1
|
Lopez M, Altamirano J, Melchor S, Perez S, Maldonado Y, Aziz N, Igbinosa I. Learning Lessons from the COVID-19 Pandemic-A Qualitative Assessment of the Experiences of Pregnant Latinas Infected with COVID-19 and Their Perspectives on Vaccination. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02010-3. [PMID: 38709334 DOI: 10.1007/s40615-024-02010-3] [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: 01/31/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To examine the experiences of pregnant Hispanic/Latine people with COVID-19, as well as their perspectives on COVID-19 vaccination in pregnancy. METHODS We interviewed birthing parents who received care from a teaching hospital in California and tested positive for COVID-19 during pregnancy or delivery. We analyzed transcripts using the constant comparative method for analyzing data to using a phenomological epidemiological approach. We used root cause analysis to identify consistent themes across interviews and assess relationships between social determinants of health and COVID-19 infectivity. RESULTS We interviewed 14 women from November 2021 to June 2022. Participants reported COVID-19 adversely impacted their clinical care and well-being during pregnancy or postpartum. Impacts among Spanish-speaking participants included unexpected financial hardships, challenges navigating in-patient experiences, and difficulty securing reliable childcare. While most participants were at least partially vaccinated, participants also described doubts and concerns about the vaccine. CONCLUSIONS Our findings suggest that Spanish-speaking Hispanic/Latine patients could benefit from receiving more information about COVID-19 in pregnancy from their healthcare providers. Leveraging familial and social networks, providing reliable information in people's preferred language, and increasing communication through trusted partners may also help combat vaccine hesitancy.
Collapse
Affiliation(s)
- Marcela Lopez
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie Melchor
- Department of Obstetrics and Gynecology, UCSF Fresno, Fresno, CA, USA
| | - Susan Perez
- Department of Kinesiology and Health Science, California State University, Sacramento, CA, USA
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Natali Aziz
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Irogue Igbinosa
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
2
|
Reed RE, Omollo M, Odero I, Awuonda E, Ochere P, Ondeng’e K, Kang JL, Altamirano J, Barsosio HC, Sarnquist C. Qualitative perspectives on COVID-19, interpersonal violence, and interventions to improve well-being from adolescent girls and young women in Kisumu, Kenya. Front Reprod Health 2023; 5:1236588. [PMID: 38107484 PMCID: PMC10722500 DOI: 10.3389/frph.2023.1236588] [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] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Adolescent girls and young women (AGYW) face a high burden of gender-based violence (GBV) worldwide. The COVID-19 pandemic and associated policies led to global increases in GBV, decreased access to resources, and disruptions of pathways to care. We aimed to understand the effects of COVID-19 on AGYW affected by GBV in Kisumu, Kenya, as well as to identify possible interventions to mitigate those effects. Methods Focus group discussions (FGDs) were conducted with AGYW aged 15-25 with a history of exposure to GBV. AGYW were split into age-matched groups; aged 15-19 for younger groups and 19-25 for older groups. Discussions focused on how COVID-19 affected experiences of GBV, access to care services, economic and social outcomes, and opportunities for interventions to mitigate negative impacts of COVID-19 and violence. Results Five FGDs with 46 AGYW were completed in June-September 2021. AGYW described increases in all types of GBV, particularly sexual abuse and intimate partner violence. Early marriage and subsistence transactional sex also increased. AGYW described violence as both a cause and effect of poor economic, social and health consequences related to the pandemic. Notably, AGYW emphasized stress, lack of mental health support and increased substance use as risk factors for violence, and discussed the deleterious mental health effects of violence-particularly in the wake of disruption of mental health services. COVID-19 disrupted referrals to violence-related services, and reduced access to both medical services and psychosocial services. AGYW believed that interventions focused on improving mental health as well as economic empowerment would be the most feasible and acceptable in mitigating the negative effects of COVID-19 and related exacerbations in violence. Discussion AGYW reported increases in almost all forms of GBV during the pandemic, with related exacerbation in mental health. Concurrently, AGYW endorsed decreased access to care services. As there is no evidence that violence and mental health challenges will quickly resolve, there is an urgent need to identify and implement interventions to mitigate these negative effects.
Collapse
Affiliation(s)
- Ruby E. Reed
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Mevis Omollo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Isdorah Odero
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eucabeth Awuonda
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peter Ochere
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ken Ondeng’e
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jennifer L. Kang
- School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Hellen C. Barsosio
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Clea Sarnquist
- School of Medicine, Stanford University, Stanford, CA, United States
| |
Collapse
|
3
|
Altamirano J, Odero IA, Omollo M, Awuonda E, Ondeng’e K, Kang JL, Behl R, Ndivo R, Baiocchi M, Barsosio HC, Sarnquist CC. Understanding ART Adherence among Adolescent Girls and Young Women in Western Kenya: A Cross-Sectional Study of Barriers and Facilitators. Int J Environ Res Public Health 2023; 20:6922. [PMID: 37887660 PMCID: PMC10606388 DOI: 10.3390/ijerph20206922] [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] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND HIV remains a leading cause of death for adolescent girls and young women (AGYW) in sub-Saharan Africa. This population has a high incidence of HIV and other comorbidities, such as experiencing violence, and low antiretroviral therapy (ART) adherence. To reach global HIV goals, data are needed on the specific adherence barriers for AGYW living with HIV, so interventions can be targeted effectively. METHODS Cross-sectional data were collected at urban and rural health facilities in and around Kisumu County, western Kenya, from January to June 2022, from AGYW 15-24 years of age who were living with HIV. Surveys included questions on intimate partner violence, mental health issues, food security, and orphanhood. Adherence was categorized using viral load testing where available and the Center for Adherence Support Evaluation (CASE) adherence index otherwise. Logistic regression was used to assess associations between potential explanatory variables and adherence. FINDINGS In total, 309 AGYW participated. AGYW with experiences of emotional violence (Odds Ratio [OR] = 1.94, 95% Confidence Interval [CI] = 1.03-3.66), moderate or severe depression (OR = 3.19, 95% CI = 1.47-6.94), and/or substance use (OR = 2.71, 95% CI = 1.24-5.92) had significantly higher odds of poor adherence when compared to AGYW without these respective experiences. Physical and sexual violence, food insecurity, and orphanhood were not associated with poor adherence in this cohort. INTERPRETATION Elucidating the risk factors associated with poor adherence among AGYW living with HIV allows us to identify potential targets for future interventions to improve ART adherence and HIV care outcomes. Mental health and violence prevention interventions, including combination interventions, may prove to be promising approaches.
Collapse
Affiliation(s)
- Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Isdorah A. Odero
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Mevis Omollo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Eucabeth Awuonda
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Ken Ondeng’e
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Jennifer L. Kang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| | - Rasika Behl
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| | - Richard Ndivo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Hellen C. Barsosio
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Clea C. Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| |
Collapse
|
4
|
Walter KS, Altamirano J, Huang C, Carrington YJ, Zhou F, Andrews JR, Maldonado Y. Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns. NPJ Vaccines 2023; 8:137. [PMID: 37749086 PMCID: PMC10520055 DOI: 10.1038/s41541-023-00740-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from children receiving OPV and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Overall, 61% (11/18) of OPV-1, 71% (34/48) OPV-2, and 96% (54/56) OPV-3 samples with available data had evidence of a reversion at the key 5' UTR attenuating position and 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutations in the VP1 gene. Our results are consistent with previous work documenting rapid reversion to virulence of OPV and underscores the need for intensive surveillance following OPV use.
Collapse
Affiliation(s)
- Katharine S Walter
- Division of Epidemiology, University of Utah, Salt Lake City, UT, 84105, USA.
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - ChunHong Huang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuan J Carrington
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Zhou
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
5
|
Rogo-Gupta LJ, Altamirano J, Homewood LN, Donnellan NM, Miles S, Stuparich M, Salinaro J, Lum D, Fassiotto M. Women physicians receive lower Press Ganey patient satisfaction scores in a multicenter study of outpatient gynecology care. Am J Obstet Gynecol 2023; 229:304.e1-304.e9. [PMID: 37330126 DOI: 10.1016/j.ajog.2023.06.023] [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: 01/02/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Emerging data suggest that patient satisfaction data are subject to inherent biases that negatively affect women physicians. OBJECTIVE This study aimed to describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care. STUDY DESIGN This was a multisite, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from 5 unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 and April 2022. The primary outcome variable was the likelihood to recommend a physician, and individual survey responses served as the unit of analysis. Patient demographic data were collected through the survey, including self-reported age, gender, and race and ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic or LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and P values for these analyses are reported, and results were considered statistically significant at P<.05. Analysis was performed using SAS, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS Data were obtained from 15,184 surveys for 130 physicians. Most physicians were women (n=95 [73%]) and White (n=98 [75%]), and patients were also predominantly White (n=10,495 [69%]). A little over half of all visits were race-concordant, meaning that both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% confidence interval, 0.69-0.95). Patient age had a statistically significant relationship with score, with patients aged ≥63 years having >3-fold increase in odds of providing a topbox score (odds ratio, 3.10; 95% confidence interval, 2.12-4.52) compared with the youngest patients. After adjustment, patient and physician race and ethnicity showed similar effects on the odds of a topbox likelihood-to-recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood-to-recommend score when compared with White physicians and patients (odds ratio: 0.89 [95% confidence interval, 0.81-0.98] and 0.62 [95% confidence interval, 0.48-0.79], respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood-to-recommend score (odds ratio: 1.27 [95% confidence interval, 1.21-1.33] and 1.03 [95% confidence interval, 1.01-1.06], respectively). The physician age quartile was not significantly associated with odds of a topbox likelihood-to-recommend score. CONCLUSION Women gynecologists were 18% less likely to receive top patient satisfaction scores compared with men in this multisite, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given that they provide data currently being used to understand patient-centered care.
Collapse
Affiliation(s)
- Lisa J Rogo-Gupta
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Laura N Homewood
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA
| | - Nicole M Donnellan
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Shana Miles
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology, University of California, Riverside, Riverside, CA
| | - Julia Salinaro
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Deirdre Lum
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
6
|
Bellamy M, Chu B, Serencsits B, Quinn B, Prasad K, Altamirano J, Williamson M, Miodownik D, Abrahams N, Chen F, Bierman D, Wutkowski M, Carter L, Dauer L. Impact of shield location on staff and caregiver dose rates for I-131 radiopharmaceutical therapy patients. J Radiol Prot 2023; 43:033501. [PMID: 37413983 DOI: 10.1088/1361-6498/ace4d4] [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] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/06/2023] [Indexed: 07/08/2023]
Abstract
The goal of this study is to investigate the effect of the location and width of a single lead shield on the dose rate of staff and caregivers in a hospital room with an I-131 patient. The best orientation of the patient and caregiver relative to the shield was determined based on minimizing staff and caregiver radiation dose rates. Shielded and unshielded dose rates were simulated using a Monte Carlo computer simulation and validated using real-world ionisation chamber measurements. Based on a radiation transport analysis using an adult voxel phantom published by the International Commission on Radiological Protection, placing the shield near the caregiver yielded the lowest dose rates. However, this strategy reduced the dose rate in only a tiny area of the room. Furthermore, positioning the shield near the patient in the caudal direction provided a modest dose rate reduction while shielding a large room area. Finally, increased shield width was associated with decreasing dose rates, but only a four-fold dose-rate reduction was observed for standard width shields. The recommendations of this case study may be considered as potential candidate room configurations where radiation dose rates are minimized, however these findings must be weighed against additional clinical, safety, and comfort considerations.
