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Bressler SS, Bruden D, Hammitt LL, Chukwuma U, Fischer M, Singleton R. Trends in Otitis Media Ambulatory Visits in American Indian and Alaska Native Children During the Pneumococcal Conjugate Vaccine Period and the COVID-19 Pandemic. Pediatr Infect Dis J 2024; 43:390-392. [PMID: 38241660 PMCID: PMC10919265 DOI: 10.1097/inf.0000000000004207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/21/2024]
Abstract
Otitis media-associated outpatient visits among American Indians/Alaska Natives children <5 years old decreased by 52% (100 to 48 per 100 children per year) from 2003 to 2019. Otitis media visits decreased by another 50% from 2019 to 2020, but rebounded between 2020 and 2021 back to a rate similar to 2019.
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Affiliation(s)
- Sara S. Bressler
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
| | - Dana Bruden
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
| | - Laura L. Hammitt
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Uzo Chukwuma
- Infectious Disease Branch, Office of Public Health Support, Indian Health Service, Rockville, Maryland
| | - Marc Fischer
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
| | - Rosalyn Singleton
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska
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Cong B, Koç U, Bandeira T, Bassat Q, Bont L, Chakhunashvili G, Cohen C, Desnoyers C, Hammitt LL, Heikkinen T, Huang QS, Markić J, Mira-Iglesias A, Moyes J, Nokes DJ, Ploin D, Seo E, Singleton R, Wolter N, Fu Yung C, Zar HJ, Feikin DR, Sparrow EG, Nair H, Li Y. Changes in the global hospitalisation burden of respiratory syncytial virus in young children during the COVID-19 pandemic: a systematic analysis. Lancet Infect Dis 2024; 24:361-374. [PMID: 38141633 DOI: 10.1016/s1473-3099(23)00630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic is reported to have affected the epidemiology of respiratory syncytial virus (RSV), which could have important implications for RSV prevention and control strategies. We aimed to assess the hospitalisation burden of RSV-associated acute lower respiratory infection (ALRI) in children younger than 5 years during the pandemic period and the possible changes in RSV epidemiology from a global perspective. METHODS We conducted a systematic literature search for studies published between Jan 1, 2020, and June 30, 2022, in MEDLINE, Embase, Global Health, Web of Science, the WHO COVID-19 Research Database, CINAHL, LILACS, OpenGrey, CNKI, WanFang, and CqVip. We included unpublished data on RSV epidemiology shared by international collaborators. Eligible studies reported data on at least one of the following measures for children (aged <5 years) hospitalised with RSV-associated ALRI: hospital admission rates, in-hospital case fatality ratio, and the proportion of hospitalised children requiring supplemental oxygen or requiring mechanical ventilation or admission to intensive care. We used a generalised linear mixed-effects model for data synthesis to measure the changes in the incidence, age distribution, and disease severity of children hospitalised with RSV-associated ALRI during the pandemic, compared with the year 2019. FINDINGS We included 61 studies from 19 countries, of which 14 (23%) studies were from the published literature (4052 identified records) and 47 (77%) were from unpublished datasets. Most (51 [84%]) studies were from high-income countries; nine (15%) were from upper-middle-income countries, one (2%) was from a lower-middle-income country (Kenya), and none were from a low-income country. 15 studies contributed to the estimates of hospitalisation rate and 57 studies contributed to the severity analyses. Compared with 2019, the rates of RSV-associated ALRI hospitalisation in all children (aged 0-60 months) in 2020 decreased by 79·7% (325 000 cases vs 66 000 cases) in high-income countries, 13·8% (581 000 cases vs 501 000 cases) in upper-middle-income countries, and 42·3% (1 378 000 cases vs 795 000 cases) in Kenya. In high-income countries, annualised rates started to rise in 2021, and by March, 2022, had returned to a level similar to 2019 (6·0 cases per 1000 children [95% uncertainty interval 5·4-6·8] in April, 2021, to March, 2022, vs 5·0 cases per 1000 children [3·6-6·8] in 2019). By contrast, in middle-income countries, rates remained lower in the latest period with data available than in 2019 (for upper-middle-income countries, 2·1 cases [0·7-6·1] in April, 2021, to March, 2022, vs 3·4 [1·2-9·7] in 2019; for Kenya, 2·2 cases [1·8-2·7] in 2021 vs 4·1 [3·5-4·7] in 2019). Across all time periods and income regions, hospitalisation rates peaked in younger infants (aged 0 to <3 months) and decreased with increasing age. A significantly higher proportion of children aged 12-24 months were hospitalised with RSV-associated ALRI in high-income and upper-middle-income countries during the pandemic years than in 2019, with odds ratios ranging from 1·30 (95% uncertainty interval 1·07-1·59) to 2·05 (1·66-2·54). No consistent changes in disease severity were observed. INTERPRETATION The hospitalisation burden of RSV-associated ALRI in children younger than 5 years was significantly reduced during the first year of the COVID-19 pandemic. The rebound in hospitalisation rates to pre-pandemic rates observed in the high-income region but not in the middle-income region by March, 2022, suggests a persistent negative impact of the pandemic on health-care systems and health-care access in the middle-income region. RSV surveillance needs to be established (or re-established) to monitor changes in RSV epidemiology, particularly in low-income and lower-middle-income countries. FUNDING EU Innovative Medicines Initiative Preparing for RSV Immunisation and Surveillance in Europe (PROMISE), Bill & Melinda Gates Foundation, and WHO.
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Affiliation(s)
- Bingbing Cong
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Uğurcan Koç
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Teresa Bandeira
- Pediatric Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, University of Lisbon, Lisbon, Portugal
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Louis Bont
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; ReSViNET Foundation, Zeist, Netherlands
| | | | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Q Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Joško Markić
- Department of Pediatrics, University Hospital Split, Split, Croatia; University of Split School of Medicine, Split, Croatia
| | - Ainara Mira-Iglesias
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Salud Pública, Valencia, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - D James Nokes
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK
| | - Dominique Ploin
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Réanimation Pédiatrique et d'Accueil des Urgences, Bron, France
| | - Euri Seo
- The Center for Viral Immunology, Korea Virus Research Institute, Institute for Basic Science, Daejeon, South Korea
| | | | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chee Fu Yung
- Infectious Diseases Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; South African Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Daniel R Feikin
- Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - Erin G Sparrow
- Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - Harish Nair
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - You Li
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
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3
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Park HS, Yin A, Barranta C, Lee JS, Caputo CA, Sachithanandham J, Li M, Yoon S, Sitaras I, Jedlicka A, Eby Y, Ram M, Fernandez RE, Baker OR, Shenoy AG, Mosnaim GS, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Lau B, Ehrhardt S, Baksh SN, Shapiro JR, Ou J, Na YB, Knoll MD, Ornelas-Gatdula E, Arroyo-Curras N, Gniadek TJ, Caturegli P, Wu J, Ndahiro N, Betenbaugh MJ, Ziman A, Hanley DF, Casadevall A, Shoham S, Bloch EM, Gebo KA, Tobian AA, Laeyendecker O, Pekosz A, Klein SL, Sullivan DJ. Outpatient COVID-19 convalescent plasma recipient antibody thresholds correlated to reduced hospitalizations within a randomized trial. JCI Insight 2024; 9:e178460. [PMID: 38483534 DOI: 10.1172/jci.insight.178460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUNDCOVID-19 convalescent plasma (CCP) virus-specific antibody levels that translate into recipient posttransfusion antibody levels sufficient to prevent disease progression are not defined.METHODSThis secondary analysis correlated donor and recipient antibody levels to hospitalization risk among unvaccinated, seronegative CCP recipients within the outpatient, double-blind, randomized clinical trial that compared CCP to control plasma. The majority of COVID-19 CCP arm hospitalizations (15/17, 88%) occurred in this unvaccinated, seronegative subgroup. A functional cutoff to delineate recipient high versus low posttransfusion antibody levels was established by 2 methods: (i) analyzing virus neutralization-equivalent anti-Spike receptor-binding domain immunoglobulin G (anti-S-RBD IgG) responses in donors or (ii) receiver operating characteristic (ROC) curve analysis.RESULTSSARS-CoV-2 anti-S-RBD IgG antibody was volume diluted 21.3-fold into posttransfusion seronegative recipients from matched donor units. Virus-specific antibody delivered was approximately 1.2 mg. The high-antibody recipients transfused early (symptom onset within 5 days) had no hospitalizations. A CCP-recipient analysis for antibody thresholds correlated to reduced hospitalizations found a statistical significant association between early transfusion and high antibodies versus all other CCP recipients (or control plasma), with antibody cutoffs established by both methods-donor-based virus neutralization cutoffs in posttransfusion recipients (0/85 [0%] versus 15/276 [5.6%]; P = 0.03) or ROC-based cutoff (0/94 [0%] versus 15/267 [5.4%]; P = 0.01).CONCLUSIONIn unvaccinated, seronegative CCP recipients, early transfusion of plasma units in the upper 30% of study donors' antibody levels reduced outpatient hospitalizations. High antibody level plasma units, given early, should be reserved for therapeutic use.TRIAL REGISTRATIONClinicalTrials.gov NCT04373460.FUNDINGDepartment of Defense (W911QY2090012); Defense Health Agency; Bloomberg Philanthropies; the State of Maryland; NIH (3R01AI152078-01S1, U24TR001609-S3, 1K23HL151826NIH); the Mental Wellness Foundation; the Moriah Fund; Octapharma; the Healthnetwork Foundation; the Shear Family Foundation; the NorthShore Research Institute; and the Rice Foundation.
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Affiliation(s)
- Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Yin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caelan Barranta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher A Caputo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steve Yoon
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Jedlicka
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | | | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, UCLA, Los Angeles, California, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, Connecticut, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Kevin Oei
- Ascada Research, Fullerton, California, USA
| | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, UCSD, San Diego, California, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington DC, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Karen Lane
- Department of Neurology, Brain Injury Outcomes
| | | | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes
| | | | - Atika Singh
- Department of Neurology, Brain Injury Outcomes
| | - Daniel E Ford
- Institute for Clinical and Translational Research, and
| | - Douglas A Jabs
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janna R Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes
| | - Yu Bin Na
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria D Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elysse Ornelas-Gatdula
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Netzahualcoyotl Arroyo-Curras
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, Illinois, USA
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jinke Wu
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nelson Ndahiro
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael J Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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4
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Gallagher KE, Awori JO, Knoll MD, Rhodes J, Higdon MM, Hammitt LL, Prosperi C, Baggett HC, Brooks WA, Fancourt N, Feikin DR, Howie SRC, Kotloff KL, Tapia MD, Levine OS, Madhi SA, Murdoch DR, O’Brien KL, Thea DM, Baillie VL, Ebruke BE, Kamau A, Moore DP, Mwananyanda L, Olutunde EO, Seidenberg P, Sow SO, Thamthitiwat S, Scott JAG. Factors predicting mortality in hospitalised HIV-negative children with lower-chest-wall indrawing pneumonia and implications for management. PLoS One 2024; 19:e0297159. [PMID: 38466696 PMCID: PMC10927117 DOI: 10.1371/journal.pone.0297159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/29/2023] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION In 2012, the World Health Organization revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) but no 'danger signs', to recommend home-based treatment. We analysed data from children hospitalized with LCWI pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) study to identify sub-groups with high odds of mortality, who might continue to benefit from hospital management but may not be admitted by staff implementing the 2012 guidelines. We compare the proportion of deaths identified using the criteria in the 2012 guidelines, and the proportion of deaths identified using an alternative set of criteria from our model. METHODS PERCH enrolled a cohort of 2189 HIV-negative children aged 2-59 months who were admitted to hospital with LCWI pneumonia (without obvious cyanosis, inability to feed, vomiting, convulsions, lethargy or head nodding) between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh, and Thailand. We analysed risk factors for mortality among these cases using predictive logistic regression. Malnutrition was defined as mid-upper-arm circumference <125mm or weight-for-age z-score <-2. RESULTS Among 2189 cases, 76 (3·6%) died. Mortality was associated with oxygen saturation <92% (aOR 3·33, 1·99-5·99), HIV negative but exposed status (4·59, 1·81-11·7), moderate or severe malnutrition (6·85, 3·22-14·6) and younger age (infants compared to children 12-59 months old, OR 2·03, 95%CI 1·05-3·93). At least one of three risk factors: hypoxaemia, HIV exposure, or malnutrition identified 807 children in this population, 40% of LCWI pneumonia cases and identified 86% of the children who died in hospital (65/76). Risk factors identified using the 2012 WHO treatment guidelines identified 66% of the children who died in hospital (n = 50/76). CONCLUSIONS Although it focuses on treatment failure in hospital, this study supports the proposal for better risk stratification of children with LCWI pneumonia. Those who have hypoxaemia, any malnutrition or those who were born to HIV positive mothers, experience poorer outcomes than other children with LCWI pneumonia. Consistent identification of these risk factors should be prioritised and children with at least one of these risk factors should not be managed in the community.
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Affiliation(s)
- Katherine E. Gallagher
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Juliet O. Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Maria D. Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Julia Rhodes
- Global Disease Detection Center, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Laura L. Hammitt
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Henry C. Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - W. Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh
| | - Nicholas Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen R. C. Howie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Basse, The Gambia
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Orin S. Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shabir A. Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David R. Murdoch
- Department of Pathology and Biomedical Sciences, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Donald M. Thea
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vicky L. Baillie
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Bernard E. Ebruke
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Basse, The Gambia
| | - Alice Kamau
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - David P. Moore
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Mwananyanda
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Right to Care-Zambia, Lusaka, Zambia
| | - Emmanuel O. Olutunde
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Basse, The Gambia
| | - Phil Seidenberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Samba O. Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Somsak Thamthitiwat
- Global Disease Detection Center, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
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5
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Cella E, Sutcliffe CG, Grant LR, Tso C, Weatherholtz RC, Littlepage S, Becenti L, Jubair M, Simons BC, Harker-Jones M, Reid R, Yazzie D, Santosham M, O'Brien KL, Hammitt LL, Azarian T. Streptococcus pneumoniae serotype 3 population structure in the era of conjugate vaccines, 2001-2018. Microb Genom 2024; 10. [PMID: 38498591 DOI: 10.1099/mgen.0.001196] [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] [Indexed: 03/20/2024] Open
Abstract
Background. Despite use of highly effective conjugate vaccines, invasive pneumococcal disease (IPD) remains a leading cause of morbidity and mortality and disproportionately affects Indigenous populations. Although included in the 13-valent pneumococcal conjugate vaccine (PCV13), which was introduced in 2010, serotype 3 continues to cause disease among Indigenous communities in the Southwest USA. In the Navajo Nation, serotype 3 IPD incidence increased among adults (3.8/100 000 in 2001-2009 and 6.2/100 000 in 2011-2019); in children the disease persisted although the rates dropped from 5.8/100 000 to 2.3/100 000.Methods. We analysed the genomic epidemiology of serotype 3 isolates collected from 129 adults and 63 children with pneumococcal carriage (n=61) or IPD (n=131) from 2001 to 2018 of the Navajo Nation. Using whole-genome sequencing data, we determined clade membership and assessed changes in serotype 3 population structure over time.Results. The serotype 3 population structure was characterized by three dominant subpopulations: clade II (n=90, 46.9 %) and clade Iα (n=59, 30.7 %), which fall into Clonal Complex (CC) 180, and a non-CC180 clade (n=43, 22.4 %). The proportion of clade II-associated IPD cases increased significantly from 2001 to 2010 to 2011-2018 among adults (23.1-71.8 %; P<0.001) but not in children (27.3-33.3 %; P=0.84). Over the same period, the proportion of clade II-associated carriage increased; this was statistically significant among children (23.3-52.6 %; P=0.04) but not adults (0-50.0 %, P=0.08).Conclusions. In this setting with persistent serotype 3 IPD and carriage, clade II has increased since 2010. Genomic changes may be contributing to the observed trends in serotype 3 carriage and disease over time.
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Affiliation(s)
- Eleonora Cella
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, Florida
| | - Catherine G Sutcliffe
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lindsay R Grant
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carol Tso
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert C Weatherholtz
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shea Littlepage
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ladonna Becenti
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Jubair
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, Florida
| | - Brenna C Simons
- Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Marcella Harker-Jones
- Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Raymond Reid
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Del Yazzie
- Navajo Epidemiology Center, Window Rock, Arizona
| | - Mathuram Santosham
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine L O'Brien
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L Hammitt
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Taj Azarian
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, Florida
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6
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Nolen LD, Bulkow L, Singleton R, Hurlburt D, Debyle C, Rudolph K, Hammitt LL, Hennessy TW, Bruce MG. An Investigation of Pediatric Case-patients With Invasive Haemophilus influenzae in Alaska, 2005-2011. Pediatr Infect Dis J 2024:00006454-990000000-00777. [PMID: 38451895 DOI: 10.1097/inf.0000000000004286] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Haemophilus influenzae (Hi) can cause severe disease in children. This study aimed to identify risk factors related to invasive Hi disease in Alaska children and evaluate carriage in people around them. METHODS From 2005 to 2011, we investigated episodes of invasive, typeable Hi disease in Alaska children aged <10 years. Three age-matched control children were enrolled for each case-patient. We evaluated oropharyngeal Hi carriage in people in close contact with Hi case-patients (contacts) as well as control children and their household members. Individual and household risk factors for illness and carriage were evaluated using questionnaires and chart reviews. RESULTS Thirty-eight of 44 (86%) children with invasive, typeable Hi disease were recruited: 20 Hi serotype a (53%), 13 serotype b (Hib) (34%) and 5 serotype f (13%). Children with the invasive Hi disease were more likely than controls to have underlying health problems (67% vs. 24%, P = 0.001), other carriers of any Hi in their household (61% vs. 15%, P < 0.001), and inadequate Hib vaccination (26% vs. 9%, P = 0.005). People who carried Hi were younger than noncarriers (mean 12.7 vs. 18.0 years, P = 0.008). The carriage was clustered within case-patient households, with carriage in 19% of household contacts, while only 6.3% of nonhousehold contacts and 5.5% of noncontacts carried the Hi serotype of interest (P < 0.001). CONCLUSIONS Factors associated with invasive Hi disease in children included underlying health problems, household carriage and inadequate Hib vaccination. The high level of carriage in case-patient households is important to consider when evaluating treatment and prophylaxis strategies.
