Infectious Diseases, Seattle Children's Hospital Research Institute, University of Washington, Seattle, WA, USA
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Englund JA, Cohen RA, Bianco V, Domachowske JB, Langley JM, Madhi SA, Zaman K, Bueso A, Ceballos A, Cousin L, Gandhi S, Gruselle O, Jose L, Klein NP, Koen A, Puthanaki T, Shi M, Silas P, Tangsathapornpong A, Teeratakulpisarn J, Vesikari T, Haars G, Leach A, Stoszek SK, Dieussaert I. Evaluation of clinical case definitions for respiratory syncytial virus lower respiratory tract infection in young children. J Pediatric Infect Dis Soc 2023:7152632. [PMID: 37142551 DOI: 10.1093/jpids/piad028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Various case definitions of respiratory syncytial virus lower respiratory tract infection (RSV-LRTI) are currently proposed. We assessed the performance of three clinical case definitions against the World Health Organization definition recommended in 2015 (WHO 2015). METHODS In this prospective cohort study conducted in eight countries, 2401 children were followed up during 2 years from birth. Suspected LRTIs were detected via active and passive surveillance, followed by in-person clinical evaluation including single timepoint respiratory rate and oxygen saturation (by pulse oximetry) assessment, and nasopharyngeal sampling for RSV testing by polymerase chain reaction. Agreement between case definitions was evaluated using Cohen's κ statistics. RESULTS Of 1652 suspected LRTIs, 227 met the WHO 2015 criteria for RSV-LRTI; 73 were classified as severe. All alternative definitions were highly concordant with the WHO 2015 definition for RSV-LRTI (κ: 0.95-1.00), but less concordant for severe RSV-LRTI (κ: 0.47-0.82). Tachypnea was present for 196/226 (86.7%) WHO 2015 RSV-LRTIs and 168/243 (69.1%) LRTI/bronchiolitis/pneumonia cases, clinically diagnosed by non-study physicians. Low oxygen saturation levels were observed in only 55/226 (24.3%) WHO 2015 RSV-LRTIs. CONCLUSION Three case definitions for RSV-LRTI showed high concordance with the WHO 2015 definition, while agreement was lower for severe RSV-LRTI. In contrast to increased respiratory rate, low oxygen saturation was not a consistent finding in RSV-LRTIs and severe RSV-LRTIs. This study demonstrates that current definitions are highly concordant for RSV-LRTIs, but a standard definition is still needed for severe RSV-LRTI.
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Affiliation(s)
- Janet A Englund
- Seattle Children's Research Institute/University of Washington, Seattle, Washington, 98105, US
| | | | | | - Joseph B Domachowske
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, 13210, US
| | - Joanne M Langley
- Canadian Center for Vaccinology (Dalhousie University, IWK Health and Nova Scotia Health), Halifax, Nova Scotia B3K 6R8, Canada
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - Khalequ Zaman
- International Centre for Diarrheal Disease, Dhaka 1212, Bangladesh
| | | | - Ana Ceballos
- Instituto Médico Río Cuarto, X5800 Río Cuarto, Córdoba, Argentina
| | | | | | | | - Lisa Jose
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California, 94612, US
| | - Anthonet Koen
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - Thanyawee Puthanaki
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Meng Shi
- GSK, Rockville, Maryland, 20850, US
| | - Peter Silas
- Wee Care Pediatrics, Syracuse, Utah, 84075, US
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37
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Fairlie T, Chu B, Thomas ES, Querns AK, Lyons A, Koziol M, Englund JA, Anderson EM, Graff K, Rigel S, Bell TR, Saydah S, Chatham-Stephens K, Vogt TM, Hoag S, Briggs-Hagen M. School-Based Interventions to Increase Student COVID-19 Vaccination Coverage in Public School Populations with Low Coverage - Seattle, Washington, December 2021-June 2022. MMWR Morb Mortal Wkly Rep 2023; 72:283-287. [PMID: 36928607 PMCID: PMC10027407 DOI: 10.15585/mmwr.mm7211a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
COVID-19 can lead to severe outcomes in children (1). Vaccination decreases risk for COVID-19 illness, severe disease, and death (2). On December 13, 2020, CDC recommended COVID-19 vaccination for persons aged ≥16 years, with expansion on May 12, 2021, to children and adolescents (children) aged 12-15 years, and on November 2, 2021, to children aged 5-11 years (3). As of March 8, 2023, COVID-19 vaccination coverage among school-aged children remained low nationwide, with 61.7% of children aged 12-17 years and approximately one third (32.7%) of those aged 5-11 years having completed the primary series (3). Intention to receive COVID-19 vaccine and vaccination coverage vary by demographic characteristics, including race and ethnicity and socioeconomic status (4-6). Seattle Public Schools (SPS) implemented a program to increase COVID-19 vaccination coverage during the 2021-22 school year, focusing on children aged 5-11 years during November 2021-June 2022, with an added focus on populations with low vaccine coverage during January 2022-June 2022.† The program included strategic messaging, school-located vaccination clinics, and school-led community engagement. Vaccination data from the Washington State Immunization Information System (WAIIS) were analyzed to examine disparities in COVID-19 vaccination by demographic and school characteristics and trends over time. In December 2021, 56.5% of all SPS students, 33.7% of children aged 5-11 years, and 81.3% of children aged 12-18 years had completed a COVID-19 primary vaccination series. By June 2022, overall series completion had increased to 80.3% and was 74.0% and 86.6% among children aged 5-11 years and 12-18 years, respectively. School-led vaccination programs can leverage community partnerships and relationships with families to improve COVID-19 vaccine access and coverage.