Collapse
Affiliation(s)
- M Bellamy
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - B Chu
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - B Serencsits
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - B Quinn
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - K Prasad
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - J Altamirano
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - M Williamson
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - D Miodownik
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - N Abrahams
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - F Chen
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - D Bierman
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - M Wutkowski
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - L Carter
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| | - L Dauer
- Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, United States of America
| |
Collapse
|
7
|
Walter KS, Altamirano J, Huang C, Carrington YJ, Zhou F, Andrews JR, Maldonado Y. Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns. medRxiv 2023:2023.03.16.23287381. [PMID: 36993386 PMCID: PMC10055580 DOI: 10.1101/2023.03.16.23287381] [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] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from vaccinated children and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Alarmingly, 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutation. Our results suggest that current definitions of cVDPVs may exclude circulating virulent viruses that pose a public health risk and underscore the need for intensive surveillance following OPV use.
Collapse
Affiliation(s)
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - ChunHong Huang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuan J. Carrington
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Zhou
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| |
Collapse
|
8
|
Walter KS, Kim E, Verma R, Altamirano J, Leary S, Carrington YJ, Jagannathan P, Singh U, Holubar M, Subramanian A, Khosla C, Maldonado Y, Andrews JR. Challenges in Harnessing Shared Within-Host Severe Acute Respiratory Syndrome Coronavirus 2 Variation for Transmission Inference. Open Forum Infect Dis 2023; 10:ofad001. [PMID: 36751652 PMCID: PMC9898879 DOI: 10.1093/ofid/ofad001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
Background The limited variation observed among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) consensus sequences makes it difficult to reconstruct transmission linkages in outbreak settings. Previous studies have recovered variation within individual SARS-CoV-2 infections but have not yet measured the informativeness of within-host variation for transmission inference. Methods We performed tiled amplicon sequencing on 307 SARS-CoV-2 samples, including 130 samples from 32 individuals in 14 households and 47 longitudinally sampled individuals, from 4 prospective studies with household membership data, a proxy for transmission linkage. Results Consensus sequences from households had limited diversity (mean pairwise distance, 3.06 single-nucleotide polymorphisms [SNPs]; range, 0-40). Most (83.1%, 255 of 307) samples harbored at least 1 intrahost single-nucleotide variant ([iSNV] median, 117; interquartile range [IQR], 17-208), above a minor allele frequency threshold of 0.2%. Pairs in the same household shared significantly more iSNVs (mean, 1.20 iSNVs; 95% confidence interval [CI], 1.02-1.39) than did pairs in different households infected with the same viral clade (mean, 0.31 iSNVs; 95% CI, .28-.34), a signal that decreases with increasingly stringent minor allele frequency thresholds. The number of shared iSNVs was significantly associated with an increased odds of household membership (adjusted odds ratio, 1.35; 95% CI, 1.23-1.49). However, the poor concordance of iSNVs detected across sequencing replicates (24.8% and 35.0% above a 0.2% and 1% threshold) confirms technical concerns that current sequencing and bioinformatic workflows do not consistently recover low-frequency within-host variants. Conclusions Shared within-host variation may augment the information in consensus sequences for predicting transmission linkages. Improving sensitivity and specificity of within-host variant identification will improve the informativeness of within-host variation.
Collapse
Affiliation(s)
- Katharine S Walter
- Correspondence: Katharine S. Walter, PhD, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA ()
| | - Eugene Kim
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Renu Verma
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Sean Leary
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yuan J Carrington
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Prasanna Jagannathan
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Upinder Singh
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Marisa Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Aruna Subramanian
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Chaitan Khosla
- Stanford ChEM-H, Stanford University, Stanford, California, USA,Department of Chemistry and Chemical Engineering, Stanford University, Stanford, California, USA
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA,Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
9
|
Lopez M, Lopez M, Stainton E, Chun LX, Tam GK, Thiessen R, Carrington YJ, Idziak L, Hannon AM, Duanmu Y, Trounce MB, Altamirano J, Ricco AJ, Li J, Li J, Maldonado YA, Govindarajan P. 1050. Breath Sample Collection from Individuals Infected with SARS-CoV-2: Biosafety Methodology. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.891] [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
Breath samples collected from patients infected with respiratory viruses are necessary for viral detection using breath analyzer devices. Given the highly transmissible nature of many of these illnesses, sample collection requires a multi-layered approach to ensure the safety of the research staff responsible for obtaining and transporting these samples. Our team established a protocol to minimize exposure to and transmission of COVID-19 when collecting breath samples.
Methods
We collected breath samples from 64 participants, of which 31 (48.4%) were positive for SARS-CoV-2 at the time of their visit. Before we started sample collection, biosafety inspection was conducted. We used a five-pronged approach to enhance safety and minimize transmission. First, we collected specimens in an outdoor space while the patients were seated in their vehicles. Second, we used a disposable mouthpiece and a one-way valve to fill a 1L TEDLAR bag. Third, patients were instructed to close the valve tightly before returning it to the staff. Fourth, we placed the bag in secondary containers which were placed in tertiary containers to minimize any contact with aerosols in the TEDLAR bag. In the last step, we placed a portable HEPA filter near the indoor sample processing unit to minimize exposure and air contamination with the samples. Study staff donned all forms of necessary personal protective equipment, including gloves, gowns, N95 respirators, and protective eyewear, during sample collection and transportation.
Results
A total of 64 breath samples were collected from 64 adult participants from February to March 2022. A total of 30 participants (46.9%) were within 7 days of their initial diagnosis. All participants were able to successfully collect samples without additional resources or attempts. All samples were able to be transported successfully into the lab. No staff contracted COVID-19 during the study period.
Conclusion
Layered safety measures, including protective equipment, physical barriers, and well-ventilated environments mitigated the risks associated with breath sample collections from infected participants.
Disclosures
Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Member, DSMB, Pfizer Meningococcal Vaccine clinical trial.
Collapse
Affiliation(s)
- Marcela Lopez
- Stanford University School of Medicine , Palo Alto, California
| | - Marcela Lopez
- Stanford University School of Medicine , Palo Alto, California
| | | | | | - Grace K Tam
- Stanford School of Medicine , Daly City, California
| | | | | | | | | | - Youyou Duanmu
- Stanford University School of Medicine , Palo Alto, California
| | | | | | | | - Jing Li
- NASA , Mountain View, California
| | - Jing Li
- NASA , Mountain View, California
| | | | | |
Collapse
|
10
|
Altamirano J, Lopez M, Lopez M, Chun LX, Tam GK, Robinson I, Shaikh N, Leary S, Stainton E, Robinson ML, Behl R, Thiessen R, Govindarajan P, Blomkalns AL, Pinsky BA, Maldonado YA. 1060. Duration of Seroprevalence among Individuals Previously Infected with SARS-CoV-2 and their Household Contacts. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.901] [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
Serological tests directed against SARS-CoV-2 can provide information about the timing of infection and immunity against the virus. However, the kinetics of the host immune response to SARS-CoV-2 remain poorly understood. We established a household transmission study to analyze the serological responses within households, to determine longitudinal immune responses to infection.
Methods
From April 2020 to April 2022, we prospectively enrolled 76 households with at least one RT-PCR confirmed case of COVID-19. Participants were asked to provide blood samples at three time points: at baseline within 2 weeks of the index’s diagnosis of COVID-19, and at one- and three-months post-enrollment. Samples were tested for the presence of IgG antibodies against SARS-CoV-2 spike protein via an FDA EUA approved ELISA. Demographics, medical history, and symptomatology were also collected.
Results
To date, we have analyzed 238 serologic samples from 135 participants, including 82 baseline samples, 89 one-month samples, and 67 three-month samples. At baseline, 67.8% (n=40/59) of all confirmed cases tested positive for SARS-CoV-2 antibodies, which increased to 86.4% (n=57/66) at the one month, and 85.1% at three months (n=40/47). Of those confirmed infected participants that failed to seroconvert at baseline, almost all reported symptoms (n=14/19, 73.7%) and did not have chronic medical conditions (n=17/19, 89.5%). Of the 19, 3 failed to seroconvert by their third visit.
All individuals who were fully vaccinated at the time of each visit tested positive for antibodies at baseline (n=26), one-month (n=27), and three-months (n=20). Of those who were not fully vaccinated, 56 (41.1%) were positive for antibodies at baseline, 62 (59.7%) were positive at one -month, and 47 (63.8%) at three-months. Differences in seropositivity rates between pediatric and adult participants, as well as between index cases and household contacts, at each visit were also identified (Table 1).
Conclusion
Identifying differences in seroprevalence in various demographic groups can provide insight into longitudinal immune responses post-infection. Future analyses on seropositivity among previously infected individuals who received therapeutics may be of interest.
Disclosures
Andra L. Blomkalns, MD, MBA, Eli Lilly and Company: Grant/Research Support Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Member, DSMB, Pfizer Meningococcal Vaccine clinical trial.
Collapse
Affiliation(s)
| | - Marcela Lopez
- Stanford University School of Medicine , Palo Alto, California
| | - Marcela Lopez
- Stanford University School of Medicine , Palo Alto, California
| | | | - Grace K Tam
- Stanford School of Medicine , Daly City, California
| | - India Robinson
- Stanford University School of Medicine , Palo Alto, California
| | - Nuzhat Shaikh
- Stanford University School of Medicine , Palo Alto, California
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Carrington YJ, Zhou F, Walter K, Leary S, Altamirano J, Maldonado YA. 579. Epidemiological Data Differences between Gel-purified vs. DNA-purified Oral Polio Vaccine in environmental samples. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.631] [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
As wild poliovirus is eradicated, preventing circulation of vaccine-derived poliovirus is top priority. Our lab developed real-time multiplex PCR assays and deep sequencing methodology to detect and characterize OPV strains from stool samples. The method requires gel purification of PCR product created from viral RNA in stool samples. However, the process filters out a significant portion of samples. Here, we compare gel- vs. DNA- purification and sample retainment for downstream analysis.
Methods
554 stool samples qPCR positive for at least one OPV serotype from a previous study were used. There are 268 serotype 1 (S1) isolates, 405 serotype 2 (S2) isolates, and 318 serotype 3 (S3) isolates. PCR amplicons created from viral RNA ran through a 0.08% agarose gel to identity presence of the ∼3.5kb amplicon of interest. PCR amplicons then underwent either a gel-purification spin column kit or a DNA purification spin column kit. Samples with DNA concentration >10ng/uL in the elution product is required for NGS.