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Affiliation(s)
- Leisha Diane Nolen
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Lisa Bulkow
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Rosalyn Singleton
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
- Alaska Native Medical Center, Anchorage, Alaska
| | - Debbie Hurlburt
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Carolyn Debyle
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Karen Rudolph
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Laura L Hammitt
- Department of International Health Center for Indigenous Health, Johns Hopkins University, Baltimore, Maryland
| | - Thomas W Hennessy
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Michael G Bruce
- From the Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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7
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Dagan R, Hammitt LL, Seoane Nuñez B, Baca Cots M, Bosheva M, Madhi SA, Muller WJ, Zar HJ, Chang Y, Currie A, Grenham A, Shroff M, Takas T, Mankad VS, Leach A, Villafana T. Infants Receiving a Single Dose of Nirsevimab to Prevent RSV Do Not Have Evidence of Enhanced Disease in Their Second RSV Season. J Pediatric Infect Dis Soc 2024; 13:144-147. [PMID: 38219024 PMCID: PMC10896255 DOI: 10.1093/jpids/piad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
To characterize nirsevimab in the prevention of RSV, children from the Phase 3 MELODY trial were followed through their second RSV season. No increase in medically attended RSV lower respiratory tract infections or evidence of antibody-dependent enhancement of infection or disease severity was found for nirsevimab vs placebo recipients. Clinical Trial Registration: Clinicaltrials.gov, NCT03979313, https://clinicaltrials.gov/ct2/show/NCT03979313.
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Affiliation(s)
- Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences at the Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Beatriz Seoane Nuñez
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Madrid, Spain
| | | | - Miroslava Bosheva
- Paediatrics, University Multiprofile, Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William J Muller
- Infectious Diseases, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Stanley Manne Children’s Research Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children’s Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Yue Chang
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Alexander Currie
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Amy Grenham
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Manish Shroff
- Patient Safety, Chief Medical Office, R&D, AstraZeneca, Waltham, Massachusetts, USA
| | - Therese Takas
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Vaishali S Mankad
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Durham, North Carolina, USA
| | - Amanda Leach
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Tonya Villafana
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
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8
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Gebo KA, Heath SL, Fukuta Y, Zhu X, Baksh S, Abraham AG, Habtehyimer F, Shade D, Ruff J, Ram M, Laeyendecker O, Fernandez RE, Patel EU, Baker OR, Shoham S, Cachay ER, Currier JS, Gerber JM, Meisenberg B, Forthal DN, Hammitt LL, Huaman MA, Levine A, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Anjan S, Gniadek T, Kassaye S, Blair JE, Lane K, McBee NA, Gawad AL, Das P, Klein SL, Pekosz A, Bloch EM, Hanley D, Casadevall A, Tobian AAR, Sullivan DJ. Erratum for Gebo et al., "Early antibody treatment, inflammation, and risk of post-COVID conditions". mBio 2024; 15:e0297923. [PMID: 38095433 PMCID: PMC10790766 DOI: 10.1128/mbio.02979-23] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
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9
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Habtehyimer F, Zhu X, Redd AD, Gebo KA, Abraham AG, Patel EU, Laeyendecker O, Gniadek TJ, Fernandez RE, Baker OR, Ram M, Cachay ER, Currier JS, Fukuta Y, Gerber JM, Heath SL, Meisenberg B, Huaman MA, Levine AC, Shenoy A, Anjan S, Blair JE, Cruser D, Forthal DN, Hammitt LL, Kassaye S, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Abinante M, Oei KS, Cluzet V, Cordisco ME, Greenblatt B, Rausch W, Shade D, Gawad AL, Klein SL, Pekosz A, Shoham S, Casadevall A, Bloch EM, Hanley D, Tobian AAR, Sullivan DJ. COVID-19 convalescent plasma therapy decreases inflammatory cytokines: a randomized controlled trial. Microbiol Spectr 2024; 12:e0328623. [PMID: 38009954 PMCID: PMC10783116 DOI: 10.1128/spectrum.03286-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE This study examined the role that cytokines may have played in the beneficial outcomes found when outpatient individuals infected with SARS-CoV-2 were transfused with COVID-19 convalescent plasma (CCP) early in their infection. We found that the pro-inflammatory cytokine IL-6 decreased significantly faster in patients treated early with CCP. Participants with COVID-19 treated with CCP later in the infection did not have the same effect. This decrease in IL-6 levels after early CCP treatment suggests a possible role of inflammation in COVID-19 progression. The evidence of IL-6 involvement brings insight into the possible mechanisms involved in CCP treatment mitigating SARS-CoV-2 severity.
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Affiliation(s)
- Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew D. Redd
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - Kelly A. Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alison G. Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - Thomas J. Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, Illinois, USA
| | - Reinaldo E. Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Owen R. Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edward R. Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, California, USA
| | - Judith S. Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan M. Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sonya L. Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barry Meisenberg
- Department of Medicine and Research Institute of Luminis Health, Annapolis, Maryland, USA
| | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Aarthi Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Janis E. Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Daniel Cruser
- Department of Pathology, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Donald N. Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Laura L. Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Giselle S. Mosnaim
- Department of Medicine, Division of Allergy and Immunology, Northshore University Health System, Evanston, Illinois, USA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - James H. Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jay S. Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Catherine G. Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Valerie Cluzet
- Department of Infectious Disease, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | | | | | - William Rausch
- Nuvance Health Danbury Hospital, Danbury, Connecticut, USA
| | - David Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amy L. Gawad
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sabra L. Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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10
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Hammitt LL, Quinn D, Janczewska E, Pasquel FJ, Tytus R, Reddy KR, Abarca K, Khaertynova IM, Dagan R, Dawson R, McCauley J, Shekar T, Fu W, Pedley A, Sterling T, Tamms G, Musey L, Buchwald UK. Phase 3 trial to evaluate the safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, followed by 23-valent pneumococcal polysaccharide vaccine 6 months later, in at-risk adults 18-49 years of age (PNEU-DAY): A subgroup analysis by baseline risk factors. Hum Vaccin Immunother 2023; 19:2177066. [PMID: 36864601 PMCID: PMC10026908 DOI: 10.1080/21645515.2023.2177066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Immunocompetent adults with certain medical and behavioral factors are at increased risk of pneumococcal disease. In some countries, sequential vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for at-risk adults. This subgroup analysis from a phase 3 study evaluated the safety, tolerability, and immunogenicity of sequential administration of either V114 (a 15-valent PCV containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F) or PCV13, followed 6 months later by PPSV23, in immunocompetent adults 18-49 years of age with pre-defined risk factors for pneumococcal disease. Safety and immunogenicity post-vaccination were analyzed by type and baseline number of risk factors for pneumococcal disease (1 and ≥2 risk factors). This analysis included 1,131 participants randomized 3:1 to receive either V114 or PCV13, followed by PPSV23. The majority (73.1%) of participants had at least one risk factor. Safety and tolerability profiles of V114 and PCV13 were similar across risk factor groups. V114 administered either alone or sequentially with PPSV23 6 months later was immunogenic for all 15 serotypes, including those not contained in PCV13, regardless of the number of baseline risk factors. V114 has the potential to broaden serotype coverage for at-risk adults.
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Affiliation(s)
- Laura L Hammitt
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dean Quinn
- P3 Research, Wellington Clinical Trial Research Unit, Wellington, New Zealand
| | - Ewa Janczewska
- The School of Health Sciences in Bytom, Medical University of Silesia, Bytom, Poland
| | - Francisco J Pasquel
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Richard Tytus
- Family Medicine, McMaster University, Ontario, Canada
| | - K Rajender Reddy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katia Abarca
- Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences of the Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | - Wei Fu
- Merck & Co., Inc., Rahway, NJ, USA
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11
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Park HS, Yin A, Barranta C, Lee JS, Caputo CA, Sachithanandham J, Li M, Yoon S, Sitaras I, Jedlicka A, Eby Y, Ram M, Fernandez RE, Baker OR, Shenoy AG, Mosnaim GS, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Lau B, Ehrhardt S, Baksh SN, Shapiro JR, Ou J, Na YB, Knoll MD, Ornelas-Gatdula E, Arroyo-Curras N, Gniadek TJ, Caturegli P, Wu J, Ndahiro N, Betenbaugh MJ, Ziman A, Hanley DF, Casadevall A, Shoham S, Bloch EM, Gebo KA, Tobian AAR, Laeyendecker O, Pekosz A, Klein SL, Sullivan DJ. Outpatient COVID-19 convalescent plasma recipient antibody thresholds correlated to reduced hospitalizations within a randomized trial. medRxiv 2023:2023.04.13.23288353. [PMID: 37131659 PMCID: PMC10153328 DOI: 10.1101/2023.04.13.23288353] [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: 05/04/2023]
Abstract
BACKGROUND The COVID-19 convalescent plasma (CCP) viral specific antibody levels that translate into recipient post-transfusion antibody levels sufficient to prevent disease progression is not defined. METHODS This secondary analysis correlated donor and recipient antibody levels to hospitalization risk among unvaccinated, seronegative CCP recipients within the outpatient, double blind, randomized clinical trial that compared CCP to control plasma. The majority of COVID-19 CCP arm hospitalizations (15/17, 88%) occurred in this unvaccinated, seronegative subgroup. A functional cutoff to delineate recipient high versus low post-transfusion antibody levels was established by two methods: 1) analyzing virus neutralization-equivalent anti-S-RBD IgG responses in donors or 2) receiver operating characteristic (ROC) analysis. RESULTS SARS-CoV-2 anti-S-RBD IgG antibody was diluted by a factor of 21.3 into post-transfusion seronegative recipients from matched donor units. Viral specific antibody delivered approximated 1.2 mg. The high antibody recipients transfused early (symptom onset within 5 days) had no hospitalizations. A CCP recipient analysis for antibody thresholds correlated to reduced hospitalizations found a significant association with Fisher's exact test between early and high antibodies versus all other CCP recipients (or control plasma) with antibody cutoffs established by both methods-donor virus neutralization-based cutoff: (0/85; 0% versus 15/276; 5.6%) p=0.03 or ROC based cutoff: (0/94; 0% versus 15/267; 5.4%) p=0.01. CONCLUSION In unvaccinated, seronegative CCP recipients, early transfusion of plasma units corresponding to the upper 30% of all study donors reduced outpatient hospitalizations. These high antibody level plasma units, given early, should be reserved for therapeutic use.Trial registration: NCT04373460. FUNDING Defense Health Agency and others.
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Affiliation(s)
- Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Yin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caelan Barranta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John S Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher A Caputo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steve Yoon
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne Jedlicka
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, IL, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA
| | | | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, OH, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, CT, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | | | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, CA, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center Washington DC, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nichol A McBee
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicky Karlen
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Atika Singh
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel E Ford
- Institute for Clinical and Translational Research Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas A Jabs
- Department of Ophthalmology Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janna R Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yu Bin Na
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria D Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elysse Ornelas-Gatdula
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore MD, USA
| | - Netzahualcoyotl Arroyo-Curras
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jinke Wu
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Nelson Ndahiro
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael J Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Daniel F Hanley
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Qiu X, McGee L, Hammitt LL, Grant LR, O’Brien KL, Hanage WP, Lipsitch M. Prediction of post-PCV13 pneumococcal evolution using invasive disease data enhanced by inverse-invasiveness weighting. medRxiv 2023:2023.12.10.23299786. [PMID: 38168234 PMCID: PMC10760274 DOI: 10.1101/2023.12.10.23299786] [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: 01/05/2024]
Abstract
Background After introduction of pneumococcal conjugate vaccines (PCVs), serotype replacement occurred in the population of Streptococcus pneumoniae. Predicting which pneumococcal clones and serotypes will become more common in carriage after vaccination can enhance vaccine design and public health interventions, while also improving our understanding of pneumococcal evolution. We sought to use invasive disease data to assess how well negative frequency-dependent selection (NFDS) models could explain pneumococcal carriage population evolution in the post-PCV13 epoch by weighting invasive data to approximate strain proportions in the carriage population. Methods Invasive pneumococcal isolates were collected and sequenced during 1998-2018 by the Active Bacterial Core surveillance (ABCs) from the Centers for Disease Control and Prevention (CDC). To predict the post-PCV13 population dynamics in the carriage population using a NFDS model, all genomic data were processed under a bioinformatic pipeline of assembly, annotation, and pangenome analysis to define genetically similar sequence clusters (i.e., strains) and a set of accessory genes present in 5% to 95% of the isolates. The NFDS model predicted the strain proportion by calculating the post-vaccine strain composition in the weighted invasive disease population that would best match pre-vaccine accessory gene frequencies. To overcome the biases of invasive disease data, serotype-specific inverse-invasiveness weights were defined as the ratio of the proportion of the serotype in the carriage data to the proportion in the invasive data, using data from 1998-2001 in the United States, before conjugate vaccine introduction. The weights were applied to adjust both the observed strain proportion and the accessory gene frequencies. Results Inverse-invasiveness weighting increased the correlation of accessory gene frequencies between invasive and carriage data with reduced residuals in linear or logit scale for pre-vaccine, post-PCV7, and post-PCV13. Similarly, weighting increased the correlation of accessory gene frequencies between different time periods in the invasive data. By weighting the invasive data, we were able to use the NFDS model to predict strain proportions in the carriage population in the post-PCV13 epoch, with the adjusted R-squared between predicted and observed strain proportions increasing from 0.176 to 0.544 after weighting. Conclusions The weighting system adjusted the invasive disease surveillance data to better represent the carriage population of S. pneumoniae. The NFDS mechanism predicted the strain proportions in the projected carriage population as estimated from the weighted invasive disease frequencies in the post-PCV13 epoch. Our methods enrich the value of genomic sequences from invasive disease surveillance, which is readily available, easy to collect, and of direct interest to public health.
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Affiliation(s)
- Xueting Qiu
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Lesley McGee
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura L Hammitt
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay R Grant
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine L O’Brien
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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13
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Gallagher KE, Adetifa IMO, Mburu C, Bottomley C, Akech D, Karani A, Pearce E, Wang Y, Kagucia EW, Goldblatt D, Hammitt LL, Scott JAG. Population immunity to pneumococcal serotypes in Kilifi, Kenya, before and 6 years after the introduction of PCV10 with a catch-up campaign: an observational study of cross-sectional serosurveys. Lancet Infect Dis 2023; 23:1291-1301. [PMID: 37429307 DOI: 10.1016/s1473-3099(23)00206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND In Kilifi (Kenya), a pneumococcal conjugate vaccine (PCV10) was introduced in 2011 in infants (aged <1 year, 3 + 0 schedule) with a catch-up campaign in children aged 1-4 years. We aimed to measure the effect of PCV10 on population immunity. METHODS In this observational study, repeated cross-sectional serosurveys were conducted in independent random samples of 500 children younger than 15 years every 2 years between 2009 and 2017. During these surveys, blood samples were collected by venesection. Concentrations of anti-capsular IgGs against vaccine serotypes (VTs) 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F, and against serotypes 6A and 19A, were assayed by ELISA. We plotted the geometric mean concentrations (GMCs) by birth year to visualise age-specific antibody profiles. In infants, IgG concentrations of 0·35 μg/mL or higher were considered protective. FINDINGS Of 3673 volunteers approached, 2152 submitted samples for analysis across the five surveys. Vaccine introduction resulted in an increase in the proportion of young children with protective IgG concentrations, compared with before vaccine introduction (from 0-33% of infants with VT-specific levels over the correlate of protection in 2009, to 60-94% of infants in 2011). However, among those vaccinated in infancy, GMCs of all ten VTs had waned rapidly by the age of 1, but rose again later in childhood. GMCs among children aged 10-14 years were consistently high over time (eg, the range of GMCs across survey rounds were between 0·45 μg/mL and 1·00 μg/mL for VT 23F and between 2·00 μg/mL and 3·11 μg/mL for VT 19F). INTERPRETATION PCV10 in a 3 + 0 schedule elicited protective IgG levels during infancy, when disease risk is high. The high antibody levels in children aged 10-14 years might indicate continued exposure to vaccine serotypes due to residual carriage or to memory responses to cross-reactive antigens. Despite rapid waning of IgG after vaccination, disease incidence among young children in this setting remains low, suggesting that lower thresholds of antibody, or other markers of immunity (eg, memory B cells), may be needed to assess population protection among children who have aged past infancy. FUNDING Gavi, the Vaccine Alliance; Wellcome Trust.
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Affiliation(s)
- Katherine E Gallagher
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ifedayo M O Adetifa
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Christian Bottomley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Donald Akech
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Angela Karani
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emma Pearce
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Yanyun Wang
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - David Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Laura L Hammitt
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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14
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Gebo KA, Heath SL, Fukuta Y, Zhu X, Baksh S, Abraham AG, Habtehyimer F, Shade D, Ruff J, Ram M, Laeyendecker O, Fernandez RE, Patel EU, Baker OR, Shoham S, Cachay ER, Currier JS, Gerber JM, Meisenberg B, Forthal DN, Hammitt LL, Huaman MA, Levine A, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Anjan S, Gniadek T, Kassaye S, Blair JE, Lane K, McBee NA, Gawad AL, Das P, Klein SL, Pekosz A, Bloch EM, Hanley D, Casadevall A, Tobian AAR, Sullivan DJ. Early antibody treatment, inflammation, and risk of post-COVID conditions. mBio 2023; 14:e0061823. [PMID: 37724870 PMCID: PMC10653913 DOI: 10.1128/mbio.00618-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/02/2023] [Indexed: 09/21/2023] Open
Abstract
IMPORTANCE Approximately 20% of individuals infected with SARS-CoV-2 experienced long-term health effects, as defined PCC. However, it is unknown if there are any early biomarkers associated with PCC or whether early intervention treatments may decrease the risk of PCC. In a secondary analysis of a randomized clinical trial, this study demonstrates that among outpatients with SARS-CoV-2, increased IL-6 at time of infection is associated with increased odds of PCC. In addition, among individuals treated early, within 5 days of symptom onset, with COVID-19 convalescent plasma, there was a trend for decreased odds of PCC after adjusting for other demographic and clinical characteristics. Future treatment studies should be considered to evaluate the effect of early treatment and anti-IL-6 therapies on PCC development.