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38
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Muñoz FM, Sher LD, Sabharwal C, Gurtman A, Xu X, Kitchin N, Lockhart S, Riesenberg R, Sexter JM, Czajka H, Paulsen GC, Maldonado Y, Walter EB, Talaat KR, Englund JA, Sarwar UN, Hansen C, Iwamoto M, Webber C, Cunliffe L, Ukkonen B, Martínez SN, Pahud BA, Munjal I, Domachowske JB, Swanson KA, Ma H, Koury K, Mather S, Lu C, Zou J, Xie X, Shi PY, Cooper D, Türeci Ö, Şahin U, Jansen KU, Gruber WC. Evaluation of BNT162b2 Covid-19 Vaccine in Children Younger than 5 Years of Age. N Engl J Med 2023; 388:621-634. [PMID: 36791162 PMCID: PMC9947923 DOI: 10.1056/nejmoa2211031] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Safe and effective vaccines against coronavirus disease 2019 (Covid-19) are urgently needed in young children. METHODS We conducted a phase 1 dose-finding study and are conducting an ongoing phase 2-3 safety, immunogenicity, and efficacy trial of the BNT162b2 vaccine in healthy children 6 months to 11 years of age. We present results for children 6 months to less than 2 years of age and those 2 to 4 years of age through the data-cutoff dates (April 29, 2022, for safety and immunogenicity and June 17, 2022, for efficacy). In the phase 2-3 trial, participants were randomly assigned (in a 2:1 ratio) to receive two 3-μg doses of BNT162b2 or placebo. On the basis of preliminary immunogenicity results, a third 3-μg dose (≥8 weeks after dose 2) was administered starting in January 2022, which coincided with the emergence of the B.1.1.529 (omicron) variant. Immune responses at 1 month after doses 2 and 3 in children 6 months to less than 2 years of age and those 2 to 4 years of age were immunologically bridged to responses after dose 2 in persons 16 to 25 years of age who received 30 μg of BNT162b2 in the pivotal trial. RESULTS During the phase 1 dose-finding study, two doses of BNT162b2 were administered 21 days apart to 16 children 6 months to less than 2 years of age (3-μg dose) and 48 children 2 to 4 years of age (3-μg or 10-μg dose). The 3-μg dose level was selected for the phase 2-3 trial; 1178 children 6 months to less than 2 years of age and 1835 children 2 to 4 years of age received BNT162b2, and 598 and 915, respectively, received placebo. Immunobridging success criteria for the geometric mean ratio and seroresponse at 1 month after dose 3 were met in both age groups. BNT162b2 reactogenicity events were mostly mild to moderate, with no grade 4 events. Low, similar incidences of fever were reported after receipt of BNT162b2 (7% among children 6 months to <2 years of age and 5% among those 2 to 4 years of age) and placebo (6 to 7% among children 6 months to <2 years of age and 4 to 5% among those 2 to 4 years of age). The observed overall vaccine efficacy against symptomatic Covid-19 in children 6 months to 4 years of age was 73.2% (95% confidence interval, 43.8 to 87.6) from 7 days after dose 3 (on the basis of 34 cases). CONCLUSIONS A three-dose primary series of 3-μg BNT162b2 was safe, immunogenic, and efficacious in children 6 months to 4 years of age. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04816643.).
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Affiliation(s)
- Flor M Muñoz
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Lawrence D Sher
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Charu Sabharwal
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Alejandra Gurtman
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Xia Xu
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Nicholas Kitchin
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Stephen Lockhart
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Robert Riesenberg
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Joanna M Sexter
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Hanna Czajka
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Grant C Paulsen
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Yvonne Maldonado
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Emmanuel B Walter
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Kawsar R Talaat
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Janet A Englund
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Uzma N Sarwar
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Caitlin Hansen
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Martha Iwamoto
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Chris Webber
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Luke Cunliffe
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Benita Ukkonen
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Silvina N Martínez
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Barbara A Pahud
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Iona Munjal
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Joseph B Domachowske
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Kena A Swanson
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Hua Ma
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Kenneth Koury
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Susan Mather
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Claire Lu
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Jing Zou
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Xuping Xie
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Pei-Yong Shi
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - David Cooper
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Özlem Türeci
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Uğur Şahin
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - Kathrin U Jansen
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
| | - William C Gruber
- From Texas Children's Hospital, Baylor College of Medicine, Houston (F.M.M.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.); Peninsula Research Associates, Rolling Hills Estates (L.D.S.), and Stanford University School of Medicine, Palo Alto (Y.M.) - both in California; Vaccine Research and Development, Pfizer, Pearl River (C.S., A.G., U.N.S., C.H., M.I., B.A.P., I.M., K.A.S., K.K., C.L., D.C., K.U.J., W.C.G.), and SUNY Upstate Medical University, Syracuse (J.B.D.) - both in New York; Vaccine Research and Development (X. Xu, H.M.), and Worldwide Safety, Safety Surveillance and Risk Management (S.M.), Pfizer, Collegeville, PA; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., C.W., L.C.); Atlanta Center for Medical Research, Atlanta (R.R.); Spring Valley Pediatrics, Washington, DC (J.M.S.); Katedra Pediatrii, Instytut Nauk Medycznych, Kolegium Nauk Medycznych, Uniwersytet Rzeszowski, Rzeszow, Poland (H.C.); the Department of Pediatrics, University of Cincinnati College of Medicine, and the Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati (G.C.P.); Duke Human Vaccine Institute, Durham, NC (E.B.W.); Johns Hopkins University, Baltimore (K.R.T.); Seattle Children's Hospital, Seattle (J.A.E.); Tampere University, Espoo Vaccine Research Clinic, Espoo, Finland (B.U.); Hospital Universitario HM Puerta del Sur, Madrid (S.N.M.); and BioNTech, Mainz, Germany (Ö.T., U.Ş.)
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Sahni LC, Naioti EA, Olson SM, Campbell AP, Michaels MG, Williams JV, Staat MA, Schlaudecker EP, McNeal MM, Halasa NB, Stewart LS, Chappell JD, Englund JA, Klein EJ, Szilagyi PG, Weinberg GA, Harrison CJ, Selvarangan R, Schuster JE, Azimi PH, Singer MN, Avadhanula V, Piedra PA, Munoz FM, Patel MM, Boom JA. Sustained Within-season Vaccine Effectiveness Against Influenza-associated Hospitalization in Children: Evidence From the New Vaccine Surveillance Network, 2015-2016 Through 2019-2020. Clin Infect Dis 2023; 76:e1031-e1039. [PMID: 35867698 DOI: 10.1093/cid/ciac577] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adult studies have demonstrated within-season declines in influenza vaccine effectiveness (VE); data in children are limited. METHODS We conducted a prospective, test-negative study of children 6 months through 17 years hospitalized with acute respiratory illness at 7 pediatric medical centers during the 2015-2016 through 2019-2020 influenza seasons. Case-patients were children with an influenza-positive molecular test matched by illness onset to influenza-negative control-patients. We estimated VE [100% × (1 - odds ratio)] by comparing the odds of receipt of ≥1 dose of influenza vaccine ≥14 days before illness onset among influenza-positive children to influenza-negative children. Changes in VE over time between vaccination date and illness onset date were estimated using multivariable logistic regression. RESULTS Of 8430 children, 4653 (55%) received ≥1 dose of influenza vaccine. On average, 48% were vaccinated through October and 85% through December each season. Influenza vaccine receipt was lower in case-patients than control-patients (39% vs 57%, P < .001); overall VE against hospitalization was 53% (95% confidence interval [CI]: 46, 60%). Pooling data across 5 seasons, the odds of influenza-associated hospitalization increased 4.2% (-3.2%, 12.2%) per month since vaccination, with an average VE decrease of 1.9% per month (n = 4000, P = .275). Odds of hospitalization increased 2.9% (95% CI: -5.4%, 11.8%) and 9.6% (95% CI: -7.0%, 29.1%) per month in children ≤8 years (n = 3084) and 9-17 years (n = 916), respectively. These findings were not statistically significant. CONCLUSIONS We observed minimal, not statistically significant within-season declines in VE. Vaccination following current Advisory Committee on Immunization Practices (ACIP) guidelines for timing of vaccine receipt remains the best strategy for preventing influenza-associated hospitalizations in children.