Purification Methods Flowchart Graph 1:Gel-purification, DNA-purification, and suggested purification workflow charts
Results
Comparing 168 S2 samples gel vs. DNA-purified, of 90 bands identified with both protocols, 100% of DNA-purified samples and 35.6% of the gel-purified samples had DNA concentration >10ng/ul. 41.3% of banded samples with < =34CT had >10ng/ul for gel-purified samples vs. 100% for DNA-purified samples. Of 43 pediatric participants, prior OPV and IPV did not impact proportion of number of individuals with viable samples for NGS (16/31 (51.6%) vs 25/43 (58.1%) respectively). Among samples processed via gel purification, the median number of samples per positive participant dropped from 2 (IQR=1-3) to 1 (IQR=1-1). From the same set of samples, gel purification reduced the number of OPV vaccinated children 38 (82.6%), their household contacts 2 (4.3%), and community contacts 6 (13%) to 21 (80.7%) OPV vaccinated children, 1 (3.8%) household contacts, and 4 (15.3%) community contacts. Table 1:Purification outcome of 168 S2 unique-participant-day (UPD) samples via gel-purification and DNA-purificationGraph 2:Demographic information of patient sample loss form the gel-purification process on 168 S2 samples via gel-purification workflow
2a. Sample collection across different days for 90 unique-participant-day (UPD) samples pre gel-purification vs 32 UPD samples post gel-purification. 2b. OPV and IPV does spread per each 43 pediatric unique-participant (UP) from the 90 UPD samples pre gel-purification vs 25 pediatric UP from the 32 UPD post gel-purification. 2c. Vaccination status (OPV vaccinated child, household contact, unvaccinated community contact) of each 43 unique-participant (UP) from the 90UPD samples pre gel-purification vs 25 UP from the 32 UPD post gel-purification. 2d. Number of samples collected per UP fron the 90 UPD samples pre gel-purification vs 32 UPD samples post gel-purification. Graph 3:Demographic information of patient sample loss form the gel-purification process on 168 S2 samples via suggested purification workflow
2a. Sample collection across different days for 75 unique-participant-day (UPD) samples pre gel-purification vs 31 UPD samples post gel-purification. 2b. OPV and IPV does spread per each 38 pediatric unique-participant (UP) from the 75 UPD samples pre gel-purification vs 24 pediatric UP from the 31 UPD post gel-purification. 2c. Vaccination status (OPV vaccinated child, household contact, unvaccinated community contact) of each 41 unique-participant (UP) from the 75UPD samples pre gel-purification vs 25 UP from the 31 UPD post gel-purification. 2d. Number of samples collected per UP fron the 75 UPD samples pre gel-purification vs 31 UPD samples post gel-purification.
Conclusion
Conclusions: Gel-purification causes a reduction in sample numbers and variation, causing an incomplete data set and data misrepresentation for downstream analysis, particularly a reduction of samples for within host variation analysis. DNA purification of banded samples with < =34CT may be most optimal for NGS. Analysis of all isolates are in process.
Disclosures
Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Member, DSMB, Pfizer Meningococcal Vaccine clinical trial.
Collapse
Affiliation(s)
| | - Frank Zhou
- Stanford University School of Medicine , Stanford, California
| | - Katharine Walter
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine , stanford, California
| | | | | | | |
Collapse
|
12
|
Burns JE, Altamirano J, Salinas J, Sarnquist C, Behl R, Thiessen R, Chun LX, Tam GK, Lopez M, Stainton E, Carrington YJ, Maldonado YA. 1943. Effect of Vaccination on Household Transmission of SARS-CoV-2. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1570] [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
Understanding how COVID-19 vaccination affects transmission of SARS-CoV-2 within households may affect policy and healthcare decisions. We hypothesized that vaccination reduces transmission and viral load in vaccinated household members.
Methods
We prospectively enrolled participants during March 2020 – October 2021. Index cases (IC) were eligible if they tested positive for SARS-CoV-2 within the previous 10 days and did not have household contacts (HC) who had tested positive or had symptoms of COVID-19. Participants self-collected anterior nares swabs daily for SARS-CoV-2 RT-PCR for at least 21 days, or once every member of the household had 7 consecutive negative tests. Baseline data included demographics and self-reported vaccination status. Complete COVID-19 vaccination was defined as receiving 2 doses of Moderna/Pfizer or 1 dose of Johnson & Johnson vaccine, and incomplete vaccination as receiving 1 dose of Moderna/Pfizer vaccine. Household transmission was analyzed via STATA 14.2 using logistic regression with robust standard error clustered by household, and SARS-CoV-2 cycle threshold was graphed by day of study enrollment using lowess smoothing.
Results
There were 60 households with positive ICs and 103 HCs for a total of 163 participants. ICs had median age 41.5 years (range 1–86) with 9 (18.0%) < 18 years. HCs had median age 34 years (range 0–87) with 32 (31.1%) HCs < 18 years. Overall, 33 (20.2%) participants received at least one COVID-19 vaccine dose. A total of 50 households had at least one HC (median 2, max 7). Transmission of SARS-CoV-2 occurred in 45 HCs (43.7%). Odds of SARS-CoV-2 transmission was lower in HCs who were vaccinated prior to study enrollment, though this finding was not statistically significant (Table 1). There were 507 positive SARS-CoV-2 tests collected among 74 participants (Figure 1). Table 1.Household Transmission By COVID-19 Vaccination Status Prior to Study Enrollment (among households with ≥ one household contact)*Using logistic regression with robust standard error, clustered by household. Reference is top group listed in each comparison (includes unvaccinated).CI: Confidence IntervalCompletely vaccinated: Received primary COVID-19 vaccination series (2 doses Pfizer or Moderna vaccine, or 1 dose Johnson & Johnson vaccine) prior to enrollmentIncompletely vaccinated: Received of 1 dose of Pfizer or Moderna vaccine prior to enrollmentUnvaccinated: No COVID-19 vaccines prior to enrollmentFigure 1.SARS-CoV-2 Cycle Threshold Over Time by COVID-19 Vaccination Status
Completely vaccinated: Received primary COVID-19 vaccination series (2 doses Pfizer or Moderna vaccine, or 1 dose Johnson & Johnson vaccine) prior to enrollment
Conclusion
Vaccination of HCs may be protective against household SARS-CoV-2 transmission. However, analyses were limited due to low numbers of vaccinated study participants. Study enrollment is ongoing, and future analyses will include transmission during the 2022 Omicron surge, and daily symptom data which has been collected.
Disclosures
Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Member, DSMB, Pfizer Meningococcal Vaccine clinical trial.
Collapse
Affiliation(s)
| | | | | | - Clea Sarnquist
- School of Medicine, Stanford University , Palo Alto, California
| | | | | | | | - Grace K Tam
- Stanford School of Medicine , Daly City, California
| | | | | | | | | |
Collapse
|
13
|
Haverfield MC, Victor R, Flores B, Altamirano J, Fassiotto M, Kline M, Weimer-Elder B. Qualitatively exploring the impact of a relationship-centered communication skills training program in improving patient perceptions of care. PEC Innov 2022; 1:100069. [PMID: 37213728 PMCID: PMC10194165 DOI: 10.1016/j.pecinn.2022.100069] [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] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/07/2022] [Accepted: 07/23/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore qualitative patient experience comments before and after a relationship-centered communication skills training to understand patient experience, program impact, and opportunities for improvement. Methods Qualitative patient experience evaluation data was captured from January 2016 to December 2018 for 483 health care clinicians who participated in the skills training. A random sampling of available open-ended patient comments (N = 33,223) were selected pre-training (n = 668) and post-training (n = 566). Comments were coded for valence (negative/neutral/positive), generality versus specificity, and based on 12 communication behaviors reflective of training objectives. Results No significant difference was found in the valence of comments, or generality versus specificity of comments before and after the training. A significant decrease was present in perceived clinician concern. "Confidence in care provider" was the communication skill most frequently identified in comments both pre- and post-training. Conclusion Perceptions of interactions largely remained the same following training. Key relationship-centered communication skills require further attention in future training efforts. Measurements of patient satisfaction and engagement may not adequately represent patient experience. Innovation This study identified areas for improvement in the training program and offers a model for utilizing patient experience qualitative data in understanding communication training impact.
Collapse
Affiliation(s)
- Marie C. Haverfield
- Department of Communication Studies, San Jose State University, San Jose, CA, USA
- Corresponding author at: 220 E. San Fernando Street, San Jose, CA 95112, USA.
| | - Robert Victor
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Brenda Flores
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Merisa Kline
- Physician Partnership Program Patient Experience, Stanford Health Care, Stanford, CA, USA
| | - Barbette Weimer-Elder
- Physician Partnership Program Patient Experience, Stanford Health Care, Stanford, CA, USA
| |
Collapse
|
14
|
Jerome B, Fassiotto M, Altamirano J, Sutha K, Maldonado Y, Poullos P. Disability Identity Among Diverse Learners and Employees at an Academic Medical Center. JAMA Netw Open 2022; 5:e2241948. [PMID: 36355375 PMCID: PMC9650606 DOI: 10.1001/jamanetworkopen.2022.41948] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This survey study evaluates representation of persons with disabilities across demographic characteristics at an academic medical center.
Collapse
Affiliation(s)
- Barbara Jerome
- Stanford University School of Medicine, Stanford, California
| | | | | | - Ken Sutha
- Stanford University School of Medicine, Stanford, California
| | | | - Peter Poullos
- Stanford University School of Medicine, Stanford, California
| |
Collapse
|
15
|
Bellamy M, Chu B, Serencsits B, Quinn B, Prasad K, Altamirano J, Williamson M, Miodownik D, Abrahams N, Chen F, Bierman D, Wutkowski M, Dauer L. SUBSTANTIAL EXTERNAL DOSE RATE VARIABILITY OBSERVED IN A COHORT OF LU-177 PATIENTS INDEPENDENT OF BMI AND SEX. Radiat Prot Dosimetry 2022; 198:1476-1482. [PMID: 36138119 PMCID: PMC9667277 DOI: 10.1093/rpd/ncac187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/06/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
External dose rates were measured 1 m away from 230 Lu-177 patients to characterise the variability in normalised dose rates as a function of administered activity, body mass index (BMI) and sex. The largest dose rate observed was 0.07 mSv/h associated with an administered activity of 7.2 GBq. Substantial variability was found in the distribution of the normalised dose rate associated that had an average of 0.0037 mSv/h per GBq and a 95% confidence interval of 0.0024-0.0058 mSv/h per GBq. Based on this study, estimating the patient dose rate based on the Lu-177 gamma exposure factor overestimates the dose rate by a factor of 2. A statistically significant inverse relationship was found between the patient dose rate and patient BMI and an empirically derived equation relating these two quantities was reported. On average, male patient dose rates were 3.5% lower than female dose rates, which may be attributed to the larger average BMI of the male patient group.
Collapse
Affiliation(s)
| | - Bae Chu
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Brian Serencsits
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Brian Quinn
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - K Prasad
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - J Altamirano
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Matthew Williamson
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Daniel Miodownik
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Natalie Abrahams
- Siena College, 515 Loudon Road, Loudonville, New York, NY 12211, USA
| | - Fanny Chen
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - David Bierman
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - M Wutkowski
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Lawrence Dauer
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| |
Collapse
|
16
|
Altamirano J, Kline M, Schwartz R, Fassiotto M, Maldonado Y, Weimer-Elder B. The effect of a relationship-centered communication program on patient experience and provider wellness. Patient Educ Couns 2022; 105:1988-1995. [PMID: 34772532 DOI: 10.1016/j.pec.2021.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness. METHODS 636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual's course participation and following participation up to September 2019. RESULTS 104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTR CP significantly increased and persisted more than 7 months following program completion. CONCLUSIONS The RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience. PRACTICE IMPLICATIONS Implementing a RCC course for providers may improve patient experience and provider wellness.