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Affiliation(s)
- Kelly A. Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonya L. Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheriza Baksh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison G. Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Shade
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica Ruff
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Malathi Ram
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland, USA
| | - Reinaldo E. Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Owen R. Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward R. Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Judith S. Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, California, USA
| | - Jonathan M. Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
| | | | - Donald N. Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
| | - Laura L. Hammitt
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Adam Levine
- Department of Emergency Medicine, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Giselle S. Mosnaim
- Department of Medicine, Division of Allergy and Immunology, Northshore University Health System, Evanston, Illinois, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - James H. Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jay S. Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Catherine G. Sutcliffe
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Janis E. Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nichol A. McBee
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy L. Gawad
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sabra L. Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - on behalf of the CSSC-004 Consortium
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, California, USA
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
- Luminis Health, Annapolis, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Emergency Medicine, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Division of Allergy and Immunology, Northshore University Health System, Evanston, Illinois, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
- Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, DC, USA
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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15
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Lee NR, King A, Vigil D, Mullaney D, Sanderson PR, Ametepee T, Hammitt LL. Infectious diseases in Indigenous populations in North America: learning from the past to create a more equitable future. Lancet Infect Dis 2023; 23:e431-e444. [PMID: 37148904 PMCID: PMC10156139 DOI: 10.1016/s1473-3099(23)00190-1] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/08/2023]
Abstract
The COVID-19 pandemic, although a profound reminder of endured injustices by and the disparate impact of infectious diseases on Indigenous populations, has also served as an example of Indigenous strength and the ability to thrive anew. Many infectious diseases share common risk factors that are directly tied to the ongoing effects of colonisation. We provide historical context and case studies that illustrate both challenges and successes related to infectious disease mitigation in Indigenous populations in the USA and Canada. Infectious disease disparities, driven by persistent inequities in socioeconomic determinants of health, underscore the urgent need for action. We call on governments, public health leaders, industry representatives, and researchers to reject harmful research practices and to adopt a framework for achieving sustainable improvements in the health of Indigenous people that is both adequately resourced and grounded in respect for tribal sovereignty and Indigenous knowledge.
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Affiliation(s)
- Naomi R Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Alexandra King
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Deionna Vigil
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dustin Mullaney
- Department of Biology, Northern Arizona University, Flagstaff, AZ, USA
| | - Priscilla R Sanderson
- Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, AZ, USA
| | - Taiwo Ametepee
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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16
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Zhu X, Gebo KA, Abraham AG, Habtehyimer F, Patel EU, Laeyendecker O, Gniadek TJ, Fernandez RE, Baker OR, Ram M, Cachay ER, Currier JS, Fukuta Y, Gerber JM, Heath SL, Meisenberg B, Huaman MA, Levine AC, Shenoy A, Anjan S, Blair JE, Cruser D, Forthal DN, Hammitt LL, Kassaye S, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Abinante M, Broderick P, Cluzet V, Cordisco ME, Greenblatt B, Petrini J, Rausch W, Shade D, Lane K, Gawad AL, Klein SL, Pekosz A, Shoham S, Casadevall A, Bloch EM, Hanley D, Sullivan DJ, Tobian AAR. Dynamics of inflammatory responses after SARS-CoV-2 infection by vaccination status in the USA: a prospective cohort study. Lancet Microbe 2023; 4:e692-e703. [PMID: 37659419 PMCID: PMC10475695 DOI: 10.1016/s2666-5247(23)00171-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Cytokines and chemokines play a critical role in the response to infection and vaccination. We aimed to assess the longitudinal association of COVID-19 vaccination with cytokine and chemokine concentrations and trajectories among people with SARS-CoV-2 infection. METHODS In this longitudinal, prospective cohort study, blood samples were used from participants enrolled in a multi-centre randomised trial assessing the efficacy of convalescent plasma therapy for ambulatory COVID-19. The trial was conducted in 23 outpatient sites in the USA. In this study, participants (aged ≥18 years) were restricted to those with COVID-19 before vaccination or with breakthrough infections who had blood samples and symptom data collected at screening (pre-transfusion), day 14, and day 90 visits. Associations between COVID-19 vaccination status and concentrations of 21 cytokines and chemokines (measured using multiplexed sandwich immunoassays) were examined using multivariate linear mixed-effects regression models, adjusted for age, sex, BMI, hypertension, diabetes, trial group, and COVID-19 waves (pre-alpha or alpha and delta). FINDINGS Between June 29, 2020, and Sept 30, 2021, 882 participants recently infected with SARS-CoV-2 were enrolled, of whom 506 (57%) were female and 376 (43%) were male. 688 (78%) of 882 participants were unvaccinated, 55 (6%) were partly vaccinated, and 139 (16%) were fully vaccinated at baseline. After adjusting for confounders, geometric mean concentrations of interleukin (IL)-2RA, IL-7, IL-8, IL-15, IL-29 (interferon-λ), inducible protein-10, monocyte chemoattractant protein-1, and tumour necrosis factor-α were significantly lower among the fully vaccinated group than in the unvaccinated group at screening. On day 90, fully vaccinated participants had approximately 20% lower geometric mean concentrations of IL-7, IL-8, and vascular endothelial growth factor-A than unvaccinated participants. Cytokine and chemokine concentrations decreased over time in the fully and partly vaccinated groups and unvaccinated group. Log10 cytokine and chemokine concentrations decreased faster among participants in the unvaccinated group than in other groups, but their geometric mean concentrations were generally higher than fully vaccinated participants at 90 days. Days since full vaccination and type of vaccine received were not correlated with cytokine and chemokine concentrations. INTERPRETATION Initially and during recovery from symptomatic COVID-19, fully vaccinated participants had lower concentrations of inflammatory markers than unvaccinated participants suggesting vaccination is associated with short-term and long-term reduction in inflammation, which could in part explain the reduced disease severity and mortality in vaccinated individuals. FUNDING US Department of Defense, National Institutes of Health, Bloomberg Philanthropies, State of Maryland, Mental Wellness Foundation, Moriah Fund, Octapharma, HealthNetwork Foundation, and the Shear Family Foundation.
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Affiliation(s)
- Xianming Zhu
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alison G Abraham
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Washington, DC, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Malathi Ram
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barry Meisenberg
- Department of Medicine and Research Institute of Luminis Health, Annapolis, MD, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH, USA
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Aarthi Shenoy
- Division of Hematology, Medstar DC Hospital, Washington, DC, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Daniel Cruser
- Department of Pathology, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, CA, USA
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Northshore University Health System, Evanston, IL, USA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | | | | | - Patrick Broderick
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - Valerie Cluzet
- Department of Infectious Disease, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Marie Elena Cordisco
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - Benjamin Greenblatt
- Department of Emergency Medicine, Nuvance Health Norwalk Hospital, Norwark, CT, USA
| | - Joann Petrini
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - William Rausch
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - David Shade
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amy L Gawad
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Sabra L Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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17
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Huaman MA, Raval JS, Paxton JH, Mosnaim GS, Patel B, Anjan S, Meisenberg BR, Levine AC, Marshall CE, Yarava A, Shenoy AG, Heath SL, Currier JS, Fukuta Y, Blair JE, Spivak ES, Petrini JR, Broderick PB, Rausch W, Cordisco M, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Kassaye SG, Ram M, Wang Y, Das P, Lane K, McBee NA, Gawad AL, Karlen N, Ford DE, Laeyendecker O, Pekosz A, Klein SL, Ehrhardt S, Lau B, Baksh SN, Shade DM, Casadevall A, Hanley DF, Ou J, Gniadek TJ, Ziman A, Shoham S, Gebo KA, Bloch EM, Tobian AAR, Sullivan DJ, Gerber JM. Transfusion reactions associated with COVID-19 convalescent plasma in outpatient clinical trials. Transfusion 2023; 63:1639-1648. [PMID: 37534607 PMCID: PMC10720768 DOI: 10.1111/trf.17485] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND COVID-19 convalescent plasma (CCP) is an important therapeutic option for outpatients at high risk of hospitalization from SARS-CoV-2 infection. We assessed the safety of outpatient CCP transfusions administered during clinical trials. STUDY DESIGN AND METHODS We analyzed data pertaining to transfusion-related reactions from two randomized controlled trials in the U.S. that evaluated the efficacy of CCP versus control plasma in various ambulatory settings. Multivariable logistic regression was used to assess whether CCP was associated with transfusion reactions, after adjusting for potential confounders. RESULTS The combined study reported 79/1351 (5.9%) adverse events during the transfusion visit, with the majority 62/1351 (4.6%) characterized by mild, allergic-type findings of urticaria, and/or pruritus consistent with minor allergic transfusion reactions; the other reported events were attributed to the patients' underlying disease, COVID-19, or vasovagal in nature. We found no difference in the likelihood of allergic transfusion reactions between those receiving CCP versus control plasma (adjusted odds ratio [AOR], 0.75; 95% CI, 0.43-1.31). Risk of urticaria and/or pruritus increased with a pre-existing diagnosis of asthma (AOR, 2.33; 95% CI, 1.16-4.67). We did not observe any CCP-attributed antibody disease enhancement in participants with COVID-19 or increased risk of infection. There were no life-threatening severe transfusion reactions and no patients required hospitalization related to transfusion-associated complications. DISCUSSION Outpatient plasma administration was safely performed for nearly 1400 participants. CCP is a safe therapeutic option for outpatients at risk of hospitalization from COVID-19.
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Affiliation(s)
- Moises A Huaman
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Giselle S Mosnaim
- Department of Medicine, Division of Allergy and Immunology, NorthShore University Health System, Evanston, Illinois, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital & Brown University, Providence, Rhode Island, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, DC, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, Connecticut, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Kevin Oei
- Ascada Research, Fullerton, California, USA
| | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, DC, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ying Wang
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nichol A McBee
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicky Karlen
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel E Ford
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- The Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sabra L Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel F Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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18
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Atwell JE, Hartman RM, Parker D, Taylor K, Brown LB, Sandoval M, Ritchie N, Desnoyers C, Wilson AS, Hammes M, Tiesinga J, Halasa N, Langley G, Prill MM, Bruden D, Close R, Moses J, Karron RA, Santosham M, Singleton RJ, Hammitt LL. RSV Among American Indian and Alaska Native Children: 2019 to 2020. Pediatrics 2023; 152:e2022060435. [PMID: 37449336 DOI: 10.1542/peds.2022-060435] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Jessica E Atwell
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rachel M Hartman
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dennie Parker
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kim Taylor
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura B Brown
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Marqia Sandoval
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nina Ritchie
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - James Tiesinga
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gayle Langley
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mila M Prill
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Bruden
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Ryan Close
- Indian Health Service, Whiteriver Service Unit, Whiteriver, Arizona
| | - Jill Moses
- Indian Health Service, Chinle Service Unit, Chinle, Arizona
| | - Ruth A Karron
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mathuram Santosham
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Laura L Hammitt
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Muller WJ, Madhi SA, Seoane Nuñez B, Baca Cots M, Bosheva M, Dagan R, Hammitt LL, Llapur CJ, Novoa JM, Saez Llorens X, Grenham A, Kelly EJ, Mankad VS, Shroff M, Takas T, Leach A, Villafana T. Nirsevimab for Prevention of RSV in Term and Late-Preterm Infants. N Engl J Med 2023; 388:1533-1534. [PMID: 37018470 DOI: 10.1056/nejmc2214773] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [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: 04/07/2023]
Affiliation(s)
| | - Shabir A Madhi
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Ron Dagan
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
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20
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Lutz CS, Hartman RM, Vigil DE, Britton A, Burrage AB, Campbell AP, Close RM, Desnoyers C, Dobson J, Garcia S, Halasa N, Honie E, Kobayashi M, McMorrow M, Mostafa HH, Parker D, Pohl K, Prill MM, Richards J, Roessler KC, Sutcliffe CG, Taylor K, Swango-Wilson A, Va P, Verani JR, Singleton RJ, Hammitt LL. Effectiveness of COVID-19 mRNA vaccines in preventing COVID-19-associated outpatient visits and hospitalizations among American Indian and Alaska Native persons, January–November 2021: a test-negative case-control analysis using surveillance data. Open Forum Infect Dis 2023; 10:ofad172. [PMID: 37089780 PMCID: PMC10114530 DOI: 10.1093/ofid/ofad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Despite the disproportionate morbidity and mortality experienced by American Indian and Alaska Native (AI/AN) persons during the COVID-19 pandemic, few studies have reported vaccine effectiveness (VE) estimates among these communities.
Methods
We conducted a test-negative case-control analysis among AI/AN persons aged ≥12 years presenting for care from January 1, 2021 through November 30, 2021 to evaluate effectiveness of mRNA COVID-19 vaccines against COVID-19-associated outpatient visits and hospitalizations. Cases and controls were patients with ≥1 symptom consistent with COVID-19-like illness; cases were defined as those test-positive for SARS-CoV-2 and controls were defined as those test-negative for SARS-CoV-2. We used unconditional multivariable logistic regression to estimate VE, defined as 1 minus the adjusted odds ratio for vaccination among cases versus controls.
Results
The analysis included 207 cases and 267 test-negative controls. Forty-four percent of cases and 78% of controls received two doses of either BNT162b2 or mRNA-1273 vaccine. VE point estimates for two doses of mRNA vaccine were higher for hospitalized participants (94.6% [88.0–97.6]) than outpatient participants (86.5% [63.0–95.0]), but confidence intervals overlapped.
Conclusions
Among AI/AN persons, mRNA COVID-19 vaccines were highly effective in preventing COVID-associated outpatient visits and hospitalizations. Maintaining high vaccine coverage, including booster doses, will reduce the burden of disease in this population.
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Affiliation(s)
- Chelsea S Lutz
- Correspondence: Chelsea S. Lutz, MPH, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 (); or Laura L. Hammitt, MD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 ()
| | - Rachel M Hartman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deionna E Vigil
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amadea Britton
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda B Burrage
- Tuba City Service Unit, Navajo Area, Indian Health Service, Tuba City, Arizona, USA
| | - Angela P Campbell
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan M Close
- Whiteriver Service Unit, Phoenix Area, Indian Health Service, Whiteriver, Arizona, USA
| | | | - Jennifer Dobson
- Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Starla Garcia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elvira Honie
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Miwako Kobayashi
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heba H Mostafa
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dennie Parker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyle Pohl
- Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Mila M Prill
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Richards
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristen C Roessler
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kim Taylor
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Puthiery Va
- Chinle Service Unit, Navajo Area, Indian Health Service, Chinle, Arizona, USA
| | - Jennifer R Verani
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Laura L Hammitt
- Correspondence: Chelsea S. Lutz, MPH, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 (); or Laura L. Hammitt, MD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 ()
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21
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Gebo KA, Heath SL, Fukuta Y, Zhu X, Baksh S, Abraham AG, Habtehyimer F, Shade D, Ruff J, Ram M, Laeyendecker O, Fernandez RE, Patel EU, Baker OR, Shoham S, Cachay ER, Currier JS, Gerber JM, Meisenberg B, Forthal DN, Hammitt LL, Huaman MA, Levine A, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Anjan S, Gniadek T, Kassaye S, Blair JE, Lane K, McBee NA, Gawad AL, Das P, Klein SL, Pekosz A, Casadevall A, Bloch EM, Hanley D, Tobian AAR, Sullivan DJ. Early Treatment, Inflammation and Post-COVID Conditions. medRxiv 2023:2023.02.13.23285855. [PMID: 36824860 PMCID: PMC9949202 DOI: 10.1101/2023.02.13.23285855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Background Post-COVID conditions (PCC) are common and have significant morbidity. Risk factors for PCC include advancing age, female sex, obesity, and diabetes mellitus. Little is known about early treatment, inflammation, and PCC. Methods Among 883 individuals with confirmed SARS-CoV-2 infection participating in a randomized trial of CCP vs. control plasma with available biospecimens and symptom data, the association between early COVID treatment, cytokine levels and PCC was evaluated. Cytokine and chemokine levels were assessed at baseline, day 14 and day 90 using a multiplexed sandwich immuosassay (Mesoscale Discovery). Presence of any self-reported PCC symptoms was assessed at day 90. Associations between COVID treatment, cytokine levels and PCC were examined using multivariate logistic regression models. Results One-third of the 882 participants had day 90 PCC symptoms, with fatigue (14.5%) and loss of smell (14.5%) being most common. Cytokine levels decreased from baseline to day 90. In a multivariable analysis including diabetes, body mass index, race, and vaccine status, female sex (adjusted odds ratio[AOR]=2.70[1.93-3.81]), older age (AOR=1.32[1.17-1.50]), and elevated baseline levels of IL-6 (AOR=1.59[1.02-2.47]) were associated with development of PCC.There was a trend for decreased PCC in those with early CCP treatment (≤5 days after symptom onset) compared to late CCP treatment. Conclusion Increased IL-6 levels were associated with the development of PCC and there was a trend for decreased PCC with early CCP treatment in this predominately unvaccinated population. Future treatment studies should evaluate the effect of early treatment and anti-IL-6 therapies on PCC development.