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Affiliation(s)
- Leila C Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Eric A Naioti
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samantha M Olson
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela P Campbell
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marian G Michaels
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John V Williams
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Allen Staat
- Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center Cincinnati, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth P Schlaudecker
- Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center Cincinnati, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica M McNeal
- Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center Cincinnati, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Natasha B Halasa
- Vanderbilit University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Vanderbilit University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Vanderbilit University Medical Center, Nashville, Tennessee, USA
| | | | | | - Peter G Szilagyi
- University of California Los Angeles (UCLA) Mattel Children's Hospital, Los Angeles, California, USA
| | - Geoffrey A Weinberg
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Christopher J Harrison
- University of Missouri-Kansas City School of Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Rangaraj Selvarangan
- University of Missouri-Kansas City School of Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Jennifer E Schuster
- University of Missouri-Kansas City School of Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Parvin H Azimi
- University of California San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Monica N Singer
- University of California San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Vasanthi Avadhanula
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Pedro A Piedra
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Flor M Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital, Houston, Texas, USA
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Manish M Patel
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital, Houston, Texas, USA
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40
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Rankin DA, Spieker AJ, Perez A, Stahl AL, Rahman HK, Stewart LS, Schuster JE, Lively JY, Haddadin Z, Probst V, Michaels MG, Williams JV, Boom JA, Sahni LC, Staat MA, Schlaudecker EP, McNeal MM, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Gerber SI, McMorrow M, Rha B, Chappell JD, Selvarangan R, Midgley CM, Halasa NB. Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6:e2254909. [PMID: 36749589 PMCID: PMC10408278 DOI: 10.1001/jamanetworkopen.2022.54909] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
IMPORTANCE Rhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting. OBJECTIVE To quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought medical care for fever and/or respiratory symptoms at 7 EDs or hospitals within NVSN across the US between December 2016 and February 2021. Persons younger than 18 years were enrolled in NVSN, and respiratory specimens were collected and tested for multiple viruses. MAIN OUTCOMES AND MEASURES Proportion of patients in whom rhinovirus and/or enterovirus, or another virus, was detected by calendar month and by prepandemic (December 1, 2016, to March 11, 2020) or pandemic (March 12, 2020, to February 28, 2021) periods. Month-specific adjusted odds ratios (aORs) for rhinovirus and/or enterovirus-positive test results (among all tested) by setting (ED or inpatient) and age group (<2, 2-4, or 5-17 years) were calculated, comparing each month during the pandemic to equivalent months of previous years. RESULTS Of the 38 198 children and adolescents who were enrolled and tested, 11 303 (29.6%; mean [SD] age, 2.8 [3.7] years; 6733 boys [59.6%]) had rhinovirus and/or enterovirus-positive test results. In prepandemic and pandemic periods, rhinoviruses and/or enteroviruses were detected in 29.4% (9795 of 33 317) and 30.9% (1508 of 4881) of all patients who were enrolled and tested and in 42.2% (9795 of 23 236) and 73.0% (1508 of 2066) of those with test positivity for any virus, respectively. Rhinoviruses and/or enteroviruses were the most frequently detected viruses in both periods and all age groups in the ED and inpatient setting. From April to September 2020 (pandemic period), rhinoviruses and/or enteroviruses were detectable at similar or lower odds than in prepandemic years, with aORs ranging from 0.08 (95% CI, 0.04-0.19) to 0.76 (95% CI, 0.55-1.05) in the ED and 0.04 (95% CI, 0.01-0.11) to 0.71 (95% CI, 0.47-1.07) in the inpatient setting. However, unlike some other viruses, rhinoviruses and/or enteroviruses soon returned to prepandemic levels and from October 2020 to February 2021 were detected at similar or higher odds than in prepandemic months in both settings, with aORs ranging from 1.47 (95% CI, 1.12-1.93) to 3.01 (95% CI, 2.30-3.94) in the ED and 1.36 (95% CI, 1.03-1.79) to 2.44 (95% CI, 1.78-3.34) in the inpatient setting, and in all age groups. Compared with prepandemic years, during the pandemic, rhinoviruses and/or enteroviruses were detected in patients who were slightly older, although most (74.5% [1124 of 1508]) were younger than 5 years. CONCLUSIONS AND RELEVANCE Results of this study show that rhinoviruses and/or enteroviruses persisted and were the most common respiratory virus group detected across all pediatric age groups and in both ED and inpatient settings. Rhinoviruses and/or enteroviruses remain a leading factor in ARI health care burden, and active ARI surveillance in children and adolescents remains critical for defining the health care burden of respiratory viruses.
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Affiliation(s)
- Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ariana Perez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology Inc, Falls Church, Virginia
| | - Anna L. Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Herdi K. Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Joana Y. Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marian G. Michaels
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V. Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Leila C. Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Mary A. Staat
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth P. Schlaudecker
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Monica M. McNeal
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christopher J. Harrison
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Geoffrey A. Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G. Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children’s Hospital, UCLA, Los Angeles
| | - Janet A. Englund
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Eileen J. Klein
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rangaraj Selvarangan
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Claire M. Midgley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Schuster JE, Hamdan L, Dulek DE, Kitko CL, Batarseh E, Haddadin Z, Stewart LS, Stahl A, Potter M, Rahman H, Kalams SA, Coffin S, Ardura MI, Wattier RL, Maron G, Bocchini CE, Moulton EA, Grimley M, Paulsen G, Harrison CJ, Freedman J, Carpenter PA, Englund JA, Munoz FM, Danziger-Isakov L, Spieker AJ, Halasa N. Influenza Vaccine in Pediatric Recipients of Hematopoietic-Cell Transplants. N Engl J Med 2023; 388:374-376. [PMID: 36630610 DOI: 10.1056/nejmc2210825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | - Lubna Hamdan
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Anna Stahl
- Vanderbilt University Medical Center, Nashville, TN
| | - Molly Potter
- Vanderbilt University Medical Center, Nashville, TN
| | - Herdi Rahman
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Susan Coffin
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Rachel L Wattier
- University of California, San Francisco, Benioff Children's Hospital-San Francisco, San Francisco, CA
| | | | | | | | - Michael Grimley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Grant Paulsen
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Hayden MK, Hanson KE, Englund JA, Lee F, Lee MJ, Loeb M, Morgan DJ, Patel R, El Alayli A, El Mikati IK, Sultan S, Falck-Ytter Y, Mansour R, Amarin JZ, Morgan RL, Murad MH, Patel P, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Antigen Testing. Clin Infect Dis 2023:ciad032. [PMID: 36702617 DOI: 10.1093/cid/ciad032] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Immunoassays designed to detect SARS-CoV-2 protein antigens (Ag) are commonly used to diagnose COVID-19. The most widely used tests are lateral flow assays that generate results in approximately 15 minutes for diagnosis at the point-of-care. Higher throughput, laboratory-based SARS-CoV-2 Ag assays have also been developed. The number of commercially available SARS-CoV-2 Ag detection tests has increased rapidly, as has the COVID-19 diagnostic literature. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the literature and develop best practice guidance related to SARS-CoV-2 Ag testing. This guideline is an update to the third in a series of frequently updated COVID-19 diagnostic guidelines developed by the IDSA. OBJECTIVE The IDSA's goal was to develop evidence-based recommendations or suggestions that assist clinicians, clinical laboratories, patients, public health authorities, administrators and policymakers in decisions related to the optimal use of SARS-CoV-2 Ag tests in both medical and non-medical settings. METHODS A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists and experts in systematic literature review identified and prioritized clinical questions related to the use of SARS-CoV-2 Ag tests. A review of relevant, peer-reviewed published literature was conducted through April 1, 2022. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. RESULTS The panel made ten diagnostic recommendations. These recommendations address Ag testing in symptomatic and asymptomatic individuals and assess single versus repeat testing strategies. CONCLUSIONS U.S. Food and Drug Administration (FDA) SARS-CoV-2 Ag tests with Emergency Use Authorization (EUA) have high specificity and low to moderate sensitivity compared to nucleic acid amplification testing (NAAT). Ag test sensitivity is dependent on the presence or absence of symptoms, and in symptomatic patients, on timing of testing after symptom onset. In contrast, Ag tests have high specificity, and, in most cases, positive Ag results can be acted upon without confirmation. Results of point-of-care testing are comparable to those of laboratory-based testing, and observed or unobserved self-collection of specimens for testing yields similar results. Modeling suggests that repeat Ag testing increases sensitivity compared to testing once, but no empirical data were available to inform this question. Based on these observations, rapid RT-PCR or laboratory-based NAAT remains the testing method of choice for diagnosing SARS-CoV-2 infection. However, when timely molecular testing is not readily available or is logistically infeasible, Ag testing helps identify individuals with SARS-CoV-2 infection. Data were insufficient to make a recommendation about the utility of Ag testing to guide release of patients with COVID-19 from isolation. The overall quality of available evidence supporting use of Ag testing was graded as very low to moderate.