Collapse
Affiliation(s)
- Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | - Merisa Kline
- Patient Experience, Stanford Health Care, Stanford, CA, USA.
| | - Rachel Schwartz
- Patient Experience, Stanford Health Care, Stanford, CA, USA.
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yvonne Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | | |
Collapse
|
17
|
Saxena M, Altamirano J, Rose C, Bennett C, Govindarajan P, Lumba-Brown A, Hirst R. Journal update monthly top five. J Accid Emerg Med 2022; 39:561-562. [PMID: 35732304 DOI: 10.1136/emermed-2022-212603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Monica Saxena
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan Altamirano
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christian Rose
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher Bennett
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Prasha Govindarajan
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Angela Lumba-Brown
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Robert Hirst
- Children's Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
18
|
Behl R, Ali S, Altamirano J, Leno A, Maldonado Y, Sarnquist C. Rebuilding child health in South Kivu, Democratic Republic of Congo (DRC): evaluating the Asili social enterprise program. Confl Health 2022; 16:21. [PMID: 35526031 PMCID: PMC9077969 DOI: 10.1186/s13031-022-00454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Democratic Republic of Congo (DRC) has a long history of conflict and ongoing local instability; the eastern provinces, including South Kivu, have been especially affected. Health systems and livelihoods have been undermined, contributing to massive inequities in access to health services and high rates of internal displacement. Asili, an innovative social enterprise program, aimed to provide essential community services and improve the health of under-five children in two South Kivu communities, Mudaka and Panzi, via provision of small-format, franchisable health clinics and clean water services. METHODS We evaluated utilization and acceptance of Asili services in two study sites, Mudaka and Panzi. Data collected included questions on housing conditions, food security, and at follow up, Asili membership and use, satisfaction with services, and recommendations for improvement. Structured pre- and post-interviews with primary caregivers of families with under-five children were the primary source of data with additional community input collected through focus group discussions. RESULTS At baseline, we enrolled 843 households in Mudaka and 890 in Panzi. Market segmentation analysis illuminated service usage patterns, showing Asili services were well received overall in both Mudaka and Panzi. Families reporting higher levels of proxy measures of socioeconomic status (SES), such as electricity, land ownership, and education, were more likely to use Asili services, findings that were further supported by focus group discussions among community members. CONCLUSIONS Rebuilding health infrastructure in post-conflict settings, especially those that continue to be conflict-affected and very low SES, is a challenging prospect. Focus group results for this study highlighted the positive community response to Asili, while also underscoring challenges related to cost of services. Programs may need, in particular, to have different levels of costs for different SES groups. Additionally, longer follow-up periods and increased stability may be needed to assess the potential of social enterprise interventions such as Asili to improve health outcomes, especially in children. TRIAL REGISTRATION Institutional Review Board approval for this study was obtained at Stanford University (IRB 35216) and the University of Kinshasa, DRC. Further, this study has been registered on Clinicaltrials.gov (record NCT03536286), retrospectively registered as of 4/23/2018.
Collapse
Affiliation(s)
- Rasika Behl
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA.
| | - Sofia Ali
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
| | - Jonathan Altamirano
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
| | - Abraham Leno
- Eastern Congo Initiative, Bukavu, South Kivu, Democratic Republic of Congo
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
| | - Clea Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
| |
Collapse
|
19
|
Morales-Arráez D, Ventura-Cots M, Altamirano J, Abraldes JG, Cruz-Lemini M, Thursz MR, Atkinson SR, Sarin SK, Kim W, Chavez-Araujo R, Higuera-de la Tijera MF, Singal AK, Shah VH, Kamath PS, Duarte-Rojo A, Charles EA, Vargas V, Jager M, Rautou PE, Rincon D, Zamarripa F, Restrepo-Gutiérrez JC, Torre A, Lucey MR, Arab JP, Mathurin P, Louvet A, García-Tsao G, González JA, Verna EC, Brown RS, Argemi J, Fernández-Carrillo C, Clemente A, Alvarado-Tapias E, Forrest E, Allison M, Bataller R. Correction to: The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study. Am J Gastroenterol 2022; 117:818. [PMID: 35501978 DOI: 10.14309/ajg.0000000000001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- D Morales-Arráez
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Canarias, Spain
| | - M Ventura-Cots
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - J Altamirano
- Department of Internal Medicine, Hospital Quironsalud, Barcelona, Spain
| | - J G Abraldes
- Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Canada
| | - M Cruz-Lemini
- Women and Perinatal Research Group, Obstetrics and Gynecology Department, Sant Pau University Hospital, Barcelona, Spain, and Maternal and Child Health and Development Network (SAMID, RD16/0022/0015), Instituto de Salud Carlos III, Spanish Ministry of Health, Spain
| | - M R Thursz
- Department of Metabolism, Digestive Disease and Reproduction, Imperial College London, London, UK
| | - S R Atkinson
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Department of Metabolism, Digestive Disease and Reproduction, Imperial College London, London, UK
| | - S K Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - W Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - R Chavez-Araujo
- Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - A K Singal
- Division of Gastroenterology and Hepatology, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - V H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - P S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - A Duarte-Rojo
- Division of Gastroenterology and Hepatology, Department of Medicine, the University of Arkansas for Medical Science, Little Rock, Arkansas, USA
| | - E A Charles
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - V Vargas
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona, CIBERehd, Barcelona, Spain
| | - M Jager
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - P E Rautou
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
- Inserm, UMR-970, Paris Cardiovascular Research Center, PARCC, Paris, France
| | - D Rincon
- Hepatology Department, Hospital General Universitario Gregorio Marañón, CIBERehd and Universidad Complutense, Madrid, Spain
| | - F Zamarripa
- Gastroenterology, Juarez Hospital, Mexico City, Mexico
| | - J C Restrepo-Gutiérrez
- Liver Transplant Program, Hospital Pablo Tobon Uribe, University of Antioquia, Medellin, Colombia
| | - A Torre
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - M R Lucey
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - J P Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Mathurin
- Service des Maladies de l'Appareil Digestif et de la Nutrition, CHU Lille, Lille, France
- LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - A Louvet
- Service des Maladies de l'Appareil Digestif et de la Nutrition, CHU Lille, Lille, France
| | - G García-Tsao
- Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven/West Haven, Connecticut¸ USA
| | - J A González
- Gastroenterology Department, Hospital Universitario "Dr. José E González" Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - E C Verna
- Division of Digestive and Liver Diseases, Department of Medicine and Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - R S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - J Argemi
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Liver Unit, Clinica Universidad de Navarra, IdisNA, Pamplona, Spain
| | - C Fernández-Carrillo
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - A Clemente
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Liver Unit and Digestive Department H.G.U. Gregorio Marañón, Madrid, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - E Alvarado-Tapias
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - E Forrest
- Glasgow Royal Infirmary, Glasgow, UK
| | - M Allison
- Liver Unit, Cambridge Biomedical Research Centre, Cambridge, UK
| | - R Bataller
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| |
Collapse
|
20
|
Jani SG, Ma J, Pulendran U, Hsing JC, Altamirano J, Shah S, Toomarian EY, Maldonado Y, Wang CHJ. Prospective Pilot Study Evaluating SARS-CoV-2 Transmission-Limiting Measures in an On-Site School. Acad Pediatr 2022; 22:671-679. [PMID: 34896273 PMCID: PMC8651529 DOI: 10.1016/j.acap.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of our study is to evaluate the feasibility and reliability of a comprehensive set of preventive measures in limiting secondary transmission of COVID-19 in schools. METHODS A prospective cohort study was conducted to evaluate SARS-CoV-2 transmission in an independent K-8 school in San Mateo County, California. The research was conducted between September 14, 2020 through March 22, 2021 and consisted of: 1) demographic and epidemiological questionnaires; 2) daily symptom reporting; 3) weekly RT-PCR testing; and 4) periodic on-site qualitative observations. RESULTS One hundred eighty (79%) students and 63 (74%) on-site staff/contractors were enrolled. Participants reported symptoms in 144 (<1%) daily surveys of the 19,409 collected. Among those who reported symptoms and exposures, none tested positive during the 22-week study period. Of all participants, a total of 6 tested positive for SARS-CoV-2 at least once by RT-PCR; all were asymptomatic at time of testing. No in-school transmission occurred. Mask adherence was high among all grades, and incidents of improper mask use mostly occurred during noninstruction time. Physical distancing was well-enforced during class time and snack breaks, although adherence during noninstruction time waned as the school year progressed. CONCLUSIONS Our comprehensive, prospective study following COVID-19 transmission over 22 weeks in a K-8 school demonstrates that: 1) surveillance testing is important for detecting asymptomatic infections in schools; 2) monitoring symptoms may not be necessary and/or sufficient for COVID-19; and 3) younger children can adhere to key mitigation measures (eg, masking) which have the potential to limit transmission.
Collapse
Affiliation(s)
- Shilpa G Jani
- Center for Policy, Outcomes, and Prevention, and Division of General Pediatrics (SG Jani, J Ma, U Pulendran, JC Hsing, S Shah and CJ Wang), Stanford University School of Medicine, Stanford, Calif
| | - Jasmin Ma
- Center for Policy, Outcomes, and Prevention, and Division of General Pediatrics (SG Jani, J Ma, U Pulendran, JC Hsing, S Shah and CJ Wang), Stanford University School of Medicine, Stanford, Calif
| | - Uma Pulendran
- Center for Policy, Outcomes, and Prevention, and Division of General Pediatrics (SG Jani, J Ma, U Pulendran, JC Hsing, S Shah and CJ Wang), Stanford University School of Medicine, Stanford, Calif
| | - Julianna C Hsing
- Center for Policy, Outcomes, and Prevention, and Division of General Pediatrics (SG Jani, J Ma, U Pulendran, JC Hsing, S Shah and CJ Wang), Stanford University School of Medicine, Stanford, Calif; Department of Epidemiology and Population Health (JC Hsing), Stanford University School of Medicine, Stanford, Calif
| | - Jonathan Altamirano
- Division of Infectious Diseases, Department of Pediatrics (Y Maldonado), Stanford University School of Medicine, Stanford, Calif
| | - Soleil Shah
- Center for Policy, Outcomes, and Prevention, and Division of General Pediatrics (SG Jani, J Ma, U Pulendran, JC Hsing, S Shah and CJ Wang), Stanford University School of Medicine, Stanford, Calif
| | - Elizabeth Y Toomarian
- Graduate School of Education (EY Toomarian), Stanford University, Stanford, Calif; Synapse School (EY Toomarian), Menlo Park, Calif
| | - Yvonne Maldonado
- Division of Infectious Diseases, Department of Pediatrics (Y Maldonado), Stanford University School of Medicine, Stanford, Calif
| | - Chih-Hung Jason Wang
- Center for Policy, Outcomes, and Prevention, and Division of General Pediatrics (SG Jani, J Ma, U Pulendran, JC Hsing, S Shah and CJ Wang), Stanford University School of Medicine, Stanford, Calif; Center for Health Policy, Freeman-Spogli Institute for International Studies (CJ Wang), Stanford University, Stanford, Calif; Department of Health Policy (CJ Wang), Stanford University School of Medicine, Stanford, Calif.
