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Sawry S, Ayalew K, Maimela G, Briggs-Hagen M, van Wyk-Heath M, Mthethwa S, Shai S, Mngomezulu NN, Tlhowe L, Achere-Darko J, Bedford J, Martin CE, Fairlie L, Imrie J. Assessment of weight gain in adult patients living with HIV receiving first-line dolutegravir-based or efavirenz-based ART regimens in routine care clinics in Tshwane district, South Africa: An observational study. HIV Med 2024. [PMID: 38520085 DOI: 10.1111/hiv.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Although dolutegravir (DTG) is deemed stable, safe, cost-effective, and clinically beneficial, it also carries the risk of side effects, including observed weight gain among patients on DTG-based antiretroviral therapy (ART) regimens. We compared weight changes among adults (≥18 years) initiating tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, and efavirenz (TEE) regimens and those switching from TEE to TLD (TEE-to-TLD switchers) in three large primary care facilities in South Africa METHODS: We conducted a retrospective longitudinal record review using patient medical records, extracting relevant demographic and clinical data from October 2018 to June 2021 from randomly selected adults who initiated TLD or TEE (initiators) and adult TEE-to-TLD switchers. We assessed weight, body mass index (BMI), and percentage weight changes for both groups and fitted linear regression and generalized linear models to determine factors associated with weight and BMI change and percentage weight change ≥10%, respectively, among treatment initiators. We fitted linear mixed-effect models among TEE-to-TLD switchers to consider repeated measures. RESULTS Of 860 initiators, 450 (52.3%) initiated on TEE and 410 (47.7%) on TLD, with median follow-up of 1.4 years and 1.0 year, respectively. At initiation, 43.3% on TEE and 40.8% on TLD were overweight or obese. TLD initiators had an adjusted higher mean weight gain of 1.6 kg (p < 0.001) and mean BMI gain of 0.51 kg/m2 (p < 0.001) than TEE initiators. Independent risk factors for higher mean weight and BMI included age ≥50 years, male, on ART for >12 months, initial BMI of <18.5 kg/m2, and CD4 counts <200 cells/μL. Of 298 TEE-to-TLD switchers, 36.6% were overweight or obese at TEE initiation. Comparing before and after TLD switch, TEE-to-TLD switchers had an adjusted mean weight of 1.2 kg less while on TLD (p = 0.026). Being overweight and CD4 counts >350 cells/μL were independent risk factors for lower weight gain after TLD switch. CONCLUSIONS We report more weight gain among TLD than among TEE initiators, although to a lesser extent than previously reported. TEE-to-TLD switchers experienced less weight gain after TLD switch; return to health before receiving TLD may be a contributory factor. The current findings are reassuring for those switching to a DTG-based regimen.
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Affiliation(s)
- Shobna Sawry
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Kassahun Ayalew
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Gloria Maimela
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Melissa Briggs-Hagen
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Marelize van Wyk-Heath
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Simangele Mthethwa
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Sannie Shai
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Lawrence Tlhowe
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jason Bedford
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | | | - Lee Fairlie
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - John Imrie
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
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2
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Arts PJ, Kelly JD, Midgley CM, Anglin K, Lu S, Abedi GR, Andino R, Bakker KM, Banman B, Boehm AB, Briggs-Hagen M, Brouwer AF, Davidson MC, Eisenberg MC, Garcia-Knight M, Knight S, Peluso MJ, Pineda-Ramirez J, Diaz Sanchez R, Saydah S, Tassetto M, Martin JN, Wigginton KR. Longitudinal and quantitative fecal shedding dynamics of SARS-CoV-2, pepper mild mottle virus, and crAssphage. mSphere 2023; 8:e0013223. [PMID: 37338211 PMCID: PMC10506459 DOI: 10.1128/msphere.00132-23] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/03/2023] [Indexed: 06/21/2023] Open
Abstract
Wastewater-based epidemiology (WBE) emerged during the coronavirus disease 2019 (COVID-19) pandemic as a scalable and broadly applicable method for community-level monitoring of infectious disease burden. The lack of high-resolution fecal shedding data for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) limits our ability to link WBE measurements to disease burden. In this study, we present longitudinal, quantitative fecal shedding data for SARS-CoV-2 RNA, as well as for the commonly used fecal indicators pepper mild mottle virus (PMMoV) RNA and crAss-like phage (crAssphage) DNA. The shedding trajectories from 48 SARS-CoV-2-infected individuals suggest a highly individualized, dynamic course of SARS-CoV-2 RNA fecal shedding. Of the individuals that provided at least three stool samples spanning more than 14 days, 77% had one or more samples that tested positive for SARS-CoV-2 RNA. We detected PMMoV RNA in at least one sample from all individuals and in 96% (352/367) of samples overall. CrAssphage DNA was detected in at least one sample from 80% (38/48) of