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Affiliation(s)
- Mary K Hayden
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois; Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Kimberly E Hanson
- Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robin Patel
- Division of Clinical Microbiology, Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abdallah El Alayli
- Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Razan Mansour
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Justin Z Amarin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca L Morgan
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Division of Public Health, Infectious diseases and occupational Medicine, Mayo Clinic, Rochester, MN
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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Rogers JH, Casto AM, Nwanne G, Link AC, Martinez MA, Nackviseth C, Wolf CR, Hughes JP, Englund JA, Sugg N, Uyeki TM, Han PD, Pfau B, Shendure J, Chu HY. Results from a test-and-treat study for influenza among residents of homeless shelters in King County, WA: A stepped-wedge cluster-randomized trial. Influenza Other Respir Viruses 2023; 17:e13092. [PMID: 36610058 PMCID: PMC9835442 DOI: 10.1111/irv.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Persons experiencing homelessness face increased risk of influenza as overcrowding in congregate shelters can facilitate influenza virus spread. Data regarding on-site influenza testing and antiviral treatment within homeless shelters remain limited. METHODS We conducted a cluster-randomized stepped-wedge trial of point-of-care molecular influenza testing coupled with antiviral treatment with baloxavir or oseltamivir in residents of 14 homeless shelters in Seattle, WA, USA. Residents ≥3 months with cough or ≥2 acute respiratory illness (ARI) symptoms and onset <7 days were eligible. In control periods, mid-nasal swabs were tested for influenza by reverse transcription polymerase chain reaction (RT-PCR). The intervention period included on-site rapid molecular influenza testing and antiviral treatment for influenza-positives if symptom onset was <48 h. The primary endpoint was monthly influenza virus infections in the control versus intervention periods. Influenza whole genome sequencing was performed to assess transmission and antiviral resistance. RESULTS During 11/15/2019-4/30/2020 and 11/2/2020-4/30/2021, 1283 ARI encounters from 668 participants were observed. Influenza virus was detected in 51 (4%) specimens using RT-PCR (A = 14; B = 37); 21 influenza virus infections were detected from 269 (8%) intervention-eligible encounters by rapid molecular testing and received antiviral treatment. Thirty-seven percent of ARI-participant encounters reported symptom onset < 48 h. The intervention had no effect on influenza virus transmission (adjusted relative risk 1.73, 95% confidence interval [CI] 0.50-6.00). Of 23 influenza genomes, 86% of A(H1N1)pdm09 and 81% of B/Victoria sequences were closely related. CONCLUSION Our findings suggest feasibility of influenza test-and-treat strategies in shelters. Additional studies would help discern an intervention effect during periods of increased influenza activity.
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Affiliation(s)
- Julia H. Rogers
- Division of Allergy and Infectious Diseases, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Amanda M. Casto
- Division of Allergy and Infectious Diseases, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA,Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Gift Nwanne
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Amy C. Link
- Division of Allergy and Infectious Diseases, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Miguel A. Martinez
- Division of Allergy and Infectious Diseases, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Callista Nackviseth
- Division of Allergy and Infectious Diseases, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - James P. Hughes
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of PediatricsUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Nancy Sugg
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Peter D. Han
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
| | - Brian Pfau
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
| | - Jay Shendure
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
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Drake AL, Escudero JN, Aurelio MC, Wetzler EA, Ellington SR, Zapata LB, Galang RR, Snead MC, Yamamoto K, Salerno CC, Richardson BA, Greninger AL, Kachikis AB, Englund JA, LaCourse SM. Severe acute respiratory syndrome coronavirus 2 seroprevalence and longitudinal antibody response following natural infection in pregnancy: A prospective cohort study. Womens Health (Lond) 2023; 19:17455057231190955. [PMID: 37615311 PMCID: PMC10467162 DOI: 10.1177/17455057231190955] [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] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Antenatal care provides unique opportunities to assess severe acute respiratory syndrome coronavirus 2 seroprevalence and antibody response duration after natural infection detected during pregnancy; transplacental antibody transfer may inform peripartum and neonatal protection. We estimated seroprevalence and durability of antibodies from natural infection (anti-nucleocapsid immunoglobulin G) among pregnant people, and evaluated transplacental transfer efficiency. OBJECTIVE AND DESIGN We conducted a cross-sectional study to measure severe acute respiratory syndrome coronavirus 2 seroprevalence, and a prospective cohort study to longitudinally measure anti-nucleocapsid immunoglobulin G responses and transplacental transfer of maternally derived anti-nucleocapsid antibodies. METHODS We screened pregnant people for the seroprevalence study between 9 December 2020 and 19 June 2021 for anti-nucleocapsid immunoglobulin G in Seattle, Washington. We enrolled anti-nucleocapsid immunoglobulin G positive people from the seroprevalence study or identified through medical records with positive reverse transcription polymerase chain reaction or antigen positive results in a prospective cohort between 9 December 2020 and 9 August 2022. RESULTS In the cross-sectional study (N = 1284), 5% (N = 65) tested severe acute respiratory syndrome coronavirus 2 anti-nucleocapsid immunoglobulin G positive, including 39 (60%) without prior positive reverse transcription polymerase chain reaction results and 42 (65%) without symptoms. In the prospective cohort study (N = 107 total; N = 65 from the seroprevalence study), 86 (N = 80%) had anti-nucleocapsid immunoglobulin G positive results during pregnancy. Among 63 participants with delivery samples and prior anti-nucleocapsid positive results, 29 (46%) were anti-nucleocapsid immunoglobulin G negative by delivery. Of 34 remaining anti-nucleocapsid immunoglobulin G positive at delivery with paired cord blood, 19 (56%) had efficient transplacental anti-nucleocapsid immunoglobulin G antibody transfer. Median time from first anti-nucleocapsid immunoglobulin G positive to below positive antibody threshold was 19 weeks and did not differ by prior positive reverse transcription polymerase chain reaction status. CONCLUSIONS Maternally derived severe acute respiratory syndrome coronavirus 2 antibodies to natural infection may wane before delivery. Vaccines are recommended for pregnant persons to reduce severe illness and confer protection to infants.