| |
Collapse
|
21
|
Contopoulos-Ioannidis DG, Altamirano J, Maldonado Y. Infectious Diseases-Related Hospitalizations During Oral Polio Vaccine(OPV) and non-OPV immunization periods: An Empirical Evaluation of all Hospital Discharges in California(1985-2010). Clin Infect Dis 2022; 75:1123-1130. [PMID: 35139187 DOI: 10.1093/cid/ciac114] [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: 08/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Live attenuated vaccines such as oral polio vaccine (OPV) can stimulate innate immunity and may have off-target protective effects on other pathogens. We aimed to address this hypothesis by examining changes in infectious diseases (ID)-related hospitalizations in all hospital discharges in California during OPV-(1985-1996) and non-OPV-immunization periods (2000-2010). METHODS We searched the OSHPD (Office of Statewide Health Planning and Development) database for all hospital discharges with any ID-related discharge diagnosis code during 1985-2010. We compared the proportion of ID-related hospitalizations (with at least one ID-related discharge diagnosis) among total hospitalizations during OPV immunization (1985-1996) vs non-OPV immunization (2000-2010) periods. RESULTS There were 19,281,039 ID-related hospitalizations (8,464,037 with an ID-related discharge-diagnosis as the principal discharge diagnosis for the hospitalization) among 98,117,475 hospitalizations in 1985-2010; 9,520,810 ID-hospitalizations/43,456,484 total hospitalizations in 2000-2010 vs 7,526,957/43,472,796 in 1985-1996. The RR for ID-related hospitalizations in 2000-2010 vs 1985-1996 was 1.27(95% CI: 1.26-1.27) for all diagnoses and 1.15(95% CI: 1.15-1.16) for principal diagnoses. Increases also existed in the proportion of lower respiratory and gastrointestinal infections. DISCUSSION The proportion of ID-related hospitalizations was lower in the OPV-immunization period compared to the period after OPV was discontinued. When focused only on hospitalizations with ID as the principal discharge diagnosis the signal remained significant but was smaller. These findings require replication in additional studies.
Collapse
Affiliation(s)
- Despina G Contopoulos-Ioannidis
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jonathan Altamirano
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Yvonne Maldonado
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America.,Senior Associate Dean for Faculty Development and Diversity, Stanford University, Stanford, CA, United States of America.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| |
Collapse
|
22
|
Morales-Arráez D, Ventura-Cots M, Altamirano J, Abraldes JG, Cruz-Lemini M, Thursz MR, Atkinson SR, Sarin SK, Kim W, Chavez-Araujo R, Higuera-de la Tijera MF, Singal AK, Shah VH, Kamath PS, Duarte-Rojo A, Charles EA, Vargas V, Jager M, Rautou PE, Rincon D, Zamarripa F, Restrepo-Gutiérrez JC, Torre A, Lucey MR, Arab JP, Mathurin P, Louvet A, García-Tsao G, González JA, Verna EC, Brown RS, Argemi J, Fernández-Carrillo C, Clemente A, Alvarado-Tapias E, Forrest E, Allison M, Bataller R. The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study. Am J Gastroenterol 2022; 117:301-310. [PMID: 34962498 PMCID: PMC8999152 DOI: 10.14309/ajg.0000000000001596] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 02/06/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.
Collapse
Affiliation(s)
- D Morales-Arráez
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Canarias, Spain
| | - M Ventura-Cots
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - J Altamirano
- Department of Internal Medicine, Hospital Quironsalud, Barcelona, Spain
| | - J G Abraldes
- Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Canada
| | - M Cruz-Lemini
- Women and Perinatal Research Group, Obstetrics and Gynecology Department, Sant Pau University Hospital, Barcelona, Spain, and Maternal and Child Health and Development Network (SAMID, RD16/0022/0015), Instituto de Salud Carlos III, Spanish Ministry of Health, Spain
| | - M R Thursz
- Department of Metabolism, Digestive disease and Reproduction, Imperial College London, UK
| | - S R Atkinson
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Department of Metabolism, Digestive disease and Reproduction, Imperial College London, UK
| | - S K Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - W Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - R Chavez-Araujo
- Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - A K Singal
- Division of Gastroenterology and Hepatology, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - V H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - P S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - A Duarte-Rojo
- Division of Gastroenterology and Hepatology, Department of Medicine, the University of Arkansas for Medical Science, Little Rock, Arkansas, USA
| | - E A Charles
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - V Vargas
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona, CIBERehd, Barcelona, Spain
| | - M Jager
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - P E Rautou
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
- Inserm, UMR-970, Paris Cardiovascular Research Center, PARCC, Paris, France
| | - D Rincon
- Hepatology Department, Hospital General Universitario Gregorio Marañón, CIBERehd and Universidad Complutense, Madrid, Spain
| | - F Zamarripa
- Gastroenterology, Juarez Hospital, Mexico City, Mexico
| | - J C Restrepo-Gutiérrez
- Liver Transplant Program, Hospital Pablo Tobon Uribe, University of Antioquia, Medellin, Colombia
| | - A Torre
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - M R Lucey
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - J P Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Mathurin
- Service des Maladies de l'Appareil Digestif et de la Nutrition, CHU Lille, Lille, France
- LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - A Louvet
- Service des Maladies de l'Appareil Digestif et de la Nutrition, CHU Lille, Lille, France
| | - G García-Tsao
- Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven/West Haven, Connecticut¸ USA
| | - J A González
- Gastroenterology Department, Hospital Universitario "Dr. José E González" Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - E C Verna
- Division of Digestive and Liver Diseases, Department of Medicine and Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - R S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - J Argemi
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Liver Unit, Clinica Universidad de Navarra, IdisNA. Pamplona, Spain
| | - C Fernández-Carrillo
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - A Clemente
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Liver Unit and Digestive Department H.G.U. Gregorio Marañón, Madrid, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - E Alvarado-Tapias
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - E Forrest
- Glasgow Royal Infirmary, Glasgow, UK
| | - M Allison
- Liver Unit, Cambridge Biomedical Research Centre, Cambridge, UK
| | - R Bataller
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| |
Collapse
|
23
|
Altamirano J, Lopez M, Robinson IG, Chun LX, Tam GKY, Shaikh NJ, Hoyte EG, Carrington YJ, Jani SG, Toomarian EY, Hsing JC, Ma J, Pulendran U, Govindarajan P, Blomkalns AL, Pinsky BA, Wang CJ, Maldonado Y. Feasibility of Specimen Self-collection in Young Children Undergoing SARS-CoV-2 Surveillance for In-Person Learning. JAMA Netw Open 2022; 5:e2148988. [PMID: 35175340 PMCID: PMC8855233 DOI: 10.1001/jamanetworkopen.2021.48988] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE There is an urgent need to assess the feasibility of COVID-19 surveillance measures in educational settings. OBJECTIVE To assess whether young children can feasibly self-collect SARS-CoV-2 samples for surveillance testing over the course of an academic year. DESIGN, SETTING, AND PARTICIPANTS This prospective pilot cohort study was conducted from September 10, 2020, to June 10, 2021, at a K-8 school in San Mateo County, California. The research consisted of quantitative data collection efforts: (1) demographic data collected, (2) student sample self-collection error rates, and (3) student sample self-collection time durations. Students were enrolled in a hybrid learning model, a teaching model in which students were taught in person and online, with students having the option to attend virtually as needed. Data were collected under waiver of consent from students participating in weekly SARS-CoV-2 testing. MAIN OUTCOMES AND MEASURES Errors over time for self-collection of nasal swabs such as contaminated swabs and inadequate or shallow swabbing; time taken for sample collection. RESULTS Of 296 participants, 148 (50.0%) were boys and 148 (50.0%) were girls. A total of 87 participants (29.2%) identified as Asian; 2 (0.6%), Black or African American; 13 (4.4%), Hispanic/Latinx; 103 (34.6%), non-Hispanic White; 87 (29.2%), multiracial; and 6 (2.0%), other. The median school grade was fourth grade. From September 2020 to March 2021, a total of 4203 samples were obtained from 221 students on a weekly basis, while data on error rates were collected. Errors occurred in 2.7% (n = 107; 95% CI, 2.2%-3.2%) of student encounters, with the highest rate occurring on the first day of testing (20 [10.2%]). There was an overall decrease in error rates over time. From April to June 2021, a total of 2021 samples were obtained from 296 students on a weekly basis while data on encounter lengths were collected. Between April and June 2021, 193 encounters were timed. The mean duration of each encounter was 70 seconds (95% CI, 66.4-73.7 seconds). CONCLUSIONS AND RELEVANCE Mastery of self-collected lower nasal swabs is possible for children 5 years and older. Testing duration can be condensed once students gain proficiency in testing procedures. Scalability for larger schools is possible if consideration is given to the resource-intensive nature of the testing and the setting's weather patterns.
Collapse
Affiliation(s)
- Jonathan Altamirano
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Marcela Lopez
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - India G. Robinson
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Leanne X. Chun
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Grace K.-Y. Tam
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nuzhat J. Shaikh
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Elisabeth G. Hoyte
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Yuan Jin Carrington
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Shilpa G. Jani
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Elizabeth Y. Toomarian
- Graduate School of Education, Stanford University, Stanford, California
- Synapse School, Menlo Park, California
| | - Julianna C. Hsing
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jasmin Ma
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Uma Pulendran
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Prasanthi Govindarajan
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Andra L. Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - C. Jason Wang
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Yvonne Maldonado
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
24
|
Murugesan K, Jagannathan P, Altamirano J, Maldonado YA, Bonilla HF, Jacobson KB, Parsonnet J, Andrews JR, Shi RZ, Boyd S, Pinsky BA, Singh U, Banaei N. Long-Term Accuracy of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Interferon-γ Release Assay and Its Application in Household Investigation. Clin Infect Dis 2022; 75:e314-e321. [PMID: 35079772 PMCID: PMC8807306 DOI: 10.1093/cid/ciac045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An immunodiagnostic assay that sensitively detects a cell-mediated immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is needed for epidemiological investigation and for clinical assessment of T- cell-mediated immune response to vaccines, particularly in the context of emerging variants that might escape antibody responses. METHODS The performance of a whole blood interferon-gamma (IFN-γ) release assay (IGRA) for the detection of SARS-CoV-2 antigen-specific T cells was evaluated in coronavirus disease 2019 (COVID-19) convalescents tested serially up to 10 months post-infection and in healthy blood donors. SARS-CoV-2 IGRA was applied in contacts of households with index cases. Freshly collected blood in the lithium heparin tube was left unstimulated, stimulated with a SARS-CoV-2 peptide pool, and stimulated with mitogen. RESULTS The overall sensitivity and specificity of IGRA were 84.5% (153/181; 95% confidence interval [CI]: 79.0-89.0) and 86.6% (123/142; 95% CI: 80.0-91.2), respectively. The sensitivity declined from 100% (16/16; 95% CI: 80.6-100) at 0.5-month post-infection to 79.5% (31/39; 95% CI: 64.4-89.2) at 10 months post-infection (P < .01). The IFN-γ response remained relatively robust at 10 months post-infection (3.8 vs 1.3 IU/mL, respectively). In 14 households, IGRA showed a positivity rate of 100% (12/12) and 65.2% (15/23), and IgG of 50.0% (6/12) and 43.5% (10/23) in index cases and contacts, respectively, exhibiting a difference of + 50% (95% CI: +25.4 to +74.6) and +21.7% (95% CI: +9.23 to +42.3), respectively. Either IGRA or IgG was positive in 100% (12/12) of index cases and 73.9% (17/23) of contacts. CONCLUSIONS The SARS-CoV-2 IGRA is a useful clinical diagnostic tool for assessing cell-mediated immune response to SARS-CoV-2.