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Affiliation(s)
- Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sheriza Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Alison G Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora CO
| | - Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - David Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jessica Ruff
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Malathi Ram
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA
| | | | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA
| | - Laura L Hammitt
- International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH
| | - Adam Levine
- Department of Emergency Medicine, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, RI
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Northshore University Health System, Evanston, IL
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, NM
| | - Catherine G Sutcliffe
- International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Shweta Anjan
- Department of Medicine, Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL
| | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, IL
| | - Seble Kassaye
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Nichol A McBee
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sabra L Klein
- Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Thomas SJ, Moreira ED, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Marc GP, Polack FP, Zerbini C, Bailey R, Swanson KA, Xu X, Roychoudhury S, Koury K, Bouguermouh S, Kalina WV, Cooper D, Frenck RW, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Yang Q, Liberator P, Tresnan DB, Mather S, Dormitzer PR, Şahin U, Gruber WC, Jansen KU. Plain language summary of Pfizer-BioNTech BNT162b2 COVID-19 vaccine safety in participants 16 years or older and protection against COVID-19 in participants 12 years or older. Future Virol 2022. [DOI: 10.2217/fvl-2022-0142] [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: 11/27/2022]
Abstract
What is this summary about? This is a summary of an article about part of a clinical study for the BNT162b2 COVID-19 vaccine, also called the Pfizer-BioNTech vaccine. The article was published in the New England Journal of Medicine in September 2021. The part of the study described in the article began in July 2020 and is ongoing. This means that the final results may be different from the results included in this summary. What happened in this study? The participants in this study received 2 injections of either the BNT162b2 vaccine or a placebo, 21 days apart. The placebo looked like the BNT162b2 vaccine but had no active vaccine in it. None of the trial participants or study teams knew who received vaccine or placebo. What were the results? Most of the reactions to the injections were mild or moderate and lasted for a short period of time. The most common reactions were pain at the injection site, extreme tiredness (fatigue), and headache. These reactions usually happened in the first 7 days after receiving a vaccine dose. A small number of participants had severe reactions to the vaccine. Compared to participants who received the placebo, participants who received the BNT162b2 vaccine were much less likely to become ill if they were infected with the virus that causes COVID-19. The vaccine also had very good efficacy at preventing severe COVID-19. Participants in South Africa who received the BNT162b2 vaccine were less likely to become ill after infection with the beta variant of the virus compared to participants who received the placebo. The beta variant was very common in South Africa when the study was taking place. Clinical Trial Registration: NCT04368728 ( ClinicalTrials.gov )
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Affiliation(s)
- Stephen J Thomas
- State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce & Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Judith Absalon
- Vaccine Research & Development, Pfizer, Pearl River, NY, USA
| | | | | | - John L Perez
- Worldwide Safety, Safety Surveillance, & Risk Management, Pfizer, Collegeville, PA, USA
| | | | | | | | - Ruth Bailey
- Vaccine Research & Development, Pfizer, Hurley, UK
| | - Kena A Swanson
- Vaccine Research & Development, Pfizer, Pearl River, NY, USA
| | - Xia Xu
- Vaccine Research & Development, Pfizer, Collegeville, PA, USA
| | | | - Kenneth Koury
- Vaccine Research & Development, Pfizer, Pearl River, NY, USA
| | | | - Warren V Kalina
- Vaccine Research & Development, Pfizer, Pearl River, NY, USA
| | - David Cooper
- Vaccine Research & Development, Pfizer, Pearl River, NY, USA
| | | | | | | | - Haylene Nell
- Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa
| | | | | | - Qi Yang
- Vaccine Research & Development, Pfizer, Pearl River, NY, USA
| | - Paul Liberator
- Vaccine Research & Development, Pfizer, Pearl River, NY, USA
| | - Dina B Tresnan
- Worldwide Safety, Safety Surveillance, & Risk Management, Pfizer, Groton, CT, USA
| | - Susan Mather
- Worldwide Safety, Safety Surveillance, & Risk Management, Pfizer, Collegeville, PA, USA
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23
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Ji N, Rule AM, Weatherholtz R, Crosby L, Bunnell JE, Orem B, Reid R, Santosham M, Hammitt LL, O'Brien KL. Evaluation of indoor PM 2.5 concentrations in a Native American Community: a pilot study. J Expo Sci Environ Epidemiol 2022; 32:554-562. [PMID: 34349228 DOI: 10.1038/s41370-021-00373-x] [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: 02/13/2020] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Indoor air pollution is associated with adverse health effects; however, few studies exist studying indoor air pollution on the Navajo Nation in the southwest U.S., a community with high rates of respiratory disease. METHODS Indoor PM2.5 concentration was evaluated in 26 homes on the Navajo Nation using real-time PM2.5 monitors. Household risk factors and daily activities were evaluated with three metrics of indoor PM2.5: time-weighted average (TWA), 90th percentile of concentration, and daily minutes exceeding 100 μg/m3. A questionnaire and recall sheet were used to record baseline household characteristics and daily activities. RESULTS The median TWA, 90th percentile, and daily minutes exceeding 100 μg/m3 were 7.9 μg/m3, 14.0 μg/m3, and 17 min, respectively. TWAs tended to be higher in autumn and in houses that used fuel the previous day. Other characteristics associated with elevated PM exposure in all metrics included overcrowded houses, nonmobile houses, and houses with current smokers, pets, and longer cooking time. CONCLUSIONS Some residents of the Navajo Nation have higher risk of exposure to indoor air pollution by Environmental Protection Agency (EPA) standards. Efforts to identify the causes and associations with adverse health effects are needed to ensure that exposure to risks and possible health impacts are mitigated.
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Affiliation(s)
- Nan Ji
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Weatherholtz
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lynn Crosby
- United States Geological Survey, Reston, VA, USA
| | | | - Bill Orem
- United States Geological Survey, Reston, VA, USA
| | - Raymond Reid
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura L Hammitt
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine L O'Brien
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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24
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Moreira ED, Kitchin N, Xu X, Dychter SS, Lockhart S, Gurtman A, Perez JL, Zerbini C, Dever ME, Jennings TW, Brandon DM, Cannon KD, Koren MJ, Denham DS, Berhe M, Fitz-Patrick D, Hammitt LL, Klein NP, Nell H, Keep G, Wang X, Koury K, Swanson KA, Cooper D, Lu C, Türeci Ö, Lagkadinou E, Tresnan DB, Dormitzer PR, Şahin U, Gruber WC, Jansen KU. Safety and Efficacy of a Third Dose of BNT162b2 Covid-19 Vaccine. N Engl J Med 2022; 386:1910-1921. [PMID: 35320659 PMCID: PMC9006787 DOI: 10.1056/nejmoa2200674] [Citation(s) in RCA: 169] [Impact Index Per Article: 84.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Active immunization with the BNT162b2 vaccine (Pfizer-BioNTech) has been a critical mitigation tool against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the coronavirus disease 2019 (Covid-19) pandemic. In light of reports of waning protection occurring 6 months after the primary two-dose vaccine series, data are needed on the safety and efficacy of offering a third (booster) dose in persons 16 years of age or older. METHODS In this ongoing, placebo-controlled, randomized, phase 3 trial, we assigned participants who had received two 30-μg doses of the BNT162b2 vaccine at least 6 months earlier to be injected with a third dose of the BNT162b2 vaccine or with placebo. We assessed vaccine safety and efficacy against Covid-19 starting 7 days after the third dose. RESULTS A total of 5081 participants received a third BNT162b2 dose and 5044 received placebo. The median interval between dose 2 and dose 3 was 10.8 months in the vaccine group and 10.7 months in the placebo group; the median follow-up was 2.5 months. Local and systemic reactogenicity events from the third dose were generally of low grade. No new safety signals were identified, and no cases of myocarditis or pericarditis were reported. Among the participants without evidence of previous SARS-CoV-2 infection who could be evaluated, Covid-19 with onset at least 7 days after dose 3 was observed in 6 participants in the vaccine group and in 123 participants in the placebo group, which corresponded to a relative vaccine efficacy of 95.3% (95% confidence interval, 89.5 to 98.3). CONCLUSIONS A third dose of the BNT162b2 vaccine administered a median of 10.8 months after the second dose provided 95.3% efficacy against Covid-19 as compared with two doses of the BNT162b2 vaccine during a median follow-up of 2.5 months. (Funded by BioNTech and Pfizer; C4591031 ClinicalTrials.gov number, NCT04955626.).
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Affiliation(s)
- Edson D Moreira
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Nicholas Kitchin
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Xia Xu
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Samuel S Dychter
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Stephen Lockhart
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Alejandra Gurtman
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - John L Perez
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Cristiano Zerbini
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Michael E Dever
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Timothy W Jennings
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Donald M Brandon
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Kevin D Cannon
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Michael J Koren
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Douglas S Denham
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Mezgebe Berhe
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - David Fitz-Patrick
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Laura L Hammitt
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Nicola P Klein
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Haylene Nell
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Georgina Keep
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Xingbin Wang
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Kenneth Koury
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Kena A Swanson
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - David Cooper
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Claire Lu
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Özlem Türeci
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Eleni Lagkadinou
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Dina B Tresnan
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Philip R Dormitzer
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Uğur Şahin
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - William C Gruber
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
| | - Kathrin U Jansen
- From Associação Obras Sociais Irmã Dulce and the Oswaldo Cruz Foundation, Bahia (E.D.M.), and Centro Paulista de Investigação Clinica, São Paulo (C.Z.) - both in Brazil; Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., G.K.); Vaccine Research and Development, Pfizer, Collegeville, PA (X.X., J.L.P., X.W.); Vaccine Research and Development, Pfizer (S.S.D.), and California Research Foundation (D.M.B.), San Diego, and Kaiser Permanente Vaccine Study Center, Oakland (N.P.K.) - all in California; Vaccine Research and Development, Pfizer, Pearl River, NY (A.G., K.K., K.A.S., D.C., C.L., P.R.D., W.C.G., K.U.J.); Clinical Neuroscience Solutions, Orlando (M.E.D.), and Jacksonville Center for Clinical Research, Jacksonville (M.J.K.) - both in Florida; Clinical Research Professionals, Chesterfield, MO (T.W.J.); Accellacare, Wilmington, NC (K.D.C.); Clinical Trials of Texas, San Antonio (D.S.D.), and North Texas Infectious Diseases Consultants, Dallas (M.B.); East-West Medical Research Institute, Honolulu (D.F.P.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); BioNTech, Mainz, Germany (Ö.T., E.L., U.Ş.); and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Groton, CT (D.B.T.)
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25
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Park DE, Watson NL, Focht C, Feikin D, Hammitt LL, Brooks WA, Howie SRC, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, O'Brien KL, Scott JAG, Thea DM, Amorninthapichet T, Awori J, Bunthi C, Ebruke B, Elhilali M, Higdon M, Hossain L, Jahan Y, Moore DP, Mulindwa J, Mwananyanda L, Naorat S, Prosperi C, Thamthitiwat S, Verwey C, Jablonski KA, Power MC, Young HA, Deloria Knoll M, McCollum ED. Digitally recorded and remotely classified lung auscultation compared with conventional stethoscope classifications among children aged 1-59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case-control study. BMJ Open Respir Res 2022; 9:9/1/e001144. [PMID: 35577452 PMCID: PMC9115042 DOI: 10.1136/bmjresp-2021-001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/28/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Diagnosis of pneumonia remains challenging. Digitally recorded and remote human classified lung sounds may offer benefits beyond conventional auscultation, but it is unclear whether classifications differ between the two approaches. We evaluated concordance between digital and conventional auscultation. METHODS We collected digitally recorded lung sounds, conventional auscultation classifications and clinical measures and samples from children with pneumonia (cases) in low-income and middle-income countries. Physicians remotely classified recordings as crackles, wheeze or uninterpretable. Conventional and digital auscultation concordance was evaluated among 383 pneumonia cases with concurrently (within 2 hours) collected conventional and digital auscultation classifications using prevalence-adjusted bias-adjusted kappa (PABAK). Using an expanded set of 737 cases that also incorporated the non-concurrently collected assessments, we evaluated whether associations between auscultation classifications and clinical or aetiological findings differed between conventional or digital auscultation using χ2 tests and logistic regression adjusted for age, sex and site. RESULTS Conventional and digital auscultation concordance was moderate for classifying crackles and/or wheeze versus neither crackles nor wheeze (PABAK=0.50), and fair for crackles-only versus not crackles-only (PABAK=0.30) and any wheeze versus no wheeze (PABAK=0.27). Crackles were more common on conventional auscultation, whereas wheeze was more frequent on digital auscultation. Compared with neither crackles nor wheeze, crackles-only on both conventional and digital auscultation was associated with abnormal chest radiographs (adjusted OR (aOR)=1.53, 95% CI 0.99 to 2.36; aOR=2.09, 95% CI 1.19 to 3.68, respectively); any wheeze was inversely associated with C-reactive protein >40 mg/L using conventional auscultation (aOR=0.50, 95% CI 0.27 to 0.92) and with very severe pneumonia using digital auscultation (aOR=0.67, 95% CI 0.46 to 0.97). Crackles-only on digital auscultation was associated with mortality compared with any wheeze (aOR=2.70, 95% CI 1.12 to 6.25). CONCLUSIONS Conventional auscultation and remotely-classified digital auscultation displayed moderate concordance for presence/absence of wheeze and crackles among cases. Conventional and digital auscultation may provide different classification patterns, but wheeze was associated with decreased clinical severity on both.
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Affiliation(s)
- Daniel E Park
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
| | | | | | - Daniel Feikin
- Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA,Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka and Matlab, Bangladesh,Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, Gambia,Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Karen L Kotloff
- Department of Pediatrics, University of Maryland Center for Vaccine Development, Baltimore, Maryland, USA
| | - Orin S Levine
- Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA,Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa,Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand,Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L O'Brien
- Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA
| | - J Anthony G Scott
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Donald M Thea
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Juliet Awori
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Charatdao Bunthi
- Division of Global Health Protection, Thailand Ministry of Public Health – US CDC Collaboration, Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | - Bernard Ebruke
- Medical Research Council Unit, Basse, Gambia,International Foundation Against Infectious Disease in Nigeria, Abuja, Nigeria
| | - Mounya Elhilali
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Melissa Higdon
- Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka and Matlab, Bangladesh
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka and Matlab, Bangladesh
| | - David P Moore
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justin Mulindwa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Lawrence Mwananyanda
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA,Right to Care - Zambia, Lusaka, Zambia
| | | | - Christine Prosperi
- Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health – US CDC Collaboration, Royal Thai Government Ministry of Public Health, Nonthaburi, Thailand
| | - Charl Verwey
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Melinda C Power
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
| | - Heather A Young
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA
| | - Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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26
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Cella E, Sutcliffe CG, Tso C, Paul E, Ritchie N, Colelay J, Denny E, Grant LR, Weatherholtz RC, Hammitt LL, Azarian T. Carriage prevalence and genomic epidemiology of Staphylococcus aureus among Native American children and adults in the Southwestern USA. Microb Genom 2022; 8. [PMID: 35551692 PMCID: PMC9465076 DOI: 10.1099/mgen.0.000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Native American individuals in the Southwestern USA experience a higher burden of invasive Staphylococcus aureus disease than the general population. However, little is known about S. aureus carriage in these communities. A cross-sectional study was conducted to determine the carriage prevalence, risk factors and genomic epidemiology of S. aureus among Native American children (<5 years, n=121) and adults (≥18 years, n=167) in the Southwestern USA. Short- and long-read sequencing data were generated using Illumina and Oxford Nanopore Technology platforms to produce high-quality hybrid assemblies, and antibiotic-resistance, virulence and pangenome analyses were performed. S. aureus carriage prevalence was 20.7 % among children, 30.2 % among adults 18–64 years and 16.7 % among adults ≥65 years. Risk factors among adults included recent surgery, prior S. aureus infection among household members, and recent use of gyms or locker rooms by household members. No risk factors were identified among children. The bacterial population structure was dominated by clonal complex 1 (CC1) (21.1 %), CC5 (22.2 %) and CC8 (22.2 %). Isolates from children and adults were intermixed throughout the phylogeny. While the S. aureus population was diverse, the carriage prevalence was comparable to that in the general USA population. Genomic and risk-factor data suggest household, community and healthcare transmission are important components of the local epidemiology.
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Affiliation(s)
- Eleonora Cella
- University of Central Florida, 4110 Libra Drive, Orlando, FL 32816, USA
| | - Catherine G Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Carol Tso
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Ella Paul
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Nina Ritchie
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Janene Colelay
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Estar Denny
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Lindsay R Grant
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA.,Present address: Global Pneumococcal Vaccines, Scientific Affairs and Epidemiology, Pfizer Inc, USA
| | - Robert C Weatherholtz
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Laura L Hammitt
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Taj Azarian
- University of Central Florida, 4110 Libra Drive, Orlando, FL 32816, USA
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27
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Sullivan DJ, Gebo KA, Shoham S, Bloch EM, Lau B, Shenoy AG, Mosnaim GS, Gniadek TJ, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Foster EC, Roth M, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Ehrhardt S, Baksh SN, Laeyendecker O, Pekosz A, Klein SL, Casadevall A, Tobian AAR, Hanley DF. Early Outpatient Treatment for Covid-19 with Convalescent Plasma. N Engl J Med 2022; 386:1700-1711. [PMID: 35353960 PMCID: PMC9006786 DOI: 10.1056/nejmoa2119657] [Citation(s) in RCA: 159] [Impact Index Per Article: 79.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Polyclonal convalescent plasma may be obtained from donors who have recovered from coronavirus disease 2019 (Covid-19). The efficacy of this plasma in preventing serious complications in outpatients with recent-onset Covid-19 is uncertain. METHODS In this multicenter, double-blind, randomized, controlled trial, we evaluated the efficacy and safety of Covid-19 convalescent plasma, as compared with control plasma, in symptomatic adults (≥18 years of age) who had tested positive for severe acute respiratory syndrome coronavirus 2, regardless of their risk factors for disease progression or vaccination status. Participants were enrolled within 8 days after symptom onset and received a transfusion within 1 day after randomization. The primary outcome was Covid-19-related hospitalization within 28 days after transfusion. RESULTS Participants were enrolled from June 3, 2020, through October 1, 2021. A total of 1225 participants underwent randomization, and 1181 received a transfusion. In the prespecified modified intention-to-treat analysis that included only participants who received a transfusion, the primary outcome occurred in 17 of 592 participants (2.9%) who received convalescent plasma and 37 of 589 participants (6.3%) who received control plasma (absolute risk reduction, 3.4 percentage points; 95% confidence interval, 1.0 to 5.8; P = 0.005), which corresponded to a relative risk reduction of 54%. Evidence of efficacy in vaccinated participants cannot be inferred from these data because 53 of the 54 participants with Covid-19 who were hospitalized were unvaccinated and 1 participant was partially vaccinated. A total of 16 grade 3 or 4 adverse events (7 in the convalescent-plasma group and 9 in the control-plasma group) occurred in participants who were not hospitalized. CONCLUSIONS In participants with Covid-19, most of whom were unvaccinated, the administration of convalescent plasma within 9 days after the onset of symptoms reduced the risk of disease progression leading to hospitalization. (Funded by the Department of Defense and others; CSSC-004 ClinicalTrials.gov number, NCT04373460.).
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Affiliation(s)
- David J Sullivan
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Kelly A Gebo
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Shmuel Shoham
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Evan M Bloch
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Bryan Lau
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Aarthi G Shenoy
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Giselle S Mosnaim
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Thomas J Gniadek
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Yuriko Fukuta
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Bela Patel
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Sonya L Heath
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Adam C Levine
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Barry R Meisenberg
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Emily S Spivak
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Shweta Anjan
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Moises A Huaman
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Janis E Blair
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Judith S Currier
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - James H Paxton
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Jonathan M Gerber
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Joann R Petrini
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Patrick B Broderick
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - William Rausch
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Marie-Elena Cordisco
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Jean Hammel
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Benjamin Greenblatt
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Valerie C Cluzet
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Daniel Cruser
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Kevin Oei
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Matthew Abinante
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Laura L Hammitt
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Catherine G Sutcliffe
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Donald N Forthal
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Martin S Zand
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Edward R Cachay
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Jay S Raval
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Seble G Kassaye
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - E Colin Foster
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Michael Roth
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Christi E Marshall
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Anusha Yarava
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Karen Lane
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Nichol A McBee
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Amy L Gawad
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Nicky Karlen
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Atika Singh
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Daniel E Ford
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Douglas A Jabs
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Lawrence J Appel
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - David M Shade
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Stephan Ehrhardt
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Sheriza N Baksh
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Oliver Laeyendecker
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Andrew Pekosz
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Sabra L Klein
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Arturo Casadevall
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Aaron A R Tobian
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
| | - Daniel F Hanley
- From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.)