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Affiliation(s)
- Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jaclyn N Escudero
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Morgan C Aurelio
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Erica A Wetzler
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Sascha R Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Romeo R Galang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret C Snead
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krissy Yamamoto
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Carol C Salerno
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA
| | - Alisa B Kachikis
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, WA, USA
| | - Sylvia M LaCourse
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Probst V, Stopczynski T, Amarin JZ, Spieker AJ, Rahman HK, Stewart LS, Selvarangan R, Schuster JE, Michaels MG, Williams J, Boom JA, Sahni LC, Avadhanula V, Staat MA, Schlaudecker EP, McNeal M, Harrison CJ, Moffatt ME, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Curns AT, Perez A, Clopper BR, Rha B, Gerber SI, Chappell J, Halasa NB. 2196. Frequencies of Adenovirus Types in U.S. Children with Acute Respiratory Illness, 2016–2019. Open Forum Infect Dis 2022. [PMCID: PMC9752507 DOI: 10.1093/ofid/ofac492.1815] [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 Adenovirus (AdV) is a common cause of acute respiratory illness (ARI). Multiple respiratory AdV types have been identified in humans, but it remains unclear which are the most common in U.S. children with ARI. Methods We conducted a multicenter, prospective viral surveillance study at seven U.S. children’s hospitals, the New Vaccine Surveillance Network, during 12/1/16–11/30/19, prior to the COVID-19 pandemic. Children < 18 years of age seen in the emergency department or hospitalized with fever and/or respiratory symptoms were enrolled, and mid-turbinate nasal +/- throat swabs were tested using multiplex respiratory pathogen assays or real time polymerase chain reaction (PCR) test for AdV, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus/enterovirus (RV), influenza, parainfluenza viruses, and endemic coronaviruses. AdV-positive specimens were subsequently typed using single-plex qPCR assays targeting sequences in the hexon gene specific for types 1-7, 11, 14, 16 and 21. Demographics, clinical characteristics, and outcomes were compared between AdV types. Results Of 29,381 enrolled children, 2,106 (7.2%) tested positive for AdV. The distribution of types among the 1,330 (63.2%) successfully typed specimens were as follows: 31.7% AdV-2, 28.9% AdV-1, 15.3% AdV-3, 7.9% AdV-5, 5.9% AdV-7, 1.4% AdV-4, 1.2% AdV-6, 0.5% AdV-14, 0.2% AdV-21, 0.1% AdV-11, and 7.0% ≥1 AdV type. Most children with AdV-1 or AdV-2 detection were < 5 years of age (Figure 1a). Demographic and clinical characteristics varied by AdV types, including age, race/ethnicity, smoke exposure, daycare/school attendance, and hospitalization (Table 1). Co-detection with other viruses was common among all AdV types, with RV and RSV being the most frequently co-detected (Figure 1b). Fever and cough were the most common symptoms for all AdV types (Figure 2). Children with AdV-7 detected as single pathogen had higher odds of hospitalization (adjusted odds ratio 6.34 [95% CI: 3.10, 12.95], p= 0.027).
![]() ![]() ![]() Conclusion AdV-2 and AdV-1 were the most frequently detected AdV types among children over the 3-year study period. Notable clinical heterogeneity of the AdV types warrants further surveillance studies to identify AdV types that could be targeted for pediatric vaccine development. Disclosures Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, F(AAM), BioFire: Grant/Research Support|Luminex: Grant/Research Support John Williams, MD, GlaxoSmithKline: Advisor/Consultant|Quidel: Advisor/Consultant Mary A. Staat, MD, MPH, Centers for Disease Control and Prevention: Grant/Research Support|Cepheid: Grant/Research Support|National Institute of Health: Grant/Research Support|Uptodate: Royalties Christopher J Harrison, MD, Astellas: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Pediatric news: Honoraria|Pfizer: Grant/Research Support Mary E. Moffatt, M.D., Becton and Dickinson and Company: Stocks/Bonds|Biogen: Stocks/Bonds|Coloplast B: Stocks/Bonds|Express Scripts: Stocks/Bonds|Novo Nordisk A/S Spons ADR: Stocks/Bonds|Novo Nordisk A/S-B: Stocks/Bonds|Steris PLC: Stocks/Bonds|Stryker Corp: Stocks/Bonds|Thermo Fisher Scientific: Stocks/Bonds Geoffrey A. Weinberg, MD, Merck & Co.: Honoraria|Merck & Co.: Honoraria for composing and reviewing textbook chapters, Merck Manual of Therapeutics Janet A. Englund, MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Natasha B. Halasa, MD, Quidel: Grant/Research Support|Quidel: equipment donation|Sanofi: Grant/Research Support|Sanofi: HAI testing and vaccine donation.
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Affiliation(s)
- Varvara Probst
- Vanderbilt Univerisity Medical Center, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Marian G Michaels
- University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - John Williams
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Leila C Sahni
- Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | | | | | | | - Monica McNeal
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Mary E Moffatt
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | | | - Peter G Szilagyi
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Janet A Englund
- Seattle Children's Hospital/ Univ. Washington, Seattle, Washington
| | - Eileen J Klein
- University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Aaron T Curns
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Brian Rha
- Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - James Chappell
- Vanderbilt University Medical Center, Nashville, Tennessee
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Kim SR, Xie H, Kim YJ, Nordlander A, Ogimi C, Leisenring WM, Boeckh MJ, Englund JA, Waghmare A. 1591. The Impact of Pretransplant Respiratory Virus Infection in Pediatric Hematopoietic Cell Transplant Recipients. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.113] [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
Respiratory virus infections (RVIs) in adult hematopoietic cell transplant (HCT) candidates have been shown to impact posttransplant outcomes; however, there are few studies in pediatric patients. We sought to evaluate the role of specific viruses and the location of viral infection on post HCT outcomes.