Collapse
Affiliation(s)
- Kanagavel Murugesan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Prasanna Jagannathan
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan Altamirano
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yvonne A Maldonado
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Hector F Bonilla
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen B Jacobson
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie Parsonnet
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA,Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA
| | - Upinder Singh
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA,Department of Microbiology and Immunology
| | - Niaz Banaei
- Corresponding Author: Niaz Banaei MD , 3375 Hillview Ave, Rm. 1602, Palo Alto, Ca 94304 USA, Phone 650-736-8052,
| |
Collapse
|
25
|
Altamirano J, Govindarajan P, Blomkalns A, Leary S, Robinson I, Chun L, Shaikh N, Tam G, Lopez M, Robinson M, Carrington YJ, De Araujo M, Walter K, Andrews J, Hogan C, Pinksy BA, Maldonado YA. 401. Natural History of Shedding and Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Using Intensive High-Resolution Sampling. Open Forum Infect Dis 2021. [PMCID: PMC8644576 DOI: 10.1093/ofid/ofab466.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In order to mitigate the spread of SARS-CoV-2 and the COVID-19 pandemic, public health officials have recommended self-isolation, self-quarantine of exposed household contacts (HHC), and mask use to limit viral spread within households and communities. While household transmission of SARS-CoV-2 is common, risk factors for HHC transmission are poorly understood. Methods In this prospective cohort study, we enrolled 37 households with at least one reverse transcription polymerase chain reaction-confirmed (RT-PCR) COVID-19 index case from March 2020 - March 2021, in order to calculate secondary attack rates (SAR) and define risk factors for secondary infections. Participants were tested daily for SARS-CoV-2 via RT-PCR, using self-collected lower nasal samples. Households were followed until all members tested negative for seven consecutive days. We collected demographics, medical conditions, relationship to index case, and socioeconomic indicators. Subgroup data analysis was conducted and stratified by positivity status. Results Of 99 enrolled participants, 37 were index cases and 62 were household contacts (HHC), of whom 25 HHC were infected (40.3%). Secondary attack rate (SAR) was highest among adults caring for a parent (n=4/4, 100%) and parents of index cases (5/10, 50%). Households whose income came from service work had greater risk of transmission compared to households whose primary income was technology (n=5/7; 71.4% vs 3/8; 37.5% respectively). Pediatric contacts were at lower risk of infection when compared to adult contacts (n=5/18, 27.8% vs n=20/44, 45.5% respectively). Conclusion This study suggests that household transmission represents a key source of community-based infection of SARS-CoV-2. Allocating resources for education/training regarding prevention among infected individuals and their close contacts will be critical for control of future outbreaks of SARS-CoV-2. Disclosures All Authors: No reported disclosures
Collapse
Affiliation(s)
| | | | | | - Sean Leary
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Altamirano J, Tam G, Lopez M, Robinson I, Chun L, Shaikh N, Leary S, Carrington YJ, Jani S, Pulendran U, Ma J, Toomarian E, Wang CJ, Govindarajan P, Blomkalns A, Robinson M, Maldonado YA. 383. Feasibility of Specimen Self-collection in Young Children Undergoing SARS-CoV-2 Surveillance for In-person Learning. Open Forum Infect Dis 2021. [PMCID: PMC8643871 DOI: 10.1093/ofid/ofab466.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
While pediatric cases of COVID-19 are at low risk for adverse events, schoolchildren should be considered for surveillance as they can become infected at school and serve as sources of household or community transmission. Our team assessed the feasibility of young children self-collecting SARS-CoV-2 samples for surveillance testing in an educational setting.
Methods
Students at a K-8 school were tested weekly for SARS-CoV-2 from September 2020 - June 2021. Error rates were collected from September 2020 - January 2021. Clinical staff provided all students with instructions for anterior nares specimen self-collection and then observed them to ensure proper technique. Instructions included holding the sterile swab while making sure not to touch the tip, inserting the swab into their nostril until they start to feel resistance, and rubbing the swab in four circles before repeating the process in their other nostril. An independent observer timed random sample self-collections from April - June 2021.
Results
2,590 samples were collected from 209 students during the study period when data on error rates were collected. Errors occurred in 3.3% of all student encounters (n=87). Error rates over time are shown in Figure 1, with the highest rate occurring on the first day of testing (n=20/197, 10.2%) and the lowest in January 2021 (n=1/202, 0.5%). 2,574 visits for sample self-collection occurred during the study period when independent timing data was collected (April - June 2021). Of those visits, 7.5% (n=193) were timed. The average duration of each visit was 70 seconds.
Figure 1. Swab Error Rates Over Time
Conclusion
Pediatric self-collected lower nasal swabs are a viable and easily tolerated specimen collection method for SARS-CoV-2 surveillance in school settings, as evidenced by the low error rate and short time window of sample self-collection during testing. School administrators should expect errors to drop quickly after implementing testing.
Disclosures
All Authors: No reported disclosures
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sean Leary
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Nosrat C, Altamirano J, Anyamba A, Caldwell JM, Damoah R, Mutuku F, Ndenga B, LaBeaud AD. Impact of recent climate extremes on mosquito-borne disease transmission in Kenya. PLoS Negl Trop Dis 2021; 15:e0009182. [PMID: 33735293 PMCID: PMC7971569 DOI: 10.1371/journal.pntd.0009182] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/26/2021] [Indexed: 01/12/2023] Open
Abstract
Climate change and variability influence temperature and rainfall, which impact vector abundance and the dynamics of vector-borne disease transmission. Climate change is projected to increase the frequency and intensity of extreme climate events. Mosquito-borne diseases, such as dengue fever, are primarily transmitted by Aedes aegypti mosquitoes. Freshwater availability and temperature affect dengue vector populations via a variety of biological processes and thus influence the ability of mosquitoes to effectively transmit disease. However, the effect of droughts, floods, heat waves, and cold waves is not well understood. Using vector, climate, and dengue disease data collected between 2013 and 2019 in Kenya, this retrospective cohort study aims to elucidate the impact of extreme rainfall and temperature on mosquito abundance and the risk of arboviral infections. To define extreme periods of rainfall and land surface temperature (LST), we calculated monthly anomalies as deviations from long-term means (1983–2019 for rainfall, 2000–2019 for LST) across four study locations in Kenya. We classified extreme climate events as the upper and lower 10% of these calculated LST or rainfall deviations. Monthly Ae. aegypti abundance was recorded in Kenya using four trapping methods. Blood samples were also collected from children with febrile illness presenting to four field sites and tested for dengue virus using an IgG enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). We found that mosquito eggs and adults were significantly more abundant one month following an abnormally wet month. The relationship between mosquito abundance and dengue risk follows a non-linear association. Our findings suggest that early warnings and targeted interventions during periods of abnormal rainfall and temperature, especially flooding, can potentially contribute to reductions in risk of viral transmission. Dengue is a rapidly spreading mosquito-borne disease transmitted primarily by Aedes aegypti mosquitoes. As climate change leads to extremes in rainfall and temperature, the abundance and populations of these vectors will be affected, thus influencing transmission of dengue. Using satellite-derived climate data for Kenya, we classified months that experienced highly abnormal rainfall and temperature as extreme climate events (floods, droughts, heat waves, or cold waves). We compared the average monthly Ae. aegypti abundance and confirmed dengue counts following extreme climate months using lag periods of one month and two months, respectively. This study utilized several statistical models to account for differences among study sites and time. Floods resulted in significantly increased egg and adult abundance. Our results contributed to a better understanding of the effect of climate variability and change on dengue. As suggested by our observed increase in vector counts yet a relatively unchanged dengue infection risk, human behavior can help reduce viral transmission. Targeted interventions should be focused on both reducing vector populations and limiting human-vector contact, especially during these climate anomalies.
Collapse
Affiliation(s)
- Cameron Nosrat
- Program in Human Biology, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Jonathan Altamirano
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Assaf Anyamba
- Universities Space Research Association & NASA Goddard Space Flight Center, Greenbelt, Maryland, United States of America
| | - Jamie M. Caldwell
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Richard Damoah
- Morgan State University & NASA Goddard Space Flight Center, Greenbelt, Maryland, United States of America
| | | | - Bryson Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - A. Desiree LaBeaud
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| |
Collapse
|
28
|
Nuyen B, Altamirano J, Fassiotto M, Alyono J. Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery 2021; 169:1441-1445. [PMID: 33531133 DOI: 10.1016/j.surg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear. METHODS This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. χ2 tests and generalized estimating equation regression models were run to assess correlation. RESULTS In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making. CONCLUSION Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.
Collapse
Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
| |
Collapse
|
29
|
Fassiotto M, Flores B, Victor R, Altamirano J, Garcia LC, Kotadia S, Maldonado Y. Rank Equity Index: Measuring Parity in the Advancement of Underrepresented Populations in Academic Medicine. Acad Med 2020; 95:1844-1852. [PMID: 32889948 DOI: 10.1097/acm.0000000000003720] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As educators, researchers, clinicians, and administrators, faculty serve pivotal roles in academic medical centers (AMCs). Thus, the quality of faculty members' experiences is inseparable from an AMC's success. In seeking new methods to assess equity in advancement in academic medicine, the authors developed the Rank Equity Index (REI)-adapted from the Executive Parity Index, a scale previously implemented within the business sector-to examine national data on gender and racial/ethnic equity across faculty ranks. The REI was employed on self-reported demographic data, collected by the Association of American Medical Colleges, from U.S. medical school faculty in 2017, to make pairwise rank comparisons of the professoriate by demographic characteristics and department. Overall results indicated that women did not attain parity at any pairwise rank comparison, while men were above parity at all ranks. Similar results were observed across all departments surveyed: women in the basic sciences had REIs closest to parity, women in pediatrics had the highest representation but had REIs that were further from parity than REIs in the basic sciences, and women in surgery demonstrated the lowest REIs. Nationally, REIs were below 1.00 for all racial/ethnic group rank comparisons except for White and, in one case, multiple-race non-Hispanic/Latinx. Across all analyzed departments, Black/African American, Asian, Hispanic/Latinx, and multiple-race Hispanic/Latinx faculty had REIs below parity at all ranks except in 2 cases. In a comparison of 2017 and 2007 data, REIs across both race/ethnicity and gender were lower in 2007 for nearly all groups. REI analyses can highlight inequities in faculty rank that may be masked when using aggregate faculty proportions, which do not account for rank. The REI provides AMCs with a new tool to better analyze institutional data to inform efforts to increase parity across all faculty ranks.