individuals and was detected in 48% (179/371) of all samples. The geometric mean concentrations of PMMoV and crAssphage in stool across all individuals were 8.7 × 104 and 1.4 × 104 gene copies/milligram-dry weight, respectively, and crAssphage shedding was more consistent for individuals than PMMoV shedding. These results provide us with a missing link needed to connect laboratory WBE results with mechanistic models, and this will aid in more accurate estimates of COVID-19 burden in sewersheds. Additionally, the PMMoV and crAssphage data are critical for evaluating their utility as fecal strength normalizing measures and for source-tracking applications. IMPORTANCE This research represents a critical step in the advancement of wastewater monitoring for public health. To date, mechanistic materials balance modeling of wastewater-based epidemiology has relied on SARS-CoV-2 fecal shedding estimates from small-scale clinical reports or meta-analyses of research using a wide range of analytical methodologies. Additionally, previous SARS-CoV-2 fecal shedding data have not contained sufficient methodological information for building accurate materials balance models. Like SARS-CoV-2, fecal shedding of PMMoV and crAssphage has been understudied to date. The data presented here provide externally valid and longitudinal fecal shedding data for SARS-CoV-2, PMMoV, and crAssphage which can be directly applied to WBE models and ultimately increase the utility of WBE.
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Affiliation(s)
- Peter J. Arts
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - J. Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Division of Hospital Medicine, UCSF, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Claire M. Midgley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Khamal Anglin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Glen R. Abedi
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Raul Andino
- Department of Microbiology and Immunology, UCSF, San Francisco, California, USA
| | - Kevin M. Bakker
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bryon Banman
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandria B. Boehm
- Department of Civil & Environmental Engineering, Stanford University, Stanford, California, USA
| | - Melissa Briggs-Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Marisa C. Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sterling Knight
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J. Peluso
- Division of HIV, Infectious Disease, and Global Medicine, UCSF, San Francisco, California, USA
| | - Jesus Pineda-Ramirez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Ruth Diaz Sanchez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Sharon Saydah
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michel Tassetto
- Department of Microbiology and Immunology, UCSF, San Francisco, California, USA
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Krista R. Wigginton
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan, USA
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3
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Goldberg SA, Lu S, Garcia-Knight M, Davidson MC, Tassetto M, Anglin K, Pineda-Ramirez J, Chen JY, Rugart PR, Mathur S, Forman CA, Donohue KC, Abedi GR, Saydah S, Briggs-Hagen M, Midgley CM, Andino R, Peluso MJ, Glidden DV, Martin JN, Kelly JD. Viral Determinants of Acute COVID-19 Symptoms in a Nonhospitalized Adult Population in the Pre-Omicron Era. Open Forum Infect Dis 2023; 10:ofad396. [PMID: 37636517 PMCID: PMC10456204 DOI: 10.1093/ofid/ofad396] [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: 06/10/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Background The influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA level and presence of infectious virus on symptom occurrence is poorly understood, particularly among nonhospitalized individuals. Methods The study included 85 nonhospitalized, symptomatic adults, who were enrolled from September 2020 to November 2021. Data from a longitudinal cohort studied over 28 days was used to analyze the association of individual symptoms with SARS-CoV-2 viral RNA load, or the presence or level of infectious (culturable) virus. Presence of infectious virus and viral RNA load were assessed daily, depending on specimen availability, and amount of infectious virus was assessed on the day of maximum RNA load. Participants were surveyed for the start and end dates of 31 symptoms at enrollment and at days 9, 14, 21, and 28; daily symptom presence was determined analytically. We describe symptoms and investigate their possible association with viral determinants through a series of single or pooled (multiple days across acute period) cross-sectional analyses. Results There was an association between viral RNA load and the same-day presence of many individual symptoms. Additionally, individuals with infectious virus were more than three times as likely to have a concurrent fever than individuals without infectious virus, and more than two times as likely to have concurrent myalgia, chills, headache, or sore throat. Conclusions We found evidence to support the association of viral RNA load and infectious virus on some, but not all symptoms. Fever was most strongly associated with the presence of infectious virus; this may support the potential for symptom-based isolation guidance for COVID-19.