Methods
We evaluated allogeneic pediatric HCT recipients receiving myeloablative conditioning from 3/2010–3/2018. All patients had a multiplex PCR for RVIs prior to HCT, regardless of symptoms. Delaying HCT was recommended when feasible for RSV, parainfluenza, metapneumovirus, adenovirus, and influenza, but not routinely for human rhinovirus (HRV) and endemic coronaviruses. We utilized Cox proportional hazards models to evaluate progression to lower respiratory disease (LRD) post HCT and linear regression models to evaluated days alive and out of hospital (DAOH) by 100 days post HCT.
Results
Of 310 allogeneic HCT recipients receiving myeloablative conditioning, 133 (43%) were positive for a RVI before HCT. Baseline characteristics were notable for differences for age, recipient CMV serostatus, and delayed HCT (Table 1). The most common RVI was HRV (97, 73%) and 81 (61%) patients were symptomatic at the time of detection. Most patients had a URI (92%) and 11 patients had LRD (3 proven, 8 possible). In univariate analysis, HRV as virus type was associated with fewer DAOH and preHCT URI as location of viral infection (with and without symptoms) trended towards fewer DAOH (Figure 1a). When adjusted for age, preHCT lymphocyte count, cell source, and conditioning regimen, both HRV and preHCT URI showed a trend towards fewer DAOH, but no significant association was found (Figure 1b,c). Twenty patients progressed to LRD after HCT with the same preHCT RVI; no factors, including delay of transplant, were associated with reduced progression to LRD.
(A) Univariable linear regression for DAOH, (B) Multivariable linear regression for DAOH by viral type, (C) Multivariable linear regression for DAOH by viral location and symptom composite.
Conclusion
In this single center study, HRV as virus type and URI as location of viral infection before myeloablative allogeneic HCT were associated with increased hospitalization after HCT, but not in multivariate models. Larger multicenter studies are needed to provide timely evaluation and adequate statistical power to definitively determine role of URI versus LRD and the impact of transplant delay and treatment strategies.
Disclosures
Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support chikara Ogimi, MD, Horiba: payment for a lecture Michael J. Boeckh, MD PhD, Allovir: Advisor/Consultant|Amazon: Grant/Research Support|Ansun Biopharma: Grant/Research Support|EvrysBio: Advisor/Consultant|Gates Ventures: Grant/Research Support|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Helocyte: Advisor/Consultant|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kyorin Pharmaceuticals: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Regeneron: Grant/Research Support|ReViral: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Grant/Research Support|Vir Biotechnology: Advisor/Consultant|Vir Biotechnology: Grant/Research Support Janet A. Englund, MD, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccine: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|SanofiPasteur: Advisor/Consultant Alpana Waghmare, MD, Allovir: Grant/Research Support|Ansun Biopharma: Grant/Research Support|Devarra Therapeutics: DSMB|Kyorin Pharmaceutical: Advisor/Consultant|Pfizer: Grant/Research Support|Vir/GSK: Grant/Research Support.
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Affiliation(s)
- Sara R Kim
- Seattle Children's Hospital , Seattle, Washington
| | - Hu Xie
- Fred Hutchinson Cancer Center , Seattle, Washington
| | - Yae-Jean Kim
- Samsung Medical Center , Seoul, Korea, Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | | | - Chikara Ogimi
- National Center for Child Health and Development , Setagaya-ku, Tokyo , Japan
| | | | | | - Janet A Englund
- Seattle Children's Hospital/ Univ. Washington , Seattle, Washington
| | - Alpana Waghmare
- Seattle Children's Hospital/Fred Hutchinson Cancer Center , Seattle, Washington
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Franko NM, Rogers JH, Chow EJ, Huden K, Link AC, Han PD, Wolf CR, Logue J, McDonald D, Shim MHM, Hughes J, Shendure J, Boeckh MJ, Englund JA, Starita L, Chu HY. 1456. Environmental and Nasal Pathogen Surveillance in Seattle Area Homeless Shelters. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1283] [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
The need for community surveillance of respiratory viruses in high-risk settings such as homeless shelters has been underscored by the COVID-19 pandemic. Here, we show that sampling high-touch surfaces is a low-cost, minimally intensive means of community respiratory virus surveillance.
Methods
Environmental samples were collected weekly from adult and family homeless shelters in King County, WA from November 2019 – April 2020. At times when residents were present, a 10cm2 area of selected high-touch surfaces were swabbed and bioaerosol samples were collected in high-traffic areas. Surfaces included entrance and restroom doorknobs, counters, and surfaces unique to each shelter. Study staff collected mid-turbinate swabs from shelter resident participants aged > 3 months with symptoms of acute respiratory illness (ARI). All samples were tested by RT-PCR for 27 viruses. From January 1, 2020 onward, samples were also tested for SARS-CoV-2.
Results
A total of 788 environmental swabs, 1509 nasal swabs, and 98 bioaerosol samples from 6 adult and 3 family shelters were tested. Adenovirus (109 positive swabs, 13.8% of tested swabs), rhinovirus (107, 13.6%) and human bocavirus (62, 7.9%) were the most frequently detected viruses in surface swabs. Rhinovirus (160, 10.6%), human coronaviruses (79, 5.24%) and influenza B (43, 2.85%) were the most detected in nasal swabs. All viruses detected in nasal swabs were found in surface swabs. Of 9 surfaces, exterior bathroom doorknobs were the physical location with the highest number of pathogens detected. SARS-CoV-2 was first detected in surface swabs on 3/20/20, and in nasal swabs on 3/10/20. Bioaerosol samples detected virus in a low percentage of samples relative to surface and nasal swabs. Table 1Count and period prevalence of environmental viral detection by shelter type, November 18, 2019 - April 10, 2020.Figure 1Number of viral pathogens detected from environmental swabs, disaggregated by shelter type.Figure 2Bar graphs comparing prevalence of respiratory pathogen detection in mid-turbinate nasal swabs and environmental swabs/bioaerosol samples by epidemiologic week, November 18, 2019 - April 30, 2020.
Conclusion
Respiratory viruses detected through environmental sampling in homeless shelters were similar to the viruses detected from ARI episodes in study participants. Environmental surface sampling presents a plausible, minimally invasive method of surveillance for both endemic and emerging respiratory pathogens, as evidenced by the detection of SARS-CoV-2 during the early stages of the pandemic. Further research could focus on sampling public locations for broader community surveillance and culturing viruses found on these surfaces.
Disclosures
Michael J. Boeckh, MD PhD, Allovir: Advisor/Consultant|Amazon: Grant/Research Support|Ansun Biopharma: Grant/Research Support|EvrysBio: Advisor/Consultant|Gates Ventures: Grant/Research Support|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Helocyte: Advisor/Consultant|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kyorin Pharmaceuticals: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Regeneron: Grant/Research Support|ReViral: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Grant/Research Support|Vir Biotechnology: Advisor/Consultant|Vir Biotechnology: Grant/Research Support Janet A. Englund, MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.