Collapse
Affiliation(s)
- Magali Fassiotto
- M. Fassiotto is associate dean for faculty development and diversity, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Brenda Flores
- B. Flores is research and program officer, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Robert Victor
- R. Victor is research and program officer, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Jonathan Altamirano
- J. Altamirano is senior research analyst, Office of Faculty Development and Diversity and Global Child Health Program, Stanford University School of Medicine, Stanford, California
| | - Luis C Garcia
- L.C. Garcia is a medical student and research assistant, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Shaila Kotadia
- S. Kotadia is director of culture and inclusion, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Yvonne Maldonado
- Y. Maldonado is professor of pediatrics and of epidemiology and population health, and senior associate dean for faculty development and diversity, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
30
|
Lee MO, Altamirano J, Garcia LC, Gisondi MA, Wang NE, Lippert S, Maldonado Y, Gharahbaghian L, Ribeira R, Fassiotto M. Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores. West J Emerg Med 2020; 21:117-124. [PMID: 33207156 PMCID: PMC7673899 DOI: 10.5811/westjem.2020.8.47277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the “topbox” score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED). Methods We looked at PG surveys from January 2015–December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: “Likelihood of your recommending our ED to others”; and “Courtesy of the doctor.” We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution. Results We analyzed a total of 3,038 surveys. For “Likelihood of your recommending our ED to others,” topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03–1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70–0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60–0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54–0.93) and vertical areas (OR 0.71; 95% CI 0.53–0.95) compared to fast track. For “Courtesy of the doctor,” topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06–1.14); less likely among Asian (OR 0.70; 95% CI, 0.58–0.84), Black (OR 0.66; 95% CI, 0.45–0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55–0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50–0.95) compared to fast track. Conclusion Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.
Collapse
Affiliation(s)
- Moon O Lee
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Jonathan Altamirano
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Luis C Garcia
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Michael A Gisondi
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - N Ewen Wang
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Suzanne Lippert
- Kaiser-Permanente East Bay, Department of Emergency Medicine, Oakland, California
| | - Yvonne Maldonado
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Laleh Gharahbaghian
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Ryan Ribeira
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Magali Fassiotto
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| |
Collapse
|
31
|
|
32
|
Chen H, Pierson E, Schmer-Galunder S, Altamirano J, Jurafsky D, Leskovec J, Fassiotto M, Kothary N. Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations. J Womens Health (Larchmt) 2020; 30:551-556. [PMID: 32857642 DOI: 10.1089/jwh.2019.8233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.
Collapse
Affiliation(s)
- Heidi Chen
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Emma Pierson
- Department of Computer Science, Stanford University, Stanford, California, USA
| | | | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Dan Jurafsky
- Department of Computer Science, Stanford University, Stanford, California, USA.,Department of Linguistics, Stanford University, Stanford, California, USA
| | - Jure Leskovec
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Nishita Kothary
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| |
Collapse
|
33
|
Liao L, Chung S, Altamirano J, Garcia L, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. The association between Asian patient race/ethnicity and lower satisfaction scores. BMC Health Serv Res 2020; 20:678. [PMID: 32698825 PMCID: PMC7374891 DOI: 10.1186/s12913-020-05534-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/13/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings. METHODS Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N = 216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex. RESULTS Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking. CONCLUSIONS Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.
Collapse
Affiliation(s)
- Lillian Liao
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
- Columbia University Vagelos College of Physicians and Surgeons, 50 Haven Avenue Box #B-26, New York, NY10032 USA
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, USA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Luis Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Bonnie Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| |
Collapse
|
34
|
Altamirano J, Govindarajan P, Blomkalns AL, Kushner LE, Stevens BA, Pinsky BA, Maldonado Y. Assessment of Sensitivity and Specificity of Patient-Collected Lower Nasal Specimens for Severe Acute Respiratory Syndrome Coronavirus 2Testing. JAMA Netw Open 2020; 3:e2012005. [PMID: 32530469 PMCID: PMC7292998 DOI: 10.1001/jamanetworkopen.2020.12005] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This prognostic study compares the diagnostic equivalence of patient-collected lower nasal specimens with that of health care worker–collected oropharyngeal specimens for sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.
Collapse
Affiliation(s)
- Jonathan Altamirano
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Prasanthi Govindarajan
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Andra L. Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Lauren E. Kushner
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Bryan Andrew Stevens
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
35
|
Halpern MS, Altamirano J, Maldonado Y. Pediatric HIV Infection and Decreased Prevalence of OPV Point Mutations Linked to Vaccine-associated Paralytic Poliomyelitis. Clin Infect Dis 2019; 67:S78-S84. [PMID: 30376083 PMCID: PMC6206102 DOI: 10.1093/cid/ciy635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Mutations associated with prolonged replication of the attenuated polioviruses found in oral poliovirus vaccine (OPV) can lead to vaccine-derived poliovirus (VDPV) and cause paralysis indistinguishable from that caused by wild poliovirus. In response, the World Health Organization has initiated the transition to exclusive use of inactivated poliovirus vaccine (IPV), with OPV administration in cases of outbreak. However, it is currently unclear how IPV-only vaccination, well known to provide humoral but not mucosal immunity, will impact the development of paralysis causing OPV variants. Children infected with human immunodeficiency virus (HIV) have been documented to show decreased mucosal immunity following OPV vaccination. Thus, HIV-infected children vaccinated with OPV may serve as proxy for children with IPV-only vaccination. Methods We conducted a prospective study of Zimbabwean infants receiving OPV as part of their routine vaccination schedule. Stool samples collected from OPV-vaccinated children serially until age 24 months were tested for OPV serotypes using a real-time polymerase chain reaction protocol that quantifies the amount of mutant OPV variants found in each sample. Results Out of 2130 stool samples collected from 402 infants 365 stool samples were OPV positive: 313 from 212 HIV-noninfected (HIV−) infants and 52 from 34 HIV-infected (HIV+) infants. HIV− infants showed significantly higher proportions of OPV mutants when compared to HIV+ infants. Conclusions HIV infection is associated with a reduced proportion of OPV vaccine associated paralytic polio mutants. These results suggest that OPV administered to individuals previously vaccinated only with IPV will show decreased propensity for OPV mutations.
Collapse
Affiliation(s)
- Meira S Halpern
- Stanford School of Medicine, Stanford University, California
| | | | | |
Collapse
|
36
|
Sarnquist C, Holubar M, García-García L, Ferreyra-Reyes L, Delgado-Sánchez G, Cruz-Hervert LP, Montero-Campos R, Altamirano J, Purington N, Boyle S, Modlin J, Ferreira-Guerrero E, Canizales-Quintero S, Díaz Ortega JL, Desai M, Maldonado YA. Protocol Paper: Oral Poliovirus Vaccine Transmissibility in Communities After Cessation of Routine Oral Poliovirus Vaccine Immunization. Clin Infect Dis 2019; 67:S115-S120. [PMID: 30376084 PMCID: PMC6206104 DOI: 10.1093/cid/ciy606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We aimed to elucidate household and community-level shedding and transmission of trivalent oral polio vaccine (tOPV) in communities with inactivated polio vaccine (IPV) routine immunization after tOPV is administered during a national health week (NHW). Methods We conducted a 3-arm, randomized trial with data collected at baseline through 10 weeks post-NHW in households with at least 1 child <5 years old in 3 semi-rural communities in Orizaba, Mexico. Selected communities were geographically isolated but socio-demographically similar. Each community was assigned an oral polio vaccine (OPV) immunization rate: 10, 30, or 70% of participating households. From 2653 households in the 3 communities, ~150 households per community were selected, for 466 in total. Households were randomized as vaccinated or unvaccinated, with only 1 child under 5 in the vaccinated household receiving OPV during the February 2015 NHW. No other community members received OPV during this NHW. Stool samples were collected up to 10 weeks post-vaccination for all members of the 466 study households and were analyzed for the presence of OPV serotypes using a multiplex polymerase chain reaction assay. Results We will report on the factors associated with, and incidence and duration of, household and community shedding and transmission of OPV. The secondary outcomes will characterize temporal and geospatial OPV serotype shedding patterns. Conclusions The current global polio eradication plan relies on transitioning away from OPV to IPV. This study contributes to understanding patterns of OPV shedding and transmission dynamics in communities with primary IPV immunity, in order to optimize the reduction of OPV transmission.