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Affiliation(s)
- Sarah A Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Miguel Garcia-Knight
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA
| | - Michelle C Davidson
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michel Tassetto
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA
| | - Khamal Anglin
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jesus Pineda-Ramirez
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jessica Y Chen
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Paulina R Rugart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Sujata Mathur
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Carrie A Forman
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kevin C Donohue
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Glen R Abedi
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Saydah
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Briggs-Hagen
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire M Midgley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Raul Andino
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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4
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Babu TM, Feldstein LR, Saydah S, Acker Z, Boisvert CL, Briggs-Hagen M, Carone M, Casto A, Cox SN, Ehmen B, Englund JA, Fortmann SP, Frivold CJ, Groom H, Han PD, Kuntz JL, Lockwood T, Midgley CM, Mularski RA, Ogilvie T, Reich SL, Schmidt MA, Smith N, Starita L, Stone J, Vandermeer M, Weil AA, Wolf CR, Chu HY, Naleway AL. CASCADIA: a prospective community-based study protocol for assessing SARS-CoV-2 vaccine effectiveness in children and adults using a remote nasal swab collection and web-based survey design. BMJ Open 2023; 13:e071446. [PMID: 37451722 PMCID: PMC10350906 DOI: 10.1136/bmjopen-2022-071446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Although SARS-CoV-2 vaccines were first approved under Emergency Use Authorization by the Food and Drug Administration in late 2020 for adults, authorisation for young children 6 months to <5 years of age did not occur until 2022. These authorisations were based on clinical trials, understanding real-world vaccine effectiveness (VE) in the setting of emerging variants is critical. The primary goal of this study is to evaluate SARS-CoV-2 VE against infection among children aged >6 months and adults aged <50 years. METHODS CASCADIA is a 4-year community-based prospective study of SARS-CoV-2 VE among 3500 adults and paediatric populations aged 6 months to 49 years in Oregon and Washington, USA. At enrolment and regular intervals, participants complete a sociodemographic questionnaire. Individuals provide a blood sample at enrolment and annually thereafter, with optional blood draws every 6 months and after infection and vaccination. Participants complete weekly self-collection of anterior nasal swabs and symptom questionnaires. Swabs are tested for SARS-CoV-2 and other respiratory pathogens by reverse transcription-PCR, with results of selected pathogens returned to participants; nasal swabs with SARS-CoV-2 detected will undergo whole genome sequencing. Participants who test positive for SARS-CoV-2 undergo serial swab collection every 3 days for 21 days. Serum samples are tested for SARS-CoV-2 antibody by binding and neutralisation assays. ANALYSIS The primary outcome is SARS-CoV-2 infection. Cox regression models will be used to estimate the incidence rate ratio associated with SARS-CoV-2 vaccination among the paediatric and adult population, controlling for demographic factors and other potential confounders. ETHICS AND DISSEMINATION All study materials including the protocol, consent forms, data collection instruments, participant communication and recruitment materials, were approved by the Kaiser Permanente Interregional Institutional Review Board, the IRB of record for the study. Results will be disseminated through peer-reviewed publications, presentations, participant newsletters and appropriate general news media.