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Affiliation(s)
| | | | - Eric J Chow
- Public Health - Seattle & King County , Seattle, Washington
| | | | - Amy C Link
- University of Washington , Seattle, Washington
| | - Peter D Han
- University of Washington , Seattle, Washington
| | | | | | | | - Mi-Hyun M Shim
- Public Health - Seattle & King County , Seattle, Washington
| | | | - Jay Shendure
- University of Washington , BBI, HHMI, Allen Discovery Center, Seattle, Washington
| | | | - Janet A Englund
- Seattle Children's Hospital/ Univ. Washington , Seattle, Washington
| | - Lea Starita
- University of Washington , Seattle, Washington
| | - Helen Y Chu
- University of Washington , Seattle, Washington
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48
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Amarin JZ, Stewart LS, Potter M, Spieker AJ, Chappell J, Williams J, Boom JA, Englund JA, Selvarangan R, Schuster JE, Staat MA, Weinberg GA, Klein EJ, Sahni LC, Munoz FM, Szilagyi PG, Harrison CJ, Campbell AP, Patel MM, Halasa NB. 2167. Use and Timing of Antiviral Therapy for Influenza in Hospitalized U.S. Children, 2016–2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1787] [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
According to the 2018 Infectious Diseases Society of America (IDSA) clinical practice guidelines and Centers for Disease Control and Prevention (CDC) guidance, clinicians should start antiviral treatment as soon as possible for children who are hospitalized with suspected or confirmed influenza. We assessed the use of influenza-specific antiviral therapy in children hospitalized with symptoms of acute respiratory illness and laboratory-confirmed influenza.
Methods
We conducted active, population-based surveillance of children hospitalized with fever and/or respiratory symptoms (12/01/2016–02/28/2020) at the seven U.S. medical centers that comprise the CDC New Vaccine Surveillance Network. We excluded children who did not undergo clinical testing (by rapid antigen testing or nucleic acid amplification test [NAAT]) or research testing (by NAAT) for influenza, those who presented out of influenza season (site- and season-specific), and those whose date of antiviral therapy or whether antiviral therapy was given was unknown. We assessed the use of influenza-specific antiviral therapy in this cohort and defined timely antiviral therapy as administration within 2 days of hospitalization.
Results
Of 11,275 eligible children, 1,149 (10.2%) tested positive for influenza by clinical and/or research assays (Table 1). Overall, 154 influenza cases (13.4%) were detected by clinical testing only, 428 (37.2%) by research testing only, and 567 (49.3%) by both. During their influenza-associated hospitalization, 620 children (54.0%) received influenza-specific antivirals, and therapy was timely in 572 cases (92.3%). Of those who tested positive clinically, 445/721 (61.7%) received timely antiviral therapy, 38 (5.3%) received delayed antiviral therapy, and 238 (33.0%) received no antiviral therapy. Oseltamivir was the antiviral used in all treated cases. The distribution of antiviral-treated cases varied by race and Hispanic origin and study site, but not by age at presentation or influenza season (Figure 1). Table 1
Demographic characteristics of 1,149 children with influenza enrolled in the New Vaccine Surveillance Network over four influenza seasons between December 1, 2016, and February 28, 2020. Figure 1Proportions of children with influenza enrolled in the New Vaccine Surveillance Network who received timely, delayed, or no antiviral therapy by age at presentation, race and Hispanic origin, study site, and influenza season (N=1,149).
Conclusion
Although antiviral therapy is recommended for all influenza-associated hospitalizations in children, antiviral prescribing remains suboptimal. Further studies would help identify and address barriers to antiviral therapy in children with influenza.
Disclosures
John Williams, MD, GlaxoSmithKline: Advisor/Consultant|Quidel: Advisor/Consultant Janet A. Englund, MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, F(AAM), BioFire: Grant/Research Support|Luminex: Grant/Research Support Mary A. Staat, MD, MPH, Centers for Disease Control and Prevention: Grant/Research Support|Cepheid: Grant/Research Support|National Institute of Health: Grant/Research Support|Uptodate: Royalties Geoffrey A. Weinberg, MD, Merck & Co.: Honoraria|Merck & Co.: Honoraria for composing and reviewing textbook chapters, Merck Manual of Therapeutics Flor M. Munoz, MD, MSc, Gilead: Grant/Research Support|Moderna: DSMB|Pfizer: DSMB Christopher J Harrison, MD, Astellas: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Pediatric news: Honoraria|Pfizer: Grant/Research Support Natasha B. Halasa, MD, Quidel: Grant/Research Support|Quidel: equipment donation|Sanofi: Grant/Research Support|Sanofi: HAI testing and vaccine donation.
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Affiliation(s)
| | | | - Molly Potter
- Vanderbilt University Medical Center , Nashville, Tennessee
| | | | - James Chappell
- Vanderbilt University Medical Center , Nashville, Tennessee
| | - John Williams
- UPMC Children's Hospital of Pittsburgh , Pittsburgh, Pennsylvania
| | | | - Janet A Englund
- Seattle Children's Hospital/ Univ. Washington , Seattle, Washington
| | | | | | | | | | - Eileen J Klein
- University of Washington/Seattle Children's Hospital , Seattle, Washington
| | - Leila C Sahni
- Baylor College of Medicine, Texas Children’s Hospital , Houston, Texas
| | | | - Peter G Szilagyi
- University of Rochester School of Medicine and Dentistry , Rochester, New York
| | | | | | - Manish M Patel
- U.S. Centers for Disease Control and Prevention , Atlanta , Georgia
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Adhikari B, Harrison CJ, Lee BR, Schuster JE, Moffatt ME, Avadhanula V, Sahni LC, Englund JA, Klein EJ, Staat MA, McNeal M, Kobayashi M, Diaz MH, Perez A, Curns AT, Lu X, Selvarangan R. 880. Molecular Subtyping and Macrolide-Resistance Determination of Mycoplasma pneumoniae from Children Enrolled in New Vaccine Surveillance Network in the United States during 2015 to 2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.073] [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: 12/16/2022] Open
Abstract
Abstract
Background
Mycoplasma pneumoniae (MP), a common pediatric pneumonia pathogen, has 2 subtypes based on P1 adhesin gene variation. Macrolide-resistant MP (MRMP), seen since 2000 in many countries, has been subtype associated. Limited U.S. pediatric data exist on MP subtype or MRMP frequency and their clinical importance.
Methods
During 2015–2020, mid-turbinate nasal swab (MTNS) specimens and/or throat swabs were collected from children with acute respiratory illness (ARI) enrolled in emergency department (ED) or outpatient and inpatient settings at 4 CDC-funded New Vaccine Surveillance Network sites (Cincinnati, Seattle, Houston, and Kansas City). Specimens were tested for MP and common respiratory viruses by singleplex or multiplex polymerase chain reaction assay (PCR). P1-subtyping for MP positive specimens used multiplex TaqMan real-time PCR while MR was assessed by real time PCR with melt curve analysis (Lightmix®, TIBMolbiol). Select demographic/clinical data were analyzed by P1 subtype (P1–1 vs. P1–2).