Collapse
Affiliation(s)
| | | | | | | | | | - Luis Pablo Cruz-Hervert
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico.,Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | | | | | | | - Shanda Boyle
- Bill & Melinda Gates Foundation, Seattle, Washington
| | - John Modlin
- Bill & Melinda Gates Foundation, Seattle, Washington
| | | | | | | | | | | |
Collapse
|
37
|
Ghatan CE, Altamirano J, Fassiotto M, Perez MG, Maldonado Y, Josephs S, Sze DY, Kothary N. Achieving Speaker Gender Equity at the SIR Annual Scientific Meeting: The Effect of Female Session Coordinators. J Vasc Interv Radiol 2019; 30:1870-1875. [DOI: 10.1016/j.jvir.2019.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 11/26/2022] Open
|
38
|
Nino-Tapias GJ, Altamirano J, Sarnquist C, Behl R, Leary S, Sommer M, Maldonado Y. 1668. No Impact of Nutritional Status on Oral Polio Vaccine shedding after Vaccination of Under 5 Children in Rural Mexico. Open Forum Infect Dis 2019. [PMCID: PMC6809165 DOI: 10.1093/ofid/ofz360.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background As wild poliovirus is nearing global eradication and countries switch from Oral Polio Vaccine (OPV) to Inactivated Polio Vaccine (IPV), preventing circulating vaccine-derived poliovirus is a top priority. However, the circulation of OPV serotypes remains a concern in undervaccinated communities. We sought to examine the relationship between pediatric nutritional status and OPV shedding based on length-for-age categorizations. Mexico provides a natural environment to study these patterns as it provides routine IPV immunization and bi-annual OPV campaigns. Methods We enrolled 466 households with children eligible for OPV before the February 2015 national health week from 3 semi-rural Indigenous communities near Orizaba, Mexico. In each community, a different proportion of eligible children received OPV (10%, 30%, 70%), with a total of 155 vaccinated children. OPV shedding was measured by RT-qPCR detection of OPV in samples collected serially over 10 weeks. Anthropometric measurements were collected and compared with the WHO Multicenter Growth Reference Study growth curves to assign stunting. Associations between stunting, OPV shedding, and shedding duration were tested by Fisher exact test and Wilcoxon-Man-Whitney Test (α = 0.05). Results Samples of fecal OPV isolates were collected over time and analyzed from 148 vaccinees. 25 (17%) of the vaccinees were stunted. There was no relationship between pediatric stunting and likelihood of ever shedding any serotype of OPV (P = 0.82). The mean duration of OPV shedding by stunted and non-stunted children differed, but not significantly (10.9 days vs. 9.3 days, respectively, P = 0.32). We did not find any statistically significant differences between stunting status and shedding of any individual OPV serotype. Conclusion Further understanding of factors related to OPV shedding is necessary to approach efficient worldwide poliovirus control. We found no relationship between stunting status and both OPV shedding and shedding duration post-vaccination, suggesting that nutritional status does not play a role in OPV shedding. The ongoing analysis includes longitudinal analysis of OPV shedding patterns by nutritional status, and the impact of stunting on viral load and reversion of OPV to vaccine-associated paralytic polio mutants. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | | | - Clea Sarnquist
- Stanford University School of Medicine, Stanford, California
| | - Rasika Behl
- Stanford University School of Medicine, Stanford, California
| | - Sean Leary
- Stanford University School of Medicine, Stanford, California
| | - Marvin Sommer
- Stanford University School of Medicine, Stanford, California
| | | |
Collapse
|
39
|
Altamirano J, Contreras A, Cifuentes J, Yanine N, Cristi E, Diaz E, Pedregal P, Martinez F. Primary diffuse large b-cell lymphoma of the mandible, literature review and report of two cases. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Altamirano J, Salas M, Contreras A, Martínez F, Slater J, Barrera A, Cifuentes J. Ameloblastic fibroodontoma, literature review apropos of a case. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Martinez F, Cifuentes J, Yanine N, Barrera A, Contreras A, Cristi E, Altamirano J, Salas M. Antiphospholipid syndrome and perioperative management in orthognathic surgery. Case report. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
42
|
Salas M, Contreras A, Altamirano J, Quiñones L, Madrid A, Capdeville F, Valdés F. Adenoid cystic carcinoma of the maxillary sinus, literature review apropos of a case. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
43
|
Sepúlveda C, Altamirano J, Salas M, Slater J, Figueroa L, Yanine N, Barrera A. Mandibular infected buccal cyst, report of 8 cases. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
44
|
Contreras A, Altamirano J, Salas M, Yanine N, Slater J, Barrera A. Necrotizing sialometaplasia, literature review and report of two cases. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Perez MG, Fassiotto M, Altamirano J, Hwang GL, Maldonado Y, Josephs S, Sze DY, Kothary N. Untapped Resources: Attaining Equitable Representation for Women in IR. J Vasc Interv Radiol 2019; 30:579-583. [DOI: 10.1016/j.jvir.2018.10.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022] Open
|
46
|
Garcia LC, Chung S, Liao L, Altamirano J, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians. JAMA Netw Open 2019; 2:e190027. [PMID: 30794297 PMCID: PMC6484609 DOI: 10.1001/jamanetworkopen.2019.0027] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Patient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients. OBJECTIVE To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians. DESIGN, SETTING, AND PARTICIPANTS This population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018. EXPOSURES Physician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken. MAIN OUTCOMES AND MEASURES The highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey. RESULTS Of the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity. CONCLUSIONS AND RELEVANCE This study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.
Collapse
Affiliation(s)
- Luis C. Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Lily Liao
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Bonnie Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
47
|
Fu R, Altamirano J, Sarnquist CC, Maldonado YA, Andrews JR. Assessing the Risk of Vaccine-derived Outbreaks After Reintroduction of Oral Poliovirus Vaccine in Postcessation Settings. Clin Infect Dis 2018; 67:S26-S34. [PMID: 30376087 PMCID: PMC6206116 DOI: 10.1093/cid/ciy605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The Polio Eradication and Endgame Strategic Plan 2013-2018 calls for the gradual withdrawal of oral poliovirus vaccine (OPV) from routine immunization. We aimed to quantify the transmission potential of Sabin strains from OPV when it is reintroduced, accidentally or deliberately, in a community vaccinated with inactivated poliovirus vaccine alone. Methods We built an individual-based stochastic epidemiological model that allows independent spread of 3 Sabin serotypes and differential transmission rates within versus between households. Model parameters were estimated by fitting to data from a prospective cohort in Mexico. We calculated the effective reproductive number for the Mexico cohort and simulated scenarios of Sabin strain resurgence under postcessation conditions, projecting the risk of prolonged circulation, which could lead to circulating vaccine-derived poliovirus (cVDPV). Results The estimated effective reproductive number for naturally infected individuals was about 1 for Sabin 2 and Sabin 3 (OPV2 and OPV3) in a postcessation setting. Most transmission events occurred between households. We estimated the probability of circulation for >9 months to be (1) <<1% for all 3 serotypes when 90% of children <5 years of age were vaccinated in a hypothetical outbreak control campaign; (2) 45% and 24% for Sabin 2 and Sabin 3, respectively, when vaccine coverage dropped to 10%; (3) 37% and 8% for Sabin 2 and Sabin 3, respectively, when a single active shedder appeared in a community. Conclusions Critical factors determining the risk of cVDPV emergence are the scale at which OPV is reintroduced and the between-household transmission rate for poliovirus, with intermediate values posing the greatest risk.
Collapse
Affiliation(s)
- Rui Fu
- Department of Management Science and Engineering, Stanford University, California
| | | | | | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California
| |
Collapse
|
48
|
Altamirano J, Sarnquist C, Behl R, García-García L, Ferreyra-Reyes L, Leary S, Maldonado Y. OPV Vaccination and Shedding Patterns in Mexican and US Children. Clin Infect Dis 2018; 67:S85-S89. [PMID: 30376085 PMCID: PMC6206113 DOI: 10.1093/cid/ciy636] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background As wild poliovirus is eradicated and countries switch from oral poliovirus vaccine (OPV) to inactivated poliovirus vaccine (IPV) per World Health Organization recommendations, preventing circulation of vaccine-derived poliovirus (cVDPV) is a top priority. Currently, the impact of prior poliovirus vaccination on OPV shedding is not fully understood. Methods Stool samples from 2 populations were tested for OPV to assess shedding patterns. 505 samples from 43 US children vaccinated with OPV were collected over 42 days post-vaccination. 1,379 samples from 148 Mexican children vaccinated with OPV were collected over 71 days post-vaccination. Prior vaccination history was recorded for both groups. Results Seventeen (40%) of the US children had never received poliovirus vaccination while the Mexican children had received at least 2 doses of IPV and 116 (78%) had OPV exposure. In total, 84% of US children and 78% of Mexican children shed OPV (P = .44, Fisher exact test), with a mean shedding duration of 17.4 days for US children and 9.3 days for Mexican children (P < .0001, Wilcoxon-Mann Whitney test). Conclusions Prior vaccination did not affect the likelihood of shedding, as the US and Mexico cohorts had similar shedding proportions. However, prior vaccination affected shedding duration as the Mexican children, who were largely OPV exposed and all of whom had at least 2 IPV vaccinations, shed OPV for half as long as the US cohort. Since different countries maintain different poliovirus vaccination schedules, it is likely that duration of shedding of OPV varies in populations around the world.
Collapse
Affiliation(s)
| | | | - Rasika Behl
- Stanford University School of Medicine, California
| | | | | | - Sean Leary
- Stanford University School of Medicine, California
| | | |
Collapse
|
49
|
Jarvis CI, Altamirano J, Sarnquist C, Edmunds WJ, Maldonado Y. Spatial Analyses of Oral Polio Vaccine Transmission in an Community Vaccinated With Inactivated Polio Vaccine. Clin Infect Dis 2018; 67:S18-S25. [PMID: 30376089 PMCID: PMC6206123 DOI: 10.1093/cid/ciy622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Understanding the spatial dynamics of oral polio vaccine (OPV) transmission will improve resource targeting. Mexico provides a natural laboratory, as it uses inactivated polio vaccine routinely as well as OPV bi-annually. Methods Using geospatial maps, we measured the distance and density of OPV vaccinees' shedding in the areas nearest to unvaccinated households in 3 Mexican villages. Comparison of transmission to unvaccinated households utilized a mixed effects logistic regression with random effects for household and time, adjusted for age, gender, area, and running water. Results The median distance from an unvaccinated household to its nearest OPV-shedding household was 85 meters (interquartile range, 46-145) and the median number of vaccinees shedding OPV within 200 m was 3 (2-6). Transmission to unvaccinated households occurred by day 1. There was no association (odds ratio [OR] 1.04; 95% credible interval [CrI] 0.92-1.16) between the distance from OPV shedding and the odds of transmission. The number of OPV vaccinees shedding within 200 m came close to a significant association with unvaccinated transmission (OR 0.93; CrI 0.84-1.01), but this was not the case for households 100 or 500 m apart. Results were consistent across the 3 villages. Conclusions Geospatial analysis did not predict community transmission from vaccinated to unvaccinated households, because OPV use resulted in rapid, low transmission levels. This finding supports the global cessation of OPV.
Collapse
Affiliation(s)
- Christopher I Jarvis
- London School of Hygiene and Tropical Medicine, United Kingdom
- Medical Research Council London Hub for Trials Methodology Research, United Kingdom
| | | | | | - W John Edmunds
- London School of Hygiene and Tropical Medicine, United Kingdom
| | | |
Collapse
|
50
|
van Hoorebeke C, Huang C, Leary S, Holubar M, Altamirano J, Halpern MS, Sommer M, Maldonado Y. Lab Protocol Paper: Use of a High-throughput, Multiplex Reverse-transcription Quantitative Polymerase Chain Reaction Assay for Detection of Sabin Oral Polio Vaccine in Fecal Samples. Clin Infect Dis 2018; 67:S121-S126. [PMID: 30376092 PMCID: PMC6206103 DOI: 10.1093/cid/ciy648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Global polio eradication efforts rely in part on molecular methods of detecting polioviruses, both wild and vaccine strains, from human and environmental samples. Previous assays used for detection of Sabin oral polio vaccine (OPV) in fecal samples have been labor and time intensive and vary in their sensitivity and specificity. Methods We developed a high-throughput, multiplex reverse-transcription quantitative polymerase chain reaction assay able to detect all 3 OPV strains in fecal samples. The assay used a KingFisher Duo Prime system for viral RNA isolation and extraction. Positive samples were retested and Sanger sequenced for verification of Sabin serotype identity. Results The 95% lower limit of detection was determined to be 3 copies per reaction for Sabin 1 and 3 and 4 copies per reaction for Sabin 2, with no cross-reactivity between the 3 serotypes and their primers. A total of 554 samples (3.6%) were positive, with 304 positive samples (54.9%) containing >1 serotype. Of the positive samples, 476 (85.9%) contained enough RNA to be sequenced, and of these all sequences were Sabin serotypes. The previous assay we used could process 48 samples in a 10-hour period, whereas the new assay processed >100 samples in 6 hours. Conclusions The new high-throughput, multiplex reverse-transcription quantitative polymerase chain reaction assay allowed for sensitive and specific detection of OPV serotypes while greatly decreasing sample handling and processing time. We were able to sequence 72.4% of the 210 positive samples in the cycle threshold range of 35-37.
Collapse
Affiliation(s)
| | | | - Sean Leary
- Stanford University School of Medicine, California
| | | | | | | | | | | |
Collapse
|