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Close RM, Sutcliffe CG, Galdun P, Reid A, Askew MR, Davidson AM, Kellywood K, Parker D, Patel J, Romancito E, Brown LB, McAuley JB, Hammitt LL. Point-of-care molecular diagnostics for the detection of group A Streptococcus in non-invasive skin and soft tissue infections: a validation study. Diagn Microbiol Infect Dis 2022; 103:115729. [DOI: 10.1016/j.diagmicrobio.2022.115729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 01/21/2023]
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Hammitt LL, Dagan R, Yuan Y, Baca Cots M, Bosheva M, Madhi SA, Muller WJ, Zar HJ, Brooks D, Grenham A, Wählby Hamrén U, Mankad VS, Ren P, Takas T, Abram ME, Leach A, Griffin MP, Villafana T. Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants. N Engl J Med 2022; 386:837-846. [PMID: 35235726 DOI: 10.1056/nejmoa2110275] [Citation(s) in RCA: 289] [Impact Index Per Article: 144.5] [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: 12/13/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection and hospitalization in infants. Nirsevimab is a monoclonal antibody to the RSV fusion protein that has an extended half-life. The efficacy and safety of nirsevimab in healthy late-preterm and term infants are uncertain. METHODS We randomly assigned, in a 2:1 ratio, infants who had been born at a gestational age of at least 35 weeks to receive a single intramuscular injection of nirsevimab or placebo before the start of an RSV season. The primary efficacy end point was medically attended RSV-associated lower respiratory tract infection through 150 days after the injection. The secondary efficacy end point was hospitalization for RSV-associated lower respiratory tract infection through 150 days after the injection. RESULTS A total of 1490 infants underwent randomization: 994 were assigned to the nirsevimab group and 496 to the placebo group. Medically attended RSV-associated lower respiratory tract infection occurred in 12 infants (1.2%) in the nirsevimab group and in 25 infants (5.0%) in the placebo group; these findings correspond to an efficacy of 74.5% (95% confidence interval [CI], 49.6 to 87.1; P<0.001) for nirsevimab. Hospitalization for RSV-associated lower respiratory tract infection occurred in 6 infants (0.6%) in the nirsevimab group and in 8 infants (1.6%) in the placebo group (efficacy, 62.1%; 95% CI, -8.6 to 86.8; P = 0.07). Among infants with data available to day 361, antidrug antibodies after baseline were detected in 58 of 951 (6.1%) in the nirsevimab group and in 5 of 473 (1.1%) in the placebo group. Serious adverse events were reported in 67 of 987 infants (6.8%) who received nirsevimab and in 36 of 491 infants (7.3%) who received placebo. CONCLUSIONS A single injection of nirsevimab administered before the RSV season protected healthy late-preterm and term infants from medically attended RSV-associated lower respiratory tract infection. (Funded by MedImmune/AstraZeneca and Sanofi; MELODY ClinicalTrials.gov number, NCT03979313.).
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MESH Headings
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antiviral Agents/administration & dosage
- Antiviral Agents/adverse effects
- Antiviral Agents/therapeutic use
- Drug Administration Schedule
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/prevention & control
- Injections, Intramuscular
- Kaplan-Meier Estimate
- Male
- Respiratory Syncytial Virus Infections/prevention & control
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Affiliation(s)
- Laura L Hammitt
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Ron Dagan
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Yuan Yuan
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Manuel Baca Cots
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Miroslava Bosheva
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Shabir A Madhi
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - William J Muller
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Heather J Zar
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Dennis Brooks
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Amy Grenham
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Ulrika Wählby Hamrén
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Vaishali S Mankad
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Pin Ren
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Therese Takas
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Michael E Abram
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Amanda Leach
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - M Pamela Griffin
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Tonya Villafana
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
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Sullivan DJ, Gebo KA, Shoham S, Bloch EM, Lau B, Shenoy AG, Mosnaim GS, Gniadek TJ, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Foster EC, Roth M, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Ehrhardt S, Baksh SN, Laeyendecker O, Pekosz A, Klein SL, Casadevall A, Tobian AAR, Hanley DF. Randomized Controlled Trial of Early Outpatient COVID-19 Treatment with High-Titer Convalescent Plasma. medRxiv 2021:2021.12.10.21267485. [PMID: 34981068 PMCID: PMC8722611 DOI: 10.1101/2021.12.10.21267485] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy of polyclonal high titer convalescent plasma to prevent serious complications of COVID-19 in outpatients with recent onset of illness is uncertain. METHODS This multicenter, double-blind randomized controlled trial compared the efficacy and safety of SARS-CoV-2 high titer convalescent plasma to placebo control plasma in symptomatic adults ≥18 years positive for SARS-CoV-2 regardless of risk factors for disease progression or vaccine status. Participants with symptom onset within 8 days were enrolled, then transfused within the subsequent day. The measured primary outcome was COVID-19-related hospitalization within 28 days of plasma transfusion. The enrollment period was June 3, 2020 to October 1, 2021. RESULTS A total of 1225 participants were randomized and 1181 transfused. In the pre-specified modified intention-to-treat analysis that excluded those not transfused, the primary endpoint occurred in 37 of 589 (6.3%) who received placebo control plasma and in 17 of 592 (2.9%) participants who received convalescent plasma (relative risk, 0.46; one-sided 95% upper bound confidence interval 0.733; P=0.004) corresponding to a 54% risk reduction. Examination with a model adjusting for covariates related to the outcome did not change the conclusions. CONCLUSION Early administration of high titer SARS-CoV-2 convalescent plasma reduced outpatient hospitalizations by more than 50%. High titer convalescent plasma is an effective early outpatient COVID-19 treatment with the advantages of low cost, wide availability, and rapid resilience to variant emergence from viral genetic drift in the face of a changing pandemic. Trial Registration ClinicalTrials.gov number, NCT04373460.
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Affiliation(s)
- David J Sullivan
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Evan M Bloch
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Bryan Lau
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Aarthi G Shenoy
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Giselle S Mosnaim
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Thomas J Gniadek
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Yuriko Fukuta
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Bela Patel
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Adam C Levine
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Barry R Meisenberg
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - James H Paxton
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Jonathan M Gerber
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Joann R Petrini
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Patrick B Broderick
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - William Rausch
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Marie Elena Cordisco
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Jean Hammel
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Benjamin Greenblatt
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Valerie C Cluzet
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Daniel Cruser
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Kevin Oei
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Matthew Abinante
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Laura L Hammitt
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Catherine G Sutcliffe
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Martin S Zand
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Jay S Raval
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - E Colin Foster
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Michael Roth
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Christi E Marshall
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Anusha Yarava
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Karen Lane
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Nichol A McBee
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Amy L Gawad
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Nicky Karlen
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Atika Singh
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Daniel E Ford
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Douglas A Jabs
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Lawrence J Appel
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - David M Shade
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Stephan Ehrhardt
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Sheriza N Baksh
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Oliver Laeyendecker
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Andrew Pekosz
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Sabra L Klein
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Arturo Casadevall
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Aaron A R Tobian
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
| | - Daniel F Hanley
- Department of Medicine, Division of Infectious Diseases (S.S., K.G.) Department of Pathology (E.B., C.M. A.T.), Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N. M., A.G., N.K. D.H.), Department of Ophthalmology (DJ), Welch Center (L.A.), Institute for Clinical and Translational Research (D.F.), Johns Hopkins University School of Medicine; the Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., A.P.), International Health (L.H., C.S.), and Epidemiology (B.L., D.S., S.E.) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH (O.L.); Department of Medicine, Division of Hematology and Oncology, Medstar Washington Hospital Center, Washington, DC (A.S.); Division of Allergy and Immunology, Department of Medicine (G.M.), Department of Pathology (T.G.), Northshore University Health System, Evanston, IL; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F.); Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX (B.P.); Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL (S.H.); Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.); Luminis Health, Annapolis, MD (B. M.); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (E.S); Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL (S.A.); Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.B.); Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.C.); Department of Emergency Medicine, Wayne State University, Detroit, MI (J.P.); Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.); Nuvance Health, Danbury, CT (J.P., W.R., M.E.C); Nuvance Health Danbury Hospital, Danbury, CT (P.B.); Nuvance Health Norwalk Hospital, Norwalk, CT (J.H., B.G.); Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY (V.C., D.C.); Ascada Research, Fullerton, CA (K.O, M.A.); Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.); Department of Medicine, University of Rochester, Rochester, NY (M.Z.); Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA (E.C.); Department of Pathology, University of New Mexico, Albuquerque, NM (J.R.); Department of Medicine, Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C. (S.K.), The Bliss Group, New York City, NY, (M.R.) The Next Practice, Austin, TX (C.F.)
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Hammitt LL, Quinn D, Janczewska E, Pasquel FJ, Tytus R, Reddy KR, Abarca K, Khaertynova IM, Dagan R, McCauley J, Cheon K, Pedley A, Sterling T, Tamms G, Musey L, Buchwald UK. Immunogenicity, Safety, and Tolerability of V114, a 15-Valent Pneumococcal Conjugate Vaccine, in Immunocompetent Adults Aged 18–49 Years With or Without Risk Factors for Pneumococcal Disease: A Randomized Phase 3 Trial (PNEU-DAY). Open Forum Infect Dis 2021; 9:ofab605. [PMID: 35146039 PMCID: PMC8826015 DOI: 10.1093/ofid/ofab605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/01/2021] [Accepted: 12/16/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Adults with certain medical and behavioral factors are at increased risk for pneumococcal disease (PD). Sequential vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for at-risk adults in some countries.
Methods
This phase 3 trial evaluated the safety, tolerability, and immunogenicity of sequential administration of either V114 (a 15-valent PCV containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F) or PCV13, followed 6 months later by PPSV23, in immunocompetent adults aged 18–49 years with or without pre-defined risk factors for PD (NCT03547167). Overall, 1515 participants were randomized 3:1 to receive either V114 or PCV13, followed by PPSV23.
Results
Most common solicited adverse events (AEs) following administration of V114 or PCV13 as well as PPSV23 were injection-site pain and fatigue. The proportion of participants with AEs was comparable in both groups. V114 and PCV13 were immunogenic based on opsonophagocytic activity (OPA) geometric mean titers (GMTs) 30 days post-vaccination for all serotypes contained in each respective vaccine. OPA GMTs to the 2 unique serotypes in V114 were robust in the V114 group. PPSV23 was immunogenic for all 15 serotypes contained in V114 in both vaccination groups, including 22F and 33F.
Conclusions
V114 administered alone or sequentially with PPSV23 is well tolerated and immunogenic for all 15 serotypes, including those not contained in PCV13, in immunocompetent adults aged 18–49 years with or without certain medical or behavioral risk factors for PD.
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Affiliation(s)
- Laura L Hammitt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dean Quinn
- P3 Research, Wellington Clinical Trial Research Unit, Wellington, New Zealand
| | - Ewa Janczewska
- The School of Health Sciences in Bytom, Medical University of Silesia, Poland
| | | | | | - K Rajender Reddy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katia Abarca
- Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Ron Dagan
- Ben-Gurion University, Beer-Sheva, Israel
| | | | | | | | | | | | - Luwy Musey
- Merck & Co., Inc., Kenilworth, New Jersey, USA
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Ebruke BE, Deloria Knoll M, Haddix M, Zaman SMA, Prosperi C, Feikin DR, Hammitt LL, Levine OS, O’Brien KL, Murdoch DR, Brooks WA, Scott JAG, Kotloff KL, Madhi SA, Thea DM, Baillie VL, Chisti MJ, Dione M, Driscoll AJ, Fancourt N, Karron RA, Le TT, Mohamed S, Moore DP, Morpeth SC, Mwaba J, Mwansa J, Bin Shahid ASMS, Sow SO, Tapia MD, Antonio M, Howie SRC. The Etiology of Pneumonia From Analysis of Lung Aspirate and Pleural Fluid Samples: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Clin Infect Dis 2021; 73:e3788-e3796. [PMID: 32710751 PMCID: PMC8662778 DOI: 10.1093/cid/ciaa1032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An improved understanding of childhood pneumonia etiology is required to inform prevention and treatment strategies. Lung aspiration is the gold standard specimen for pneumonia diagnostics. We report findings from analyses of lung and pleural aspirates collected in the Pneumonia Etiology Research for Child Health (PERCH) study. METHODS The PERCH study enrolled children aged 1-59 months hospitalized with World Health Organization-defined severe or very severe pneumonia in 7 countries in Africa and Asia. Percutaneous transthoracic lung aspiration (LA) and pleural fluid (PF) aspiration was performed on a sample of pneumonia cases with radiological consolidation and/or PF in 4 countries. Venous blood and nasopharyngeal/oropharyngeal swabs were collected from all cases. Multiplex quantitative polymerase chain reaction (PCR) and routine microbiologic culture were applied to clinical specimens. RESULTS Of 44 LAs performed within 3 days of admission on 622 eligible cases, 13 (30%) had a pathogen identified by either culture (5/44) or by PCR (11/29). A pathogen was identified in 12/14 (86%) PF specimens tested by either culture (9/14) or PCR (9/11). Bacterial pathogens were identified more frequently than viruses. All but 1 of the cases with a virus identified were coinfected with bacterial pathogens. Streptococcus pneumoniae (9/44 [20%]) and Staphylococcus aureus (7/14 [50%]) were the predominant pathogens identified in LA and PF, respectively. CONCLUSIONS Bacterial pathogens predominated in this selected subgroup of PERCH participants drawn from those with radiological consolidation or PF, with S. pneumoniae and S. aureus the leading pathogens identified.
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Affiliation(s)
- Bernard E Ebruke
- Medical Research Council Unit, Basse, The Gambia
- International Foundation Against Infectious Disease in Nigeria (IFAIN), Herbert Macaulay Way Central Business District, Abuja, Nigeria
- Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Syed M A Zaman
- Medical Research Council Unit, Basse, The Gambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel R Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Orin S Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine L O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David R Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - W Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - J Anthony G Scott
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Donald M Thea
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Vicky L Baillie
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammod Jobayer Chisti
- Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Michel Dione
- Medical Research Council Unit, Basse, The Gambia
- International Livestock Research Institute, Ouagadougou, Burkina Faso
| | - Amanda J Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas Fancourt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Royal Darwin Hospital, Darwin, Australia
| | - Ruth A Karron
- Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tham T Le
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA
| | - Shebe Mohamed
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
| | - David P Moore
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Susan C Morpeth
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - John Mwaba
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - James Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- Department of Microbiology, Lusaka Apex Medical University, Lusaka, Zambia
| | | | - Samba O Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Martin Antonio
- Medical Research Council Unit, Basse, The Gambia
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, The Gambia
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
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Thomas SJ, Moreira ED, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez Marc G, Polack FP, Zerbini C, Bailey R, Swanson KA, Xu X, Roychoudhury S, Koury K, Bouguermouh S, Kalina WV, Cooper D, Frenck RW, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Yang Q, Liberator P, Tresnan DB, Mather S, Dormitzer PR, Şahin U, Gruber WC, Jansen KU. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months. N Engl J Med 2021; 385:1761-1773. [PMID: 34525277 PMCID: PMC8461570 DOI: 10.1056/nejmoa2110345] [Citation(s) in RCA: 853] [Impact Index Per Article: 284.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND BNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA vaccine encoding a prefusion-stabilized, membrane-anchored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) full-length spike protein. BNT162b2 is highly efficacious against coronavirus disease 2019 (Covid-19) and is currently approved, conditionally approved, or authorized for emergency use worldwide. At the time of initial authorization, data beyond 2 months after vaccination were unavailable. METHODS In an ongoing, placebo-controlled, observer-blinded, multinational, pivotal efficacy trial, we randomly assigned 44,165 participants 16 years of age or older and 2264 participants 12 to 15 years of age to receive two 30-μg doses, at 21 days apart, of BNT162b2 or placebo. The trial end points were vaccine efficacy against laboratory-confirmed Covid-19 and safety, which were both evaluated through 6 months after vaccination. RESULTS BNT162b2 continued to be safe and have an acceptable adverse-event profile. Few participants had adverse events leading to withdrawal from the trial. Vaccine efficacy against Covid-19 was 91.3% (95% confidence interval [CI], 89.0 to 93.2) through 6 months of follow-up among the participants without evidence of previous SARS-CoV-2 infection who could be evaluated. There was a gradual decline in vaccine efficacy. Vaccine efficacy of 86 to 100% was seen across countries and in populations with diverse ages, sexes, race or ethnic groups, and risk factors for Covid-19 among participants without evidence of previous infection with SARS-CoV-2. Vaccine efficacy against severe disease was 96.7% (95% CI, 80.3 to 99.9). In South Africa, where the SARS-CoV-2 variant of concern B.1.351 (or beta) was predominant, a vaccine efficacy of 100% (95% CI, 53.5 to 100) was observed. CONCLUSIONS Through 6 months of follow-up and despite a gradual decline in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing Covid-19. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.).
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Affiliation(s)
- Stephen J Thomas
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Edson D Moreira
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Nicholas Kitchin
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Judith Absalon
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Alejandra Gurtman
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Stephen Lockhart
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - John L Perez
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Gonzalo Pérez Marc
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Fernando P Polack
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Cristiano Zerbini
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Ruth Bailey
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Kena A Swanson
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Xia Xu
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Satrajit Roychoudhury
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Kenneth Koury
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Salim Bouguermouh
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Warren V Kalina
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - David Cooper
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Robert W Frenck
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Laura L Hammitt
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Özlem Türeci
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Haylene Nell
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Axel Schaefer
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Serhat Ünal
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Qi Yang
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Paul Liberator
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Dina B Tresnan
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Susan Mather
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Philip R Dormitzer
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Uğur Şahin
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - William C Gruber
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
| | - Kathrin U Jansen
- From the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (J.A., A.G., K.A.S., K.K., S.B., W.V.K., D.C., Q.Y., P.L., P.R.D., W.C.G., K.U.J.) - both in New York; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Bahia (E.D.M.), and iTrials-Hospital Militar Central (G.P.M.) and Fundacion INFANT, Buenos Aires (F.P.P.) - all in Brazil; Centro Paulista de Investigação Clinica, São Paulo (C.Z.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (N.K., S.L., R.B.); Vaccine Research and Development (J.L.P., X.X.) and Worldwide Safety, Safety Surveillance, and Risk Management (D.B.T., S.M.), Pfizer, Collegeville, PA; Global Product Development, Pfizer, Peapack, NJ (S.R.); Cincinnati Children's Hospital, Cincinnati (R.W.F.); Johns Hopkins Bloomberg School of Public Health, Baltimore (L.L.H.); BioNTech, Mainz (Ö.T., U.Ş.) and Medizentrum Essen Borbeck, Essen (A.S.) - both in Germany; Tiervlei Trial Centre, Karl Bremer Hospital, Cape Town, South Africa (H.N.); Hacettepe University, Ankara, Turkey (S.Ü.); and Worldwide Safety, Safety Surveillance, and Risk Management, Pfizer, Groton, CT (D.B.T., S.M.)