Results
Of 208 MTNS specimens from 208 children (median age 5.5 years), 110 (53%) were P1–1, 89 (43%) P1–2, and 9 (4%) untypeable. Of 199 typeable specimens, 111 (56%) came from inpatients while 88 (44%) came from ED/outpatients.Overall MRMP prevalence during 2015–2020 was low (3/208,1.4%); all MRMP (Houston: 1 each in 2016–2017 and 2019–2020, Seattle: 1 in 2018–2019) were P1–1. Differences in P1–2 vs. P1–1 proportions were significant in 2 years: P1–2 dominated in 2015–2016; P1-1 in 2019–2020 (Figure 1). Common clinical symptoms for 199 MP-positive patients were fever (84%, mean 102.5±1.5oF), shortness of breath (82%), wheezing (67%), and cough (60%). Clinical manifestations, hospitalization, and antibiotic use did not differ in P1-1 vs. P1-2 patients. Antibiotics were used in 59/199 (30%) patients overall; amoxicillin was most frequent (48/199, 24%), followed by cefdinir (9/199, 5%) and azithromycin (5/199, 3%).
Conclusion
MP subtypes co-circulated during 2015–2020; P1-2 dominated in 2015–2016, P1-1 in 2018–2019. Signs/symptoms were similar for P1-1 and P1-2. MRMP detection was uncommon among our pediatric subjects. Ongoing surveillance is important to assess potential changes in MR prevalence and temporal subtype variation.
Disclosures
Christopher J Harrison, MD, Astellas: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Pediatric news: Honoraria|Pfizer: Grant/Research Support Brian R. Lee, PhD, MPH, CDC: Grant/Research Support|Merck: Grant/Research Support Mary E. Moffatt, M.D., Becton and Dickinson and Company: Stocks/Bonds|Biogen: Stocks/Bonds|Coloplast B: Stocks/Bonds|Express Scripts: Stocks/Bonds|Novo Nordisk A/S Spons ADR: Stocks/Bonds|Novo Nordisk A/S-B: Stocks/Bonds|Steris PLC: Stocks/Bonds|Stryker Corp: Stocks/Bonds|Thermo Fisher Scientific: Stocks/Bonds Janet A. Englund, MD, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccine: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|SanofiPasteur: Advisor/Consultant.
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Affiliation(s)
| | | | - Brian R Lee
- Children's Mercy Kansas City , Kansas City, Missouri
| | | | - Mary E Moffatt
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine , Kansas City, Missouri
| | | | - Leila C Sahni
- Baylor College of Medicine, Texas Children’s Hospital , Houston, Texas
| | - Janet A Englund
- Seattle Children's Hospital/ Univ. Washington , Seattle, Washington
| | - Eileen J Klein
- University of Washington/Seattle Children's Hospital , Seattle, Washington
| | | | - Monica McNeal
- Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | | | - Maureen H Diaz
- US Centers for Disease Control and Prevention , Atlanta , Georgia
| | | | - Aaron T Curns
- Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Xiaoyan Lu
- Centers for Disease Control and Prevention , Atlanta , Georgia
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50
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LaCourse SM, Aurelio MC, Escudero JN, Ellington SR, Zapata LB, Snead MC, Yamamoto K, Salerno CC, Greninger AL, Kachikis AB, Englund JA, Drake AL. 1958. Longitudinal SARS-COV-2 anti-spike antibody response in pregnant people with natural infection and variable vaccine uptake. Open Forum Infect Dis 2022. [PMCID: PMC9752645 DOI: 10.1093/ofid/ofac492.1584] [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 Natural SARS-CoV-2 infection results in anti-nucleocapsid (N) and anti-spike (S) antibody (Ab) development. Anti-S Ab response (conferred by infection and/or vaccination) is more closely associated with protection. We evaluated anti-N/S Ab responses in vaccinated (> 1 dose) and unvaccinated pregnant people with prior SAR-CoV-2 infection. Methods During January 2021-March 2022, we enrolled participants with SARS-CoV-2 infection identified in pregnancy (26 via anti-N IgG+; 52 via prior RT-PCR+). Baseline, 1, 2, 3, 6, and 12 months, and delivery samples were tested for anti-N (index ≥ 1.4 positive) and anti-S (≥ 50 AU/mL positive) IgG Ab by Abbott Architect. Kaplan-Meier methods were used to measure Ab response duration. Results Among 78 participants, 62 (79%) enrolled in pregnancy (median 27 weeks gestation), and 16 (21%) at delivery/postpartum (median 2 weeks); 34 (44%) had received ≥1 vaccine prior to initial Ab testing. At baseline, 59 (75%) participants had concordant anti-N/S positive results (median anti-N index 3.58 [IQR 2.01-5.82], median anti-S 5529 AU/ml [IQR 687-25000]). Anti-S IgG was higher (25000 vs 774, p< 0.001) among participants receiving ≥1 vaccine vs no vaccine, while anti-N IgG indices were similar. Among 59 participants with initial anti-N IgG+ results, median time to anti-N IgG negative results was 31 weeks after first RT-PCR+ (median 17 weeks after first anti-N IgG+ result). Only 1 (unvaccinated) participant had an anti-S IgG negative result by 22 weeks after first RT-PCR+ result. Among 30 participants with delivery samples (median 16 weeks after RT-PCR+, 12 weeks after baseline anti-N IgG+ samples), 15 (52%) remained anti-N IgG+; 29 (97%) remained anti-S IgG+. Anti-S IgG was higher (25000 vs 826 AU/ml, p< 0.001) among participants receiving ≥ 1 vaccine vs. no vaccine prior to delivery. Conclusion Among pregnant persons with prior SARS-CoV-2 infection, duration of anti-S IgG response was longer than anti-N IgG irrespective of vaccine status; vaccination during pregnancy was associated with higher anti-S levels at baseline and delivery. While anti-S IgG were detectable for ≥ 6 months, longer term follow-up is needed to assess durability of hybrid immunity vs. infection alone and has implications for maternal and infant protection. Disclosures Sylvia M. LaCourse, MD, MPH, Aurum Institute: Advisor/Consultant|Merck: Grant/Research Support Alexander L. Greninger, MD, PhD, Abbott: Contract Testing|Cepheid: Contract Testing|Gilead: Grant/Research Support|Gilead: Contract Testing|Hologic: Contract Testing|Merck: Grant/Research Support|Novavax: Contract Testing|Pfizer: Contract Testing Alisa B. Kachikis, MD, MSc, GSK: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant Janet A. Englund, MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Alison L. Drake, PhD, MPH, Merck: Grant/Research Support.
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Affiliation(s)
| | | | | | - Sascha R Ellington
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren B Zapata
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret C Snead
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Janet A Englund
- Seattle Children's Hospital/ Univ. Washington, Seattle, Washington
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