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Affiliation(s)
- Tara M Babu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Leora R Feldstein
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Saydah
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary Acker
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | | | - Melissa Briggs-Hagen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Amanda Casto
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sarah N Cox
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Brenna Ehmen
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Stephen P Fortmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Collrane J Frivold
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Holly Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Peter D Han
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer L Kuntz
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Tina Lockwood
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Claire M Midgley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard A Mularski
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Tara Ogilvie
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sacha L Reich
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Lea Starita
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
- Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Jeremy Stone
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Meredith Vandermeer
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Ana A Weil
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Caitlin R Wolf
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Helen Y Chu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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Jones JM, Manrique IM, Stone MS, Grebe E, Saa P, Germanio CD, Spencer BR, Notari E, Bravo M, Lanteri MC, Green V, Briggs-Hagen M, Coughlin MM, Stramer SL, Opsomer J, Busch MP. Estimates of SARS-CoV-2 Seroprevalence and Incidence of Primary SARS-CoV-2 Infections Among Blood Donors, by COVID-19 Vaccination Status - United States, April 2021-September 2022. MMWR Morb Mortal Wkly Rep 2023; 72:601-605. [PMID: 37262007 DOI: 10.15585/mmwr.mm7222a3] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Changes in testing behaviors and reporting requirements have hampered the ability to estimate the U.S. SARS-CoV-2 incidence (1). Hybrid immunity (immunity derived from both previous infection and vaccination) has been reported to provide better protection than that from infection or vaccination alone (2). To estimate the incidence of infection and the prevalence of infection- or vaccination-induced antibodies (or both), data from a nationwide, longitudinal cohort of blood donors were analyzed. During the second quarter of 2021 (April-June), an estimated 68.4% of persons aged ≥16 years had infection- or vaccination-induced SARS-CoV-2 antibodies, including 47.5% from vaccination alone, 12.0% from infection alone, and 8.9% from both. By the third quarter of 2022 (July-September), 96.4% had SARS-CoV-2 antibodies from previous infection or vaccination, including 22.6% from infection alone and 26.1% from vaccination alone; 47.7% had hybrid immunity. Prevalence of hybrid immunity was lowest among persons aged ≥65 years (36.9%), the group with the highest risk for severe disease if infected, and was highest among those aged 16-29 years (59.6%). Low prevalence of infection-induced and hybrid immunity among older adults reflects the success of public health infection prevention efforts while also highlighting the importance of older adults staying up to date with recommended COVID-19 vaccination, including at least 1 bivalent dose.*,†.
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6
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Fairlie T, Chu B, Thomas ES, Querns AK, Lyons A, Koziol M, Englund JA, Anderson EM, Graff K, Rigel S, Bell TR, Saydah S, Chatham-Stephens K, Vogt TM, Hoag S, Briggs-Hagen M. School-Based Interventions to Increase Student COVID-19 Vaccination Coverage in Public School Populations with Low Coverage - Seattle, Washington, December 2021-June 2022. MMWR Morb Mortal Wkly Rep 2023; 72:283-287. [PMID: 36928607 PMCID: PMC10027407 DOI: 10.15585/mmwr.mm7211a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
COVID-19 can lead to severe outcomes in children (1). Vaccination decreases risk for COVID-19 illness, severe disease, and death (2). On December 13, 2020, CDC recommended COVID-19 vaccination for persons aged ≥16 years, with expansion on May 12, 2021, to children and adolescents (children) aged 12-15 years, and on November 2, 2021, to children aged 5-11 years (3). As of March 8, 2023, COVID-19 vaccination coverage among school-aged children remained low nationwide, with 61.7% of children aged 12-17 years and approximately one third (32.7%) of those aged 5-11 years having completed the primary series (3). Intention to receive COVID-19 vaccine and vaccination coverage vary by demographic characteristics, including race and ethnicity and socioeconomic status (4-6). Seattle Public Schools (SPS) implemented a program to increase COVID-19 vaccination coverage during the 2021-22 school year, focusing on children aged 5-11 years during November 2021-June 2022, with an added focus on populations with low vaccine coverage during January 2022-June 2022.† The program included strategic messaging, school-located vaccination clinics, and school-led community engagement. Vaccination data from the Washington State Immunization Information System (WAIIS) were analyzed to examine disparities in COVID-19 vaccination by demographic and school characteristics and trends over time. In December 2021, 56.5% of all SPS students, 33.7% of children aged 5-11 years, and 81.3% of children aged 12-18 years had completed a COVID-19 primary vaccination series. By June 2022, overall series completion had increased to 80.3% and was 74.0% and 86.6% among children aged 5-11 years and 12-18 years, respectively. School-led vaccination programs can leverage community partnerships and relationships with families to improve COVID-19 vaccine access and coverage.