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Moore DP, Baillie VL, Mudau A, Wadula J, Adams T, Mangera S, Verwey C, Prosperi C, Higdon MM, Haddix M, Hammitt LL, Feikin DR, O’Brien KL, Deloria Knoll M, Murdoch DR, Simões EA, Madhi SA. The Etiology of Pneumonia in HIV-uninfected South African Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S59-S68. [PMID: 34448745 PMCID: PMC8448398 DOI: 10.1097/inf.0000000000002650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pneumonia is the major contributor to under 5 childhood mortality globally. We evaluated the etiology of pneumonia amongst HIV-uninfected South African children enrolled into the Pneumonia Etiology Research for Child Health case-control study. METHODS Cases, 1-59 months of age hospitalized with World Health Organization clinically defined severe/very severe pneumonia, were frequency-matched by age and season to community controls. Nasopharyngeal-oropharyngeal swabs were analyzed using polymerase chain reaction for 33 respiratory pathogens, and whole blood was tested for pneumococcal autolysin. Cases were also tested for Mycobacterium tuberculosis. Population etiologic fractions (EF) of pneumonia with radiologic evidence of consolidation/infiltrate were derived for each pathogen through Bayesian analysis. RESULTS Of the 805 HIV-uninfected cases enrolled based on clinical criteria, radiologically confirmed pneumonia was evident in 165 HIV-exposed, -uninfected, and 246 HIV-unexposed children. In HIV-exposed and HIV-unexposed children, respiratory syncytial virus was the most important pathogen with EFs of 31.6% [95% credible interval (CrI), 24.8%-38.8%] and 36.4% (95% CrI, 30.5%-43.1%), respectively. M. tuberculosis contributed EFs of 11.6% (95% CrI, 6.1%-18.8%) in HIV-exposed and 8.3% (95% CrI, 4.5%-13.8%) in HIV-unexposed children, including an EF of 16.3% (95% CrI, 6.1%-33.3%) in HIV-exposed children ≥12 months of age. Bacteremia (3.0% vs. 1.6%) and case fatality risk (3.6% vs. 3.7%) were similar in HIV-exposed and HIV-unexposed children. CONCLUSIONS Vaccination strategies targeting respiratory syncytial virus should be prioritized for prevention of pneumonia in children. Furthermore, interventions are required to address the high burden of tuberculosis in the pathogenesis of acute community-acquired pneumonia in settings such as ours.
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Affiliation(s)
- David P. Moore
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, South Africa
| | - Vicky L. Baillie
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azwifarwi Mudau
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- Department of Clinical Microbiology and Infectious Diseases, Chris Hani Baragwanath Academic Hospital, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Tanja Adams
- Department of Clinical Microbiology and Infectious Diseases, Chris Hani Baragwanath Academic Hospital, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Shafeeka Mangera
- Department of Clinical Microbiology and Infectious Diseases, Chris Hani Baragwanath Academic Hospital, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, South Africa
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Eric A.F. Simões
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Pediatrics, University of Colorado School of Medicine and Center for Global Health, Colorado School of Public Health, Aurora, CO
| | - Shabir A. Madhi
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Seidenberg P, Mwananyanda L, Chipeta J, Kwenda G, Mulindwa JM, Mwansa J, Mwenechanya M, Wa Somwe S, Feikin DR, Haddix M, Hammitt LL, Higdon MM, Murdoch DR, Prosperi C, O’Brien KL, Deloria Knoll M, Thea DM. The Etiology of Pneumonia in HIV-infected Zambian Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S50-S58. [PMID: 34448744 PMCID: PMC8448411 DOI: 10.1097/inf.0000000000002649] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite recent declines in new pediatric HIV infections and childhood HIV-related deaths, pneumonia remains the leading cause of death in HIV-infected children under 5. We describe the patient population, etiology and outcomes of childhood pneumonia in Zambian HIV-infected children. METHODS As one of the 9 sites for the Pneumonia Etiology Research for Child Health study, we enrolled children 1-59 months of age presenting to University Teaching Hospital in Lusaka, Zambia, with World Health Organization-defined severe and very severe pneumonia. Controls frequency-matched on age group and HIV infection status were enrolled from the Lusaka Pediatric HIV Clinics as well as from the surrounding communities. Clinical assessments, chest radiographs (CXR; cases) and microbiologic samples (nasopharyngeal/oropharyngeal swabs, blood, urine, induced sputum) were obtained under highly standardized procedures. Etiology was estimated using Bayesian methods and accounted for imperfect sensitivity and specificity of measurements. RESULTS Of the 617 cases and 686 controls enrolled in Zambia over a 24-month period, 103 cases (16.7%) and 85 controls (12.4%) were HIV infected and included in this analysis. Among the HIV-infected cases, 75% were <1 year of age, 35% received prophylactic trimethoprim-sulfamethoxazole, 13.6% received antiretroviral therapy and 36.9% of caregivers reported knowing their children's HIV status at time of enrollment. A total of 35% of cases had very severe pneumonia and 56.3% had infiltrates on CXR. Bacterial pathogens [50.6%, credible interval (CrI): 32.8-67.2], Pneumocystis jirovecii (24.9%, CrI: 15.5-36.2) and Mycobacterium tuberculosis (4.5%, CrI: 1.7-12.1) accounted for over 75% of the etiologic fraction among CXR-positive cases. Streptococcus pneumoniae (19.8%, CrI: 8.6-36.2) was the most common bacterial pathogen, followed by Staphylococcus aureus (12.7%, CrI: 0.0-25.9). Outcomes were poor, with 41 cases (39.8%) dying in hospital. CONCLUSIONS HIV-infected children in Zambia with severe and very severe pneumonia have poor outcomes, with continued limited access to care, and the predominant etiologies are bacterial pathogens, P. jirovecii and M. tuberculosis.
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Affiliation(s)
- Phil Seidenberg
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Lawrence Mwananyanda
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Right To Care-Zambia, Lusaka, Zambia
| | - James Chipeta
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Justin M. Mulindwa
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - James Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- Department of Microbiology, Lusaka Apex Medical University, Lusaka, Zambia
| | - Musaku Mwenechanya
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Somwe Wa Somwe
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Donald M. Thea
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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Brooks WA, Zaman K, Goswami D, Prosperi C, Endtz HP, Hossain L, Rahman M, Ahmed D, Rahman MZ, Banu S, Shikder AU, Jahan Y, Nahar K, Chisti MJ, Yunus M, Khan MA, Matin FB, Mazumder R, Shahriar Bin Elahi M, Saifullah M, Alam M, Bin Shahid ASMS, Haque F, Sultana S, Higdon MM, Haddix M, Feikin DR, Murdoch DR, Hammitt LL, O’Brien KL, Deloria Knoll M. The Etiology of Childhood Pneumonia in Bangladesh: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S79-S90. [PMID: 34448747 PMCID: PMC8448409 DOI: 10.1097/inf.0000000000002648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pneumonia remains the leading infectious cause of death among children <5 years, but its cause in most children is unknown. We estimated etiology for each child in 2 Bangladesh sites that represent rural and urban South Asian settings with moderate child mortality. METHODS As part of the Pneumonia Etiology Research for Child Health study, we enrolled children 1-59 months of age with World Health Organization-defined severe and very severe pneumonia, plus age-frequency-matched controls, in Matlab and Dhaka, Bangladesh. We applied microbiologic methods to nasopharyngeal/oropharyngeal swabs, blood, induced sputum, gastric and lung aspirates. Etiology was estimated using Bayesian methods that integrated case and control data and accounted for imperfect sensitivity and specificity of the measurements. RESULTS We enrolled 525 cases and 772 controls over 24 months. Of the cases, 9.1% had very severe pneumonia and 42.0% (N = 219) had infiltrates on chest radiograph. Three cases (1.5%) had positive blood cultures (2 Salmonella typhi, 1 Escherichia coli and Klebsiella pneumoniae). All 4 lung aspirates were negative. The etiology among chest radiograph-positive cases was predominantly viral [77.7%, 95% credible interval (CrI): 65.3-88.6], primarily respiratory syncytial virus (31.2%, 95% CrI: 24.7-39.3). Influenza virus had very low estimated etiology (0.6%, 95% CrI: 0.0-2.3). Mycobacterium tuberculosis (3.6%, 95% CrI: 0.5-11.0), Enterobacteriaceae (3.0%, 95% CrI: 0.5-10.0) and Streptococcus pneumoniae (1.8%, 95% CrI: 0.0-5.9) were the only nonviral pathogens in the top 10 etiologies. CONCLUSIONS Childhood severe and very severe pneumonia in young children in Bangladesh is predominantly viral, notably respiratory syncytial virus.
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Affiliation(s)
- W. Abdullah Brooks
- From the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hubert P. Endtz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Department of Clinical Microbiology & Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Fondation Mérieux, Lyon, France
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mustafizur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mohammed Ziaur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Arif Uddin Shikder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Mohammed Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | | | - Razib Mazumder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Muhammad Saifullah
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Muntasir Alam
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Fahim Haque
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabiha Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Hammitt LL, Vigil DE, Reid R. Tribal Sovereignty in Research and Community Engagement for a COVID-19 Vaccine Clinical Trial on the Navajo Nation: Beyond a Facebook Town Hall. Am J Public Health 2021; 111:1431-1432. [PMID: 34464194 DOI: 10.2105/ajph.2021.306400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Laura L Hammitt
- Laura L. Hammitt and Raymond Reid (Diné) are with the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Shiprock, NM. Deionna E. Vigil (Nanbé Ówîngeh) is with the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Chinle, AZ
| | - Deionna E Vigil
- Laura L. Hammitt and Raymond Reid (Diné) are with the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Shiprock, NM. Deionna E. Vigil (Nanbé Ówîngeh) is with the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Chinle, AZ
| | - Raymond Reid
- Laura L. Hammitt and Raymond Reid (Diné) are with the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Shiprock, NM. Deionna E. Vigil (Nanbé Ówîngeh) is with the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Chinle, AZ
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38
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Howie SRC, Ebruke BE, McLellan JL, Deloria Knoll M, Dione MM, Feikin DR, Haddix M, Hammitt LL, Machuka EM, Murdoch DR, O’Brien KL, Ofordile O, Olutunde OE, Parker D, Prosperi C, Salaudeen RA, Shamsul A, Mackenzie G, Antonio M, Zaman SMA. The Etiology of Childhood Pneumonia in The Gambia: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S7-S17. [PMID: 34448740 PMCID: PMC8448408 DOI: 10.1097/inf.0000000000002766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumonia remains the leading cause of death in young children globally. The changing epidemiology of pneumonia requires up-to-date data to guide both case management and prevention programs. The Gambia study site contributed a high child mortality, high pneumonia incidence, low HIV prevalence, Haemophilus influenzae type b and pneumococcal conjugate vaccines-vaccinated rural West African setting to the Pneumonia Etiology Research for Child Health (PERCH) Study. METHODS The PERCH study was a 7-country case-control study of the etiology of hospitalized severe pneumonia in children 1-59 months of age in low and middle-income countries. Culture and nucleic acid detection methods were used to test nasopharyngeal/oropharyngeal swabs, blood, induced sputum and, in selected cases, lung or pleural fluid aspirates. Etiology was determined by integrating case and control data from multiple specimens using the PERCH integrated analysis based on Bayesian probabilistic methods. RESULTS At The Gambia study site, 638 cases of World Health Organization-defined severe and very severe pneumonia (286 of which were chest radiograph [CXR]-positive and HIV-negative) and 654 age-frequency matched controls were enrolled. Viral causes predominated overall (viral 58% vs. bacterial 28%), and of CXR-positive cases respiratory syncytial virus (RSV) accounted for 37%, Streptococcus pneumoniae 13% and parainfluenza was responsible for 9%. Nevertheless, among very severe cases bacterial causes dominated (77% bacterial vs. 11% viral), led by S. pneumoniae (41%); Mycobacterium tuberculosis, not included in "bacterial", accounted for 9%. 93% and 80% of controls ≥1 year of age were, respectively, fully vaccinated for age against Haemophilus influenzae and S. pneumoniae. CONCLUSIONS Viral causes, notably RSV, predominated in The Gambia overall, but bacterial causes dominated the severest cases. Efforts must continue to prevent disease by optimizing access to existing vaccines, and to develop new vaccines, notably against RSV. A continued emphasis on appropriate case management of severe pneumonia remains important.
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Affiliation(s)
- Stephen R. C. Howie
- From the Medical Research Council Unit, Basse, The Gambia
- Department of Paediatrics, University of Auckland, New Zealand
| | | | - Jessica L. McLellan
- From the Medical Research Council Unit, Basse, The Gambia
- The University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michel M. Dione
- From the Medical Research Council Unit, Basse, The Gambia
- International Livestock Research Institute, Kampala, Uganda
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - David Parker
- From the Medical Research Council Unit, Basse, The Gambia
- AstraZeneca, Cambridge, United Kingdom
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rasheed A. Salaudeen
- From the Medical Research Council Unit, Basse, The Gambia
- Medical Microbiology Department, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Arifin Shamsul
- From the Medical Research Council Unit, Basse, The Gambia
| | - Grant Mackenzie
- From the Medical Research Council Unit, Basse, The Gambia
- Murdoch Children’s Research Institute, Melbourne, Australia
- London School of Hygiene & Tropical Medicine
| | - Martin Antonio
- From the Medical Research Council Unit, Basse, The Gambia
- Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Syed M. A. Zaman
- From the Medical Research Council Unit, Basse, The Gambia
- London School of Hygiene & Tropical Medicine
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Awori JO, Kamau A, Morpeth S, Kazungu S, Silaba M, Sande J, Karani A, Nyongesa S, Mwarumba S, Musyimi R, Bett A, Wande S, Shebe M, Ngama M, Munywoki PK, Muturi N, Nokes DJ, Feikin DR, Murdoch DR, Prosperi C, O’Brien KL, Deloria Knoll M, Hammitt LL, Scott JAG. The Etiology of Pneumonia in HIV-uninfected Children in Kilifi, Kenya: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S29-S39. [PMID: 34448742 PMCID: PMC8448399 DOI: 10.1097/inf.0000000000002653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In the 1980s, Streptococcus pneumoniae and Haemophilus influenzae were identified as the principal causes of severe pneumonia in children. We investigated the etiology of severe childhood pneumonia in Kenya after introduction of conjugate vaccines against H. influenzae type b, in 2001, and S. pneumoniae, in 2011. METHODS We conducted a case-control study between August 2011 and November 2013 among residents of the Kilifi Health and Demographic Surveillance System 28 days to 59 months of age. Cases were hospitalized at Kilifi County Hospital with severe or very severe pneumonia according to the 2005 World Health Organization definition. Controls were randomly selected from the community and frequency matched to cases on age and season. We tested nasal and oropharyngeal samples, sputum, pleural fluid, and blood specimens and used the Pneumonia Etiology Research for Child Health Integrated Analysis, combining latent class analysis and Bayesian methods, to attribute etiology. RESULTS We enrolled 630 and 863 HIV-uninfected cases and controls, respectively. Among the cases, 282 (44%) had abnormal chest radiographs (CXR positive), 33 (5%) died in hospital, and 177 (28%) had diagnoses other than pneumonia at discharge. Among CXR-positive pneumonia cases, viruses and bacteria accounted for 77% (95% CrI: 67%-85%) and 16% (95% CrI: 10%-26%) of pneumonia attribution, respectively. Respiratory syncytial virus, S. pneumoniae and H. influenza, accounted for 37% (95% CrI: 31%-44%), 5% (95% CrI: 3%-9%), and 6% (95% CrI: 2%-11%), respectively. CONCLUSIONS Respiratory syncytial virus was the main cause of CXR-positive pneumonia. The small contribution of H. influenzae type b and pneumococcus to pneumonia may reflect the impact of vaccine introductions in this population.
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Affiliation(s)
- Juliet O. Awori
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alice Kamau
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Susan Morpeth
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Sidi Kazungu
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Micah Silaba
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | | | - Angela Karani
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Sammy Nyongesa
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Salim Mwarumba
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Robert Musyimi
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Anne Bett
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Siti Wande
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Mohammed Shebe
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Mwanajuma Ngama
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Patrick K. Munywoki
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Neema Muturi
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - D. James Nokes
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- School of Life Sciences and WIDER, University of Warwick, Coventry, United Kingdom
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - J. Anthony G. Scott
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Nuffield Department of Tropical Medicine, Oxford University, Oxford, United Kingdom
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40
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Tapia MD, Sylla M, Driscoll AJ, Touré A, Kourouma N, Sissoko S, Tamboura B, Diakité AA, Panchalingam S, Keïta AM, Tennant S, Onwuchekwa U, Roose A, Deloria Knoll M, Higdon MM, Prosperi C, Hammitt LL, Feikin DR, Murdoch DR, O’Brien KL, Sow SO, Kotloff KL. The Etiology of Childhood Pneumonia in Mali: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S18-S28. [PMID: 34448741 PMCID: PMC8448406 DOI: 10.1097/inf.0000000000002767] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We present findings from the Pneumonia Etiology Research for Child Health (PERCH) site in Bamako, Mali. METHODS Cases were patients 28 days to 59 months of age, admitted to hospital with severe or very severe pneumonia (2005 World Health Organization definition). Community controls were frequency matched by age. Both provided nasopharyngeal and oropharyngeal swabs for multiplex polymerase chain reaction and Streptococcus pneumoniae culture. Cases underwent blood culture and induced sputum culture for Mycobacterium tuberculosis. A subset had pleural fluid and lung aspirates collected for culture and polymerase chain reaction. Primary analyses included participants with negative or unknown HIV status (HIV-) and cases with abnormal chest radiographs (CXR+). Cases and controls were compared using logistic regression adjusting for age. Etiologic fractions were calculated by a Bayesian nested partially latent class analysis, the PERCH integrated analysis. RESULTS Between January 1, 2012, and January 14, 2014, we enrolled 241 CXR+/HIV- cases and 725 HIV- controls. Compared with controls, cases were more likely to have moderate-to-severe wasting (43.1% vs. 14.1%, P < 0.001) and stunting (26.6% vs. 9.4%, P < 0.001). Predominant etiologies were respiratory syncytial virus [24.0%; 95% credible interval (CrI): 18.3%-31.1%], S. pneumoniae (15.2%; 95% CrI: 9.5-21.6), human metapneumovirus (11.8%; 95% CrI: 8.3%-16.2%) and parainfluenza virus type 3 (9.0%; 95% CrI: 5.8%-13.3%). Case fatality was 13.3%, with Staphylococcus aureus, Pneumocystis jirovecii and Haemophilus influenzae type b predominating (40% of fatal cases). CONCLUSIONS PERCH uncovered high case fatality among children with severe pneumonia in Mali, highlighting a role for new interventions (eg, respiratory syncytial virus vaccines) and a need to improve vaccine coverage and strengthen healthcare delivery.