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7
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Gundlapalli AV, Beekmann SE, Jones JM, Thornburg NJ, Clarke KEN, Uyeki TM, Satheshkumar PS, Carroll DS, Plumb ID, Briggs-Hagen M, Santibañez S, David-Ferdon C, Polgreen PM, McDonald LC. Use of Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Tests by US Infectious Disease Physicians: Results of an Emerging Infections Network Survey, March 2022. Open Forum Infect Dis 2023; 10:ofad091. [PMID: 36949879 PMCID: PMC10026543 DOI: 10.1093/ofid/ofad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/16/2023] [Indexed: 02/20/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests have had limited recommended clinical application during the coronavirus disease 2019 (COVID-19) pandemic. To inform clinical practice, an understanding is needed of current perspectives of United States-based infectious disease (ID) physicians on the use, interpretation, and need for SARS-CoV-2 antibody tests. Methods In March 2022, members of the Emerging Infections Network (EIN), a national network of practicing ID physicians, were surveyed on types of SARS-CoV-2 antibody assays ordered, interpretation of test results, and clinical scenarios for which antibody tests were considered. Results Of 1867 active EIN members, 747 (40%) responded. Among the 583 who managed or consulted on COVID-19 patients, a majority (434/583 [75%]) had ordered SARS-CoV-2 antibody tests and were comfortable interpreting positive (452/578 [78%]) and negative (405/562 [72%]) results. Antibody tests were used for diagnosing post-COVID-19 conditions (61%), identifying prior SARS-CoV-2 infection (60%), and differentiating prior infection and response to COVID-19 vaccination (37%). Less than a third of respondents had used antibody tests to assess need for additional vaccines or risk stratification. Lack of sufficient evidence for use and nonstandardized assays were among the most common barriers for ordering tests. Respondents indicated that statements from professional societies and government agencies would influence their decision to order SARS-CoV-2 antibody tests for clinical decision making. Conclusions Practicing ID physicians are using SARS-CoV-2 antibody tests, and there is an unmet need for clarifying the appropriate use of these tests in clinical practice. Professional societies and US government agencies can support clinicians in the community through the creation of appropriate guidance.
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Affiliation(s)
- Adi V Gundlapalli
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan E Beekmann
- Infectious Diseases Society of America–Emerging Infections Network and Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jefferson M Jones
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kristie E N Clarke
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy M Uyeki
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Darin S Carroll
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian D Plumb
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Briggs-Hagen
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Santibañez
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Corinne David-Ferdon
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip M Polgreen
- Infectious Diseases Society of America–Emerging Infections Network and Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - L Clifford McDonald
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Sahle ET, Amogne W, Manyazewal T, Blumenthal J, Jain S, Sun S, Young J, Ellorin E, Woldeamanuel H, Teferra L, Feleke B, Vandenberg O, Rey Z, Briggs-Hagen M, Haubrich R, McCutchan JA. Prevalence of and risk factors for Human Immunodeficiency Virus (HIV) infection in entrants and residents of an Ethiopian prison. PLoS One 2023; 18:e0271666. [PMID: 36758059 PMCID: PMC9910692 DOI: 10.1371/journal.pone.0271666] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/05/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Prisoners generally have a higher prevalence of HIV infection compared to the general population from which they come. Whether this higher prevalence reflects a higher HIV prevalence in those entering prisons or intramural transmission of HIV within prisons or both is unclear. Any of these possibilities would increase the prevalence found in resident prisoners above that in the general population. Moreover, comparisons of HIV prevalence in entrants and residents and in men and women in African prisons are not well documented. The purpose of this study was to estimate and compare the prevalence and risk factors for HIV infection amongst both male as well as female and entrant and resident prisoners in a large Ethiopian Federal Prison. METHODS We studied consenting prisoners cross-sectionally from August 2014 through November 2016. Prison entrants were screened continuously for HIV infection and its associated risk factors and residents were screened in two waves one year apart. HIV was diagnosed at the prison hospital laboratory based on the Ethiopian national HIV rapid antibody testing protocol. An external, internationally-accredited reference laboratory confirmed results. Agreement of results between the laboratories were assessed. RESULTS A total of 10,778 participants were screened for HIV. Most participants were young (median age of 26 years, IQR: 21-33), male (84%), single (61%), literate (89%), and urban residents (91%) without prior incarceration (96%). Prevalence