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Affiliation(s)
- Milagritos D. Tapia
- From the Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mamadou Sylla
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Amanda J. Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aliou Touré
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Nana Kourouma
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Seydou Sissoko
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | | | | | - Sandra Panchalingam
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Adama M. Keïta
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Sharon Tennant
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Anna Roose
- From the Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Samba O. Sow
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Karen L. Kotloff
- From the Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
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Mwananyanda L, Thea DM, Chipeta J, Kwenda G, Mulindwa JM, Mwenechanya M, Prosperi C, Higdon MM, Haddix M, Hammitt LL, Feikin DR, Murdoch DR, O’Brien KL, Deloria Knoll M, Mwansa J, Wa Somwe S, Seidenberg P. The Etiology of Pneumonia in Zambian Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S40-S49. [PMID: 34448743 PMCID: PMC8448410 DOI: 10.1097/inf.0000000000002652] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Childhood pneumonia in developing countries is the foremost cause of morbidity and death. Fresh information on etiology is needed, considering the changing epidemiology of pneumonia in the setting of greater availability of effective vaccines, changing antibiotic use and improved access to care. We report here the Zambia site results of the Pneumonia Etiology Research for Child Health study on the etiology of pneumonia among HIV-uninfected children in Lusaka, Zambia. METHODS We conducted a case-control study of HIV-uninfected children age 1-59 months admitted with World Health Organization-defined severe or very severe pneumonia to a large tertiary care hospital in Lusaka. History, physical examination, chest radiographs (CXRs), blood cultures and nasopharyngeal/oropharyngeal swabs were obtained and tested by polymerase chain reaction and routine microbiology for the presence of 30 bacteria and viruses. From age and seasonally matched controls, we tested blood and nasopharyngeal/oropharyngeal samples. We used the Pneumonia Etiology Research for Child Health integrated analysis to determine the individual and population etiologic fraction for individual pathogens as the cause of pneumonia. RESULTS Among the 514 HIV-uninfected case children, 208 (40.5%) had abnormal CXRs (61 of 514 children were missing CXR), 8 (3.8%) of which had positive blood cultures. The overall mortality was 16.0% (82 deaths). The etiologic fraction was highest for respiratory syncytial virus [26.1%, 95% credible interval (CrI): 17.0-37.7], Mycobacterium tuberculosis (12.8%, 95% CrI: 4.3-25.3) and human metapneumovirus (12.8%, CrI: 6.1-21.8). CONCLUSIONS Childhood pneumonia in Zambia among HIV-uninfected children is most frequently caused by respiratory syncytial virus, M. tuberculosis and human metapneumovirus, and the mortality remains high.
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Affiliation(s)
- Lawrence Mwananyanda
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Right To Care-Zambia, Lusaka, Zambia
| | - Donald M. Thea
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - James Chipeta
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Justin M. Mulindwa
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Musaku Mwenechanya
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology and Biomedical Sciences, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- Department of Microbiology, Lusaka Apex Medical University, Lusaka, Zambia
| | - Somwe Wa Somwe
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Phil Seidenberg
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
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42
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Bunthi C, Rhodes J, Thamthitiwat S, Higdon MM, Chuananon S, Amorninthapichet T, Paveenkittiporn W, Chittaganpitch M, Sawatwong P, Hammitt LL, Feikin DR, Murdoch DR, Deloria-Knoll M, O’Brien KL, Prosperi C, Maloney SA, Baggett HC, Akarasewi P. Etiology and Clinical Characteristics of Severe Pneumonia Among Young Children in Thailand: Pneumonia Etiology Research for Child Health (PERCH) Case-Control Study Findings, 2012-2013. Pediatr Infect Dis J 2021; 40:S91-S100. [PMID: 34448748 PMCID: PMC8448397 DOI: 10.1097/inf.0000000000002768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pneumonia remains the leading cause of death among children <5 years of age beyond the neonatal period in Thailand. Using data from the Pneumonia Etiology Research for Child Health (PERCH) Study, we provide a detailed description of pneumonia cases and etiology in Thailand to inform local treatment and prevention strategies in this age group. METHODS PERCH, a multi-country case-control study, evaluated the etiology of hospitalized cases of severe and very severe pneumonia among children 1-59 months of age. The Thailand site enrolled children for 24 consecutive months during January 2012-February 2014 with staggered start dates in 2 provinces. Cases were children hospitalized with pre-2013 WHO-defined severe or very severe pneumonia. Community controls were randomly selected from health services registries in each province. Analyses were restricted to HIV-negative cases and controls. We calculated adjusted odds ratios (ORs) and 95% CIs comparing organism prevalence detected by nasopharyngeal/oropharyngeal (NP/OP) polymerase chain reaction between cases and controls. The PERCH Integrated Analysis (PIA) used Bayesian latent variable analysis to estimate pathogen-specific etiologic fractions and 95% credible intervals. RESULTS Over 96% of both cases (n = 223) and controls (n = 659) had at least 1 organism detected; multiple organisms were detected in 86% of cases and 88% of controls. Among 98 chest Radiograph positive (CXR+) cases, respiratory syncytial virus (RSV) had the highest NP/OP prevalence (22.9%) and the strongest association with case status (OR 20.5; 95% CI: 10.2, 41.3) and accounted for 34.6% of the total etiologic fraction. Tuberculosis (TB) accounted for 10% (95% CrI: 1.6-26%) of the etiologic fraction among CXR+ cases. DISCUSSION More than one-third of hospitalized cases of severe and very severe CXR+ pneumonia among children 1-59 months of age in Thailand were attributable to RSV. TB accounted for 10% of cases, supporting evaluation for TB among children hospitalized with pneumonia in high-burden settings. Similarities in pneumonia etiology in Thailand and other PERCH sites suggest that global control strategies based on PERCH study findings are relevant to Thailand and similar settings.
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Affiliation(s)
- Charatdao Bunthi
- From the Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Julia Rhodes
- From the Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- From the Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Pongpun Sawatwong
- From the Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Maria Deloria-Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan A. Maloney
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Henry C. Baggett
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - Pasakorn Akarasewi
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
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Deloria Knoll M, Prosperi C, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, Howie SR, Kotloff KL, Madhi SA, Murdoch DR, Scott JAG, Thea DM, O’Brien KL. Introduction to the Site-specific Etiologic Results From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S1-S6. [PMID: 34448739 PMCID: PMC8448396 DOI: 10.1097/inf.0000000000002778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
The Pneumonia Etiology Research for Child Health (PERCH) study evaluated the etiology of severe and very severe pneumonia in children hospitalized in 7 African and Asian countries. Here, we summarize the highlights of in-depth site-specific etiology analyses published separately in this issue, including how etiology varies by age, mortality status, malnutrition, severity, HIV status, and more. These site-specific results impart important lessons that can inform disease control policy implications.
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Affiliation(s)
- Maria Deloria Knoll
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Prosperi
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Henry C. Baggett
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W. Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh
| | - Daniel R. Feikin
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Kenya Medical Research Institute—Wellcome Trust Research Programme, Kilifi, Kenya
| | - Stephen R.C. Howie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Basse, The Gambia
- Department of Paediatrics University of Auckland, New Zealand
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - J. Anthony G. Scott
- Kenya Medical Research Institute—Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Donald M. Thea
- Department of Global Health and Development, Boston University School of Public Health, Boston, Massachusetts
| | - Katherine L. O’Brien
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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44
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Moore DP, Baillie VL, Mudau A, Wadula J, Adams T, Mangera S, Verwey C, Sipambo N, Liberty A, Prosperi C, Higdon MM, Haddix M, Hammitt LL, Feikin DR, O’Brien KL, Deloria Knoll M, Murdoch DR, Simões EAF, Madhi SA. The Etiology of Pneumonia in HIV-1-infected South African Children in the Era of Antiretroviral Treatment: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S69-S78. [PMID: 34448746 PMCID: PMC8448402 DOI: 10.1097/inf.0000000000002651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND HIV-1 infection predisposes to an increased burden of pneumonia caused by community-acquired and opportunistic pathogens. METHODS Within the context of the Pneumonia Etiology Research for Child Health case-control study of under 5 pneumonia, we investigated the etiology of World Health Organization-defined severe/very severe pneumonia requiring hospitalization in South African HIV-infected children. Nasopharyngeal-oropharyngeal swabs and blood, collected from cases and age- and season-matched HIV-infected controls attending outpatient antiretroviral therapy (ART) clinics, were analyzed using molecular diagnostic methods. Cases were also investigated for tuberculosis. Etiologic fractions among cases with radiologically confirmed pneumonia were derived using Bayesian analytic techniques. RESULTS Of 115 HIV-infected cases, 89 (77.4%) had radiologically confirmed pneumonia. Severe immunosuppression (adjusted odds ratio, 32.60; 95% confidence interval, 7.25-146.64) was significantly associated with radiologically confirmed pneumonia. Cotrimoxazole prophylaxis (46.4% vs. 77.4%) and ART (28.2% vs. 83.1%) coverage were significantly lower in cases compared with ART-clinic controls. An etiologic agent was identified in 99.0% of the radiologically confirmed cases. The 'top 4' pathogens associated with radiologically confirmed pneumonia were Pneumocystis jirovecii [23.0%; 95% credible interval (CrI), 12.4%-31.5%], Staphylococcus aureus (10.6%; 95% CrI, 2.2%-20.2%), pneumococcus (9.5%; 95% CrI, 2.2%-18.0%) and respiratory syncytial virus (9.3%; 95% CrI, 2.2%-14.6%). Bacteremia (6.7%) and in-hospital death (10.1%) were frequent among those with radiologically confirmed disease. CONCLUSIONS Pneumocystis jirovecii, S. aureus, pneumococcus and respiratory syncytial virus contribute a considerable burden of radiologically confirmed pneumonia in South African HIV-infected children under 5 years. Expediting access to ART and cotrimoxazole prophylaxis would decrease the burden of pneumonia in these children.
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Affiliation(s)
- David P. Moore
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L. Baillie
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azwifarwi Mudau
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- Department of Clinical Microbiology and Infectious Diseases, Chris Hani Baragwanath Academic Hospital, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Tanja Adams
- Department of Clinical Microbiology and Infectious Diseases, Chris Hani Baragwanath Academic Hospital, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Shafeeka Mangera
- Department of Clinical Microbiology and Infectious Diseases, Chris Hani Baragwanath Academic Hospital, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Nosisa Sipambo
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Eric A. F. Simões
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Pediatrics, University of Colorado School of Medicine and Center for Global Health, Colorado School of Public Health, Aurora, CO
| | - Shabir A. Madhi
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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45
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Hammitt LL. Invasive Haemophilus influenzae Type a Disease: An Unmet Health Need. Clin Infect Dis 2021; 73:e287-e289. [PMID: 32531015 DOI: 10.1093/cid/ciaa756] [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: 05/29/2020] [Accepted: 06/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura L Hammitt
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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46
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Baillie VL, Moore DP, Mathunjwa A, Baggett HC, Brooks A, Feikin DR, Hammitt LL, Howie SRC, Knoll MD, Kotloff KL, Levine OS, O’Brien KL, Scott AG, Thea DM, Antonio M, Awori JO, Driscoll AJ, Fancourt NSS, Higdon MM, Karron RA, Morpeth SC, Mulindwa JM, Murdoch DR, Park DE, Prosperi C, Rahman MZ, Rahman M, Salaudeen RA, Sawatwong P, Somwe SW, Sow SO, Tapia MD, Simões EAF, Madhi SA. Epidemiology of the Rhinovirus (RV) in African and Southeast Asian Children: A Case-Control Pneumonia Etiology Study. Viruses 2021; 13:v13071249. [PMID: 34198998 PMCID: PMC8310211 DOI: 10.3390/v13071249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/12/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Rhinovirus (RV) is commonly detected in asymptomatic children; hence, its pathogenicity during childhood pneumonia remains controversial. We evaluated RV epidemiology in HIV-uninfected children hospitalized with clinical pneumonia and among community controls. PERCH was a case-control study that enrolled children (1–59 months) hospitalized with severe and very severe pneumonia per World Health Organization clinical criteria and age-frequency-matched community controls in seven countries. Nasopharyngeal/oropharyngeal swabs were collected for all participants, combined, and tested for RV and 18 other respiratory viruses using the Fast Track multiplex real-time PCR assay. RV detection was more common among cases (24%) than controls (21%) (aOR = 1.5, 95%CI:1.3–1.6). This association was driven by the children aged 12–59 months, where 28% of cases vs. 18% of controls were RV-positive (aOR = 2.1, 95%CI:1.8–2.5). Wheezing was 1.8-fold (aOR 95%CI:1.4–2.2) more prevalent among pneumonia cases who were RV-positive vs. RV-negative. Of the RV-positive cases, 13% had a higher probability (>75%) that RV was the cause of their pneumonia based on the PERCH integrated etiology analysis; 99% of these cases occurred in children over 12 months in Bangladesh. RV was commonly identified in both cases and controls and was significantly associated with severe pneumonia status among children over 12 months of age, particularly those in Bangladesh. RV-positive pneumonia was associated with wheezing.
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Affiliation(s)
- Vicky L. Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
- Correspondence: ; Tel.: +27-(11)-9834283
| | - David P. Moore
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Azwifarwi Mathunjwa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Henry C. Baggett
- Division of Global Health Protection, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand; (H.C.B.); (P.S.)
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh; (M.Z.R.); (M.R.)
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
| | - Stephen R. C. Howie
- Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse 273, The Gambia; (S.R.C.H.); (M.A.); (R.A.S.)
- Department of Paediatrics: Child & Youth Health, University of Auckland, Park Rd, Auckland 1023, New Zealand
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Karen L. Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21205, USA; (K.L.K.); (M.D.T.)
| | - Orin S. Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Anthony G. Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Donald M. Thea
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Martin Antonio
- Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse 273, The Gambia; (S.R.C.H.); (M.A.); (R.A.S.)
- Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry CV4 7JJ, UK
| | - Juliet O. Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
| | - Amanda J. Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21205, USA
| | - Nicholas S. S. Fancourt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Ruth A. Karron
- Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Susan C. Morpeth
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland 1640, New Zealand
| | - Justin M. Mulindwa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka 50110, Zambia; (J.M.M.); (S.W.S.)
| | - David R. Murdoch
- Department of Pathology and Biomedical Sciences, University of Otago, Christchurch 8011, New Zealand;
- Microbiology Unit, Canterbury Health Laboratories, Christchurch 8140, New Zealand
| | - Daniel E. Park
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Milken Institute School of Public Health, Department of Epidemiology, George Washington University, Washington, DC 20052, USA
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Mohammed Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh; (M.Z.R.); (M.R.)
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh; (M.Z.R.); (M.R.)
| | - Rasheed A. Salaudeen
- Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse 273, The Gambia; (S.R.C.H.); (M.A.); (R.A.S.)
- Medical Microbiology Department, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Pongpun Sawatwong
- Division of Global Health Protection, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand; (H.C.B.); (P.S.)
| | - Somwe Wa Somwe
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka 50110, Zambia; (J.M.M.); (S.W.S.)
| | - Samba O. Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako 198, Mali;
| | - Milagritos D. Tapia
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21205, USA; (K.L.K.); (M.D.T.)
| | - Eric A. F. Simões
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Pediatrics, University of Colorado School of Medicine and Center for Global Health, Colorado School of Public Health, Aurora, CO 80309, USA
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
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Park DE, Higdon MM, Prosperi C, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, Howie SRC, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, O’Brien KL, Scott JAG, Thea DM, Antonio M, Awori JO, Baillie VL, Bunthi C, Kwenda G, Mackenzie GA, Moore DP, Morpeth SC, Mwananyanda L, Paveenkittiporn W, Ziaur Rahman M, Rahman M, Rhodes J, Sow SO, Tapia MD, Deloria Knoll M. Upper Respiratory Tract Co-detection of Human Endemic Coronaviruses and High-density Pneumococcus Associated With Increased Severity Among HIV-Uninfected Children Under 5 Years Old in the PERCH Study. Pediatr Infect Dis J 2021; 40:503-512. [PMID: 33883479 PMCID: PMC8104011 DOI: 10.1097/inf.0000000000003139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severity of viral respiratory illnesses can be increased with bacterial coinfection and can vary by sex, but influence of coinfection and sex on human endemic coronavirus (CoV) species, which generally cause mild to moderate respiratory illness, is unknown. We evaluated CoV and pneumococcal co-detection by sex in childhood pneumonia. METHODS In the 2011-2014 Pneumonia Etiology Research for Child Health study, nasopharyngeal and oropharyngeal (NP/OP) swabs and other samples were collected from 3981 children <5 years hospitalized with severe or very severe pneumonia in 7 countries. Severity by NP/OP detection status of CoV (NL63, 229E, OC43 or HKU1) and high-density (≥6.9 log10 copies/mL) pneumococcus (HDSpn) by real-time polymerase chain reaction was assessed by sex using logistic regression adjusted for age and site. RESULTS There were 43 (1.1%) CoV+/HDSpn+, 247 CoV+/HDSpn-, 449 CoV-/HDSpn+ and 3149 CoV-/HDSpn- cases with no significant difference in co-detection frequency by sex (range 51.2%-64.0% male, P = 0.06). More CoV+/HDSpn+ pneumonia was very severe compared with other groups for both males (13/22, 59.1% versus range 29.1%-34.7%, P = 0.04) and females (10/21, 47.6% versus 32.5%-43.5%, P = 0.009), but only male CoV+/HDSpn+ required supplemental oxygen more frequently (45.0% versus 20.6%-28.6%, P < 0.001) and had higher mortality (35.0% versus 5.3%-7.1%, P = 0.004) than other groups. For females with CoV+/HDSpn+, supplemental oxygen was 25.0% versus 24.8%-33.3% (P = 0.58) and mortality was 10.0% versus 9.2%-12.9% (P = 0.69). CONCLUSIONS Co-detection of endemic CoV and HDSpn was rare in children hospitalized with pneumonia, but associated with higher severity and mortality in males. Findings may warrant investigation of differences in severity by sex with co-detection of HDSpn and SARS-CoV-2.
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Affiliation(s)
- Daniel E. Park
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Melissa M. Higdon
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Prosperi
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Henry C. Baggett
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W. Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Daniel R. Feikin
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steve R. C. Howie
- Medical Research Council Unit, Basse, The Gambia
- Department of Paediatrics, University of Auckland, New Zealand
| | - Karen L. Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Orin S. Levine
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Bill & Melinda Gates Foundation, Seattle, Washington
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David R. Murdoch
- Department of Pathology and Biomedical Sciences, University of Otago
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L. O’Brien
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - J. Anthony G. Scott
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Donald M. Thea
- Department of Global Health and Development, Boston University School of Public Health, Boston, Massachusetts
| | - Martin Antonio
- Medical Research Council Unit, Basse, The Gambia
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Juliet O. Awori
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
| | - Vicky L. Baillie
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit
| | - Charatdao Bunthi
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Geoffrey Kwenda
- Right to Care-Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Grant A. Mackenzie
- Medical Research Council Unit, Basse, The Gambia
- Murdoch Children’s Research Institute, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of Melbourne, Australia
| | - David P. Moore
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, South Africa
| | - Susan C. Morpeth
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Lawrence Mwananyanda
- Department of Global Health and Development, Boston University School of Public Health, Boston, Massachusetts
- EQUIP-Zambia, Lusaka, Zambia
| | | | - Mohammed Ziaur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Mustafizur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Julia Rhodes
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Samba O. Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Maria Deloria Knoll
- From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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48
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Garcia Quesada M, Yang Y, Bennett JC, Hayford K, Zeger SL, Feikin DR, Peterson ME, Cohen AL, Almeida SCG, Ampofo K, Ang M, Bar-Zeev N, Bruce MG, Camilli R, Chanto Chacón G, Ciruela P, Cohen C, Corcoran M, Dagan R, De Wals P, Desmet S, Diawara I, Gierke R, Guevara M, Hammitt LL, Hilty M, Ho PL, Jayasinghe S, Kleynhans J, Kristinsson KG, Ladhani SN, McGeer A, Mwenda JM, Nuorti JP, Oishi K, Ricketson LJ, Sanz JC, Savrasova L, Setchanova LP, Smith A, Valentiner-Branth P, Valenzuela MT, van der Linden M, van Sorge NM, Varon E, Winje BA, Yildirim I, Zintgraff J, Knoll MD. Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the PSERENADE Project. Microorganisms 2021; 9:microorganisms9040738. [PMID: 33916227 PMCID: PMC8066874 DOI: 10.3390/microorganisms9040738] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.
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Affiliation(s)
| | - Yangyupei Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Julia C Bennett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Kyla Hayford
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Scott L Zeger
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - Meagan E Peterson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Adam L Cohen
- World Health Organization, 1202 Geneva, Switzerland
| | - Samanta C G Almeida
- Center of Bacteriology, National Laboratory for Meningitis and Pneumococcal Infections, Institute Adolfo Lutz (IAL), São Paulo 01246-902, Brazil
| | - Krow Ampofo
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
| | - Michelle Ang
- National Centre for Infectious Diseases, National Public Health Laboratory, Singapore 308442, Singapore
| | - Naor Bar-Zeev
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
| | - Michael G Bruce
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Arctic Investigations Program, Division of Preparedness and Emerging Infections, Anchorage, AK 99508, USA
| | - Romina Camilli
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
| | - Grettel Chanto Chacón
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Tres Ríos, 30301 Cartago, Costa Rica
| | - Pilar Ciruela
- CIBER Epidemiología y Salud Pública, (CIBERESP), 28029 Madrid, Spain
- Surveillance and Public Health Emergency Response, Public Health Agency of Catalonia, 08005 Barcelona, Spain
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, 2192 Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2000 Johannesburg, South Africa
| | - Mary Corcoran
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Temple Street, D01 YC76 Dublin 1, Ireland
| | - Ron Dagan
- Distinguished Professor of Pediatrics and Infectious Diseases, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Québec, QC G1V 0A6, Canada
| | - Stefanie Desmet
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
- National Reference Centre for Streptococcus Pneumoniae, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Idrissa Diawara
- Faculty of Sciences and Health Techniques, Mohammed VI University of Health Sciences (UM6SS) of Casablanca, 20250 Casablanca, Morocco
- National Reference Laboratory, Mohammed VI University of Health Sciences (UM6SS), 82403 Casablanca, Morocco
| | - Ryan Gierke
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Marcela Guevara
- CIBER Epidemiología y Salud Pública, (CIBERESP), 28029 Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, 31003 Pamplona, Spain
| | - Laura L Hammitt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Markus Hilty
- Swiss National Reference Centre for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, 3012 Bern, Switzerland
| | - Pak-Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Children's Hospital Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, 2192 Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2000 Johannesburg, South Africa
| | - Karl G Kristinsson
- Department of Clinical Microbiology, Landspitali-The National University Hospital, Hringbraut, 101 Reykjavik, Iceland
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London NW9 5EQ, UK
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network, and Department of Laboratory, Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, P.O. Box 06, Brazzaville, Congo
| | - J Pekka Nuorti
- Department of Health Security, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland
| | - Kazunori Oishi
- Toyama Institute of Health, Imizu, Toyama 939-0363, Japan
| | - Leah J Ricketson
- Department of Pediatrics, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Juan Carlos Sanz
- Laboratorio Regional de Salud Pública, Dirección General de Salud Pública, Comunidad de Madrid, 28053 Madrid, Spain
| | - Larisa Savrasova
- Centre for Disease Prevention and Control of Latvia, 1005 Riga, Latvia
- Doctoral Studies Department, Riga Stradinš University, 1007 Riga, Latvia
| | - Lena Petrova Setchanova
- Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Andrew Smith
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, NHS GG&C, Glasgow G4 0SF, UK
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow G2 3JZ, UK
| | - Palle Valentiner-Branth
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, DK-2300 Copenhagen S, Denmark
| | - Maria Teresa Valenzuela
- Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de Los Andes, 12455 Santiago, Chile
| | - Mark van der Linden
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Nina M van Sorge
- Medical Microbiology and Infection Prevention, Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Emmanuelle Varon
- National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Brita A Winje
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0456 Oslo, Norway
| | - Inci Yildirim
- Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, CT 06504, USA
| | - Jonathan Zintgraff
- Servicio de Bacteriología Clínica, Departamento de Bacteriología, INEI-ANLIS "Dr. Carlos G. Malbrán", C1282 AFF Buenos Aires, Argentina
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49
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Bennett JC, Hetrich MK, Garcia Quesada M, Sinkevitch JN, Deloria Knoll M, Feikin DR, Zeger SL, Kagucia EW, Cohen AL, Ampofo K, Brandileone MCC, Bruden D, Camilli R, Castilla J, Chan G, Cook H, Cornick JE, Dagan R, Dalby T, Danis K, de Miguel S, De Wals P, Desmet S, Georgakopoulou T, Gilkison C, Grgic-Vitek M, Hammitt LL, Hilty M, Ho PL, Jayasinghe S, Kellner JD, Kleynhans J, Knol MJ, Kozakova J, Kristinsson KG, Ladhani SN, MacDonald L, Mackenzie GA, Mad’arová L, McGeer A, Mereckiene J, Morfeldt E, Mungun T, Muñoz-Almagro C, Nuorti JP, Paragi M, Pilishvili T, Puentes R, Saha SK, Sahu Khan A, Savrasova L, Scott JA, Skoczyńska A, Suga S, van der Linden M, Verani JR, von Gottberg A, Winje BA, Yildirim I, Zerouali K, Hayford K. Changes in Invasive Pneumococcal Disease Caused by Streptococcus pneumoniae Serotype 1 Following Introduction of PCV10 and PCV13: Findings from the PSERENADE Project. Microorganisms 2021; 9:microorganisms9040696. [PMID: 33801760 PMCID: PMC8066231 DOI: 10.3390/microorganisms9040696] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Streptococcus pneumoniae serotype 1 (ST1) was an important cause of invasive pneumococcal disease (IPD) globally before the introduction of pneumococcal conjugate vaccines (PCVs) containing ST1 antigen. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project gathered ST1 IPD surveillance data from sites globally and aimed to estimate PCV10/13 impact on ST1 IPD incidence. We estimated ST1 IPD incidence rate ratios (IRRs) comparing the pre-PCV10/13 period to each post-PCV10/13 year by site using a Bayesian multi-level, mixed-effects Poisson regression and all-site IRRs using a linear mixed-effects regression (N = 45 sites). Following PCV10/13 introduction, the incidence rate (IR) of ST1 IPD declined among all ages. After six years of PCV10/13 use, the all-site IRR was 0.05 (95% credibility interval 0.04–0.06) for all ages, 0.05 (0.04–0.05) for <5 years of age, 0.08 (0.06–0.09) for 5–17 years, 0.06 (0.05–0.08) for 18–49 years, 0.06 (0.05–0.07) for 50–64 years, and 0.05 (0.04–0.06) for ≥65 years. PCV10/13 use in infant immunization programs was followed by a 95% reduction in ST1 IPD in all ages after approximately 6 years. Limited data availability from the highest ST1 disease burden countries using a 3 + 0 schedule constrains generalizability and data from these settings are needed.
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Affiliation(s)
- Julia C. Bennett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
- Correspondence: (J.C.B.); (M.D.K.)
| | - Marissa K. Hetrich
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
| | - Maria Garcia Quesada
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
| | - Jenna N. Sinkevitch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
| | - Maria Deloria Knoll
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
- Correspondence: (J.C.B.); (M.D.K.)
| | | | - Scott L. Zeger
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
| | - Eunice W. Kagucia
- KEMRI-Wellcome Trust Research Programme, Epidemiology and Demography Department, Centre for Geographic Medicine-Coast, P.O. Box 230-80108 Kilifi, Kenya; (E.W.K.); (J.A.S.)
| | - Adam L. Cohen
- World Health Organization, 1202 Geneva, Switzerland;
| | - Krow Ampofo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA;
| | - Maria-Cristina C. Brandileone
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo 01246-902, Brazil;
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK 99508, USA;
| | - Romina Camilli
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy;
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.C.); (C.M.-A.)
- Instituto de Salud Pública de Navarra—IdiSNA, 31003 Pamplona, Navarra, Spain
| | - Guanhao Chan
- Singapore Ministry of Health, Communicable Diseases Division, Singapore 308442, Singapore;
| | - Heather Cook
- Centre for Disease Control, Department of Health and Community Services, Darwin, NT 8000, Australia;
| | - Jennifer E. Cornick
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK;
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, P.O. Box 30096 Blantyre, Malawi
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 8410501 Beer-Sheva, Israel;
| | - Tine Dalby
- Bacteria, Parasites and Fungi, Statens Serum Institut, DK-2300 Copenhagen, Denmark;
| | - Kostas Danis
- Santé Publique France, the French National Public Health Agency, Saint Maurice CEDEX, 94415 Paris, France;
| | - Sara de Miguel
- Epidemiology Department, Dirección General de Salud Pública, 28009 Madrid, Spain;
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Québec, QC G1V 0A6, Canada;
| | - Stefanie Desmet
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium;
- National Reference Centre for Streptococcus Pneumoniae, University Hospitals Leuven, 3000 Leuven, Belgium
| | | | - Charlotte Gilkison
- Epidemiology Team, Institute of Environmental Science and Research, Porirua, Wellington 5240, New Zealand;
| | - Marta Grgic-Vitek
- Communicable Diseases Centre, National Institute of Public Health, 1000 Ljubljana, Slovenia;
| | - Laura L. Hammitt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
- KEMRI-Wellcome Trust Research Programme, Epidemiology and Demography Department, Centre for Geographic Medicine-Coast, P.O. Box 230-80108 Kilifi, Kenya; (E.W.K.); (J.A.S.)
| | - Markus Hilty
- Swiss National Reference Centre for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, 3012 Bern, Switzerland;
| | - Pak-Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China;
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia;
| | - James D. Kellner
- Department of Pediatrics, University of Calgary, and Alberta Health Services, Calgary, AB T3B 6A8, Canada;
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (J.K.); (A.v.G.)
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Mirjam J. Knol
- National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands;
| | - Jana Kozakova
- National Institute of Public Health (NIPH), 100 42 Praha, Czech Republic;
| | - Karl G. Kristinsson
- Department of Clinical Microbiology, Landspitali—The National University Hospital, Hringbraut, 101 Reykjavik, Iceland;
| | - Shamez N. Ladhani
- Immunisation and Countermeasures Division, Public Health England, London NW9 5EQ, UK;
| | | | - Grant A. Mackenzie
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK;
- Medical Research Council Unit the Gambia at London School of Hygiene & Tropical Medicine, P.O. Box 273 Banjul, The Gambia
- New Vaccines Group, Murdoch Children’s Research Institute, Parkville, Melbourne, VIC 3052, Australia
| | - Lucia Mad’arová
- National Reference Centre for Pneumococcal and Haemophilus Diseases, Regional Authority of Public Health, 975 56 Banská Bystrica, Slovakia;
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Jolita Mereckiene
- HSE Health Protection Surveillance Centre, Mountjoy, Dublin D01 A4A3, Ireland;
| | - Eva Morfeldt
- Department of Microbiology, Public Health Agency of Sweden, 171 82 Solna, Sweden;
| | - Tuya Mungun
- National Center of Communicable Diseases (NCCD), Ministry of Health, Bayanzurkh District, Ulaanbaatar 13336, Mongolia;
| | - Carmen Muñoz-Almagro
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.C.); (C.M.-A.)
- Medicine Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Molecular Microbiology Department, Hospital Sant Joan de Déu Research Institute, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - J. Pekka Nuorti
- Department of Health Security, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland;
- Health Sciences Unit, Faculty of Social Sciences, University of Tampere, 33100 Tampere, Finland
| | - Metka Paragi
- Centre for Medical Microbiology, National Laboratory of Health, Environment and Food, 2000 Maribor, Slovenia;
| | - Tamara Pilishvili
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (T.P.); (J.R.V.)
| | - Rodrigo Puentes
- Instituto de Salud Pública de Chile, Santiago 7780050, Santiago Metropolitan, Chile;
| | - Samir K. Saha
- Child Health Research Foundation, Dhaka 1207, Bangladesh;
| | | | - Larisa Savrasova
- Centre for Disease Prevention and Control of Latvia, 1005 Riga, Latvia;
- Doctoral Studies Department, Riga Stradinš University, 1007 Riga, Latvia
| | - J. Anthony Scott
- KEMRI-Wellcome Trust Research Programme, Epidemiology and Demography Department, Centre for Geographic Medicine-Coast, P.O. Box 230-80108 Kilifi, Kenya; (E.W.K.); (J.A.S.)
| | - Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, 00-725 Warsaw, Poland;
| | - Shigeru Suga
- Infectious Disease Center and Department of Clinical Research, National Hospital Organization Mie Hospital, Tsu, Mie 514-0125, Japan;
| | - Mark van der Linden
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Jennifer R. Verani
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (T.P.); (J.R.V.)
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), P.O. Box 606-00621 Nairobi, Kenya
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (J.K.); (A.v.G.)
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg 2000, South Africa
| | - Brita A. Winje
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0456 Oslo, Norway;
| | - Inci Yildirim
- Department of Pediatrics, Yale New Haven Children’s Hospital, New Haven, CT 06504, USA;
| | - Khalid Zerouali
- Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca 20250, Morocco;
- Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca 20000, Morocco
| | - Kyla Hayford
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.K.H.); (M.G.Q.); (J.N.S.); (S.L.Z.); (L.L.H.); (K.H.)
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Gallagher KE, Knoll MD, Prosperi C, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, Howie SRC, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, O'Brien KL, Thea DM, Awori JO, Baillie VL, Ebruke BE, Goswami D, Kamau A, Maloney SA, Moore DP, Mwananyanda L, Olutunde EO, Seidenberg P, Sissoko S, Sylla M, Thamthitiwat S, Zaman K, Scott JAG. The Predictive Performance of a Pneumonia Severity Score in Human Immunodeficiency Virus-negative Children Presenting to Hospital in 7 Low- and Middle-income Countries. Clin Infect Dis 2021; 70:1050-1057. [PMID: 31111870 PMCID: PMC7610754 DOI: 10.1093/cid/ciz350] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/26/2019] [Indexed: 12/26/2022] Open
Abstract
Background In 2015, pneumonia remained the leading cause of mortality in children aged 1−59 months. Methods Data from 1802 human immunodeficiency virus (HIV)−negative children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) study with severe or very severe pneumonia during 2011−2014 were used to build a parsimonious multivariable model predicting mortality using backwards stepwise logistic regression. The PERCH severity score, derived from model coefficients, was validated on a second, temporally discrete dataset of a further 1819 cases and compared to other available scores using the C statistic. Results Predictors of mortality, across 7 low- and middle-income countries, were age <1 year, female sex, ≥3 days of illness prior to presentation to hospital, low weight for height, unresponsiveness, deep breathing, hypoxemia, grunting, and the absence of cough. The model discriminated well between those who died and those who survived (C statistic = 0.84), but the predictive capacity of the PERCH 5-stratum score derived from the coefficients was moderate (C statistic = 0.76). The performance of the Respiratory Index of Severity in Children score was similar (C statistic = 0.76). The number of World Health Organization (WHO) danger signs demonstrated the highest discrimination (C statistic = 0.82; 1.5% died if no danger signs, 10% if 1 danger sign, and 33% if ≥2 danger signs). Conclusions The PERCH severity score could be used to interpret geographic variations in pneumonia mortality and etiology. The number of WHO danger signs on presentation to hospital could be the most useful of the currently available tools to aid clinical management of pneumonia.
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Affiliation(s)
- Katherine E Gallagher
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Maria D Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chrissy Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Henry C Baggett
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Global Disease Detection Center, Thailand Ministry of Public Health-US CDC Collaboration, Nonthaburi
| | - W Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka and Matlab
| | - Daniel R Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, The Gambia.,Department of Paediatrics, University of Auckland, New Zealand.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | - Orin S Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David R Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand.,Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Donald M Thea
- Department of Global Health, Boston University School of Public Health, Massachusetts
| | - Juliet O Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Vicky L Baillie
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka and Matlab
| | - Alice Kamau
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Susan A Maloney
- Global Disease Detection Center, Thailand Ministry of Public Health-US CDC Collaboration, Nonthaburi.,Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia
| | - David P Moore
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Mwananyanda
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts.,EQUIP-Zambia, Lusaka
| | | | - Phil Seidenberg
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts
| | | | - Mamadou Sylla
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Somsak Thamthitiwat
- Global Disease Detection Center, Thailand Ministry of Public Health-US CDC Collaboration, Nonthaburi
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka and Matlab
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
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