of HIV was 3.4% overall. Rates of HIV (p = 0.80) were similar in residents and entrants in wave 1 and in entrants in both waves, but were 1.9-fold higher (5.4% vs 2.8%) in residents than entrants in wave 2 (both p<0.001). At entrance to the prison women were more likely to be HIV+ than men (5.5% in women vs 2.5% in men, p< 0.001). In contrast resident women were less likely to be HIV+, but this difference was not statistically significant (3.2% in women vs 4.3% in men, p = 0.125). Other risk factors associated with HIV infection were increasing age (p<0.001), female gender (p<0.001), marital status (never vs other categories, p = 0.016), smaller number of rooms in their houses pre-imprisonment (p = 0.031), TB diagnosis ever (p<0.001), number of lifetime sex partners (especially having 2-10, p<0.001), and genital ulcer (p = 0.037). CONCLUSIONS Prevalence of HIV in the residents at this large, central Ethiopian prison was higher than that estimated for the general population and lower than in many other studies from other smaller Ethiopian prisons. A higher prevalence in residents than in entrants were found only in our second wave of screening after one year of continuous screening and treatment, possibly representing increased willingness of residents at increased risk of HIV to participate in the second wave. Thus, this findings did not clearly support intramural transmission of HIV or the effectiveness of screening to reduce prevalence. Finally, the higher HIV prevalence in women than men requires that they be similarly screened and treated for HIV infection.
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Affiliation(s)
- Eliyas Tsegaye Sahle
- ADDIS-VP Project/Ethiopian Public Health Association, Addis Ababa, Ethiopia
- Université Libre de Bruxelles/Ecole de Sante Public, Brussels, Belgium
| | - Wondwossen Amogne
- ADDIS-VP Project/Ethiopian Public Health Association, Addis Ababa, Ethiopia
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- ADDIS-VP Project/Ethiopian Public Health Association, Addis Ababa, Ethiopia
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jill Blumenthal
- University of California San Diego, San Diego, California, United States of America
| | - Sonia Jain
- University of California San Diego, San Diego, California, United States of America
| | - Shelly Sun
- University of California San Diego, San Diego, California, United States of America
| | - Jason Young
- University of California San Diego, San Diego, California, United States of America
| | - Eric Ellorin
- University of California San Diego, San Diego, California, United States of America
| | | | - Lemma Teferra
- Ethiopian Federal Prison Administration, Addis Ababa, Ethiopia
| | - Beniam Feleke
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Olivier Vandenberg
- Environmental and Occupational Health Research Centre (CRSET), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Zilma Rey
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Melissa Briggs-Hagen
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Richard Haubrich
- Gilead Sciences, Foster City, California, United States of America
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9
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Mohr NM, Plumb ID, Harland KK, Pilishvili T, Fleming-Dutra KE, Krishnadasan A, Hoth KF, Saydah SH, Mankoff Z, Haran JP, Briggs-Hagen M, León ES, Talan DA. Presence of symptoms 6 weeks after COVID-19 among vaccinated and unvaccinated US healthcare personnel: a prospective cohort study. BMJ Open 2023; 13:e063141. [PMID: 36731936 PMCID: PMC9895915 DOI: 10.1136/bmjopen-2022-063141] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Although COVID-19 vaccines offer protection against infection and severe disease, there is limited information on the effect of vaccination on prolonged symptoms following COVID-19. Our objective was to determine differences in prevalence of prolonged symptoms 6 weeks after onset of COVID-19 among healthcare personnel (HCP) by vaccination status, and to assess differences in timing of return to work. DESIGN Cohort analysis of HCP with COVID-19 enrolled in a multicentre vaccine effectiveness study. HCP with COVID-19 between December 2020 and August 2021 were followed up 6 weeks after illness onset. SETTING Health systems in 12 US states. PARTICIPANTS HCP participating in a vaccine effectiveness study were eligible for inclusion if they had laboratory-confirmed symptomatic SARS-CoV-2 with mRNA vaccination (symptom onset ≥14 days after two doses) or no prior vaccination. Among 681 eligible participants, 419 (61%) completed a follow-up survey to assess symptoms reported 6 weeks after illness onset. EXPOSURES Two doses of a COVID-19 mRNA vaccine compared with no COVID-19 vaccine. MAIN OUTCOME MEASURES Prevalence of symptoms 6 weeks after onset of COVID-19 illness and days to return to work. RESULTS Among 419 HCP with COVID-19, 298 (71%) reported one or more COVID-like symptoms 6 weeks after illness onset, with a lower prevalence among vaccinated participants compared with unvaccinated participants (60.6% vs 79.1%; adjusted risk ratio 0.70, 95% CI 0.58 to 0.84). Following their illness, vaccinated HCP returned to work a median 2.0 days (95% CI 1.0 to 3.0) sooner than unvaccinated HCP (adjusted HR 1.37, 95% CI 1.04 to 1.79). CONCLUSIONS Receipt of two doses of a COVID-19 mRNA vaccine among HCP with COVID-19 illness was associated with decreased prevalence of COVID-like symptoms at 6 weeks and earlier return to work.
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Affiliation(s)
- Nicholas M Mohr
- Emergency Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, Iowa, USA
- Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ian D Plumb
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kari K Harland
- Emergency Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, Iowa, USA
| | - Tamara Pilishvili
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Anusha Krishnadasan
- Olive View and Ronald Reagan-UCLA Medical Center Emergency Medicine, University of California - Los Angeles, Los Angeles, California, USA
| | - Karin F Hoth
- Internal Medicine, University of Iowa Carver College of Medicine, Iowa CIty, Iowa, USA
| | - Sharon H Saydah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary Mankoff
- Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John P Haran
- Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Melissa Briggs-Hagen
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eliezer Santos León
- Emergency Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, Iowa, USA
| | - David A Talan
- Olive View and Ronald Reagan-UCLA Medical Center Emergency Medicine, University of California - Los Angeles, Los Angeles, California, USA
- Internal Medicine Division of Infectious Diseases, University of California - Los Angeles, Los Angeles, California, USA
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10
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Tassetto M, Garcia-Knight M, Anglin K, Kelly D, Lu S, Pineda-Ramirez J, Saydah S, Briggs-Hagen M, Zhang A, Sanchez RD, Donohue K, Romero M, Peluso MJ, Martin J, Andino R, Midgley C. 1880. Detection of Infectious SARS-CoV-2 in Specimens with High CT Values Is More Common for Omicron than for Delta Variants. Open Forum Infect Dis 2022. [PMCID: PMC9752745 DOI: 10.1093/ofid/ofac492.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Although not validated, cycle threshold (Ct) values from real-time (r)RT-PCR are sometimes used as a proxy for infectiousness to inform public health decision-making. A better understanding of variant-specific viral dynamics, including RNA and infectious virus relationships, is needed to clarify implications for diagnostics and transmission. Methods Non-hospitalized SARS-CoV-2-infected individuals were recruited ≤ 5 days post-onset and self-collected nasal swabs daily for two weeks. Sequencing was used to determine variant, an in-house quantitative rRT-PCR targeting N gene was used to produce Ct values and determine RNA load, and cytopathic effect was used to assess the presence or absence of infectious virus (binary outcome). We used a Ct threshold of 30 to define high-Ct (Ct > 30) or low-Ct (Ct ≤ 30) specimens and assessed the percentage of RNA-positive specimens that had infectious virus; variant-specific percentages were compared by Χ2 test. Results We included 113 and 200 RNA-positive specimens from 18 and 28 Omicron- and Delta-infected participants, respectively; timing of RNA-positive specimen collection was similar in both groups (median = 8d post-onset). Maximum observed RNA levels occurred at median of 5 days post-onset for both variants but were lower for participants with Omicron vs Delta [mean RNA copies/mL = 105.2 vs 107.9]. Despite lower RNA levels, infectious virus was frequently detected for both variants [Omicron: median duration = 4.5d; Delta: median = 6d; p = 0.13]. Omicron specimens with infectious virus had higher Cts vs Delta specimens [mean Ct = 29.9 vs 23.2, p < 0.001]. In high-Ct specimens (Ct > 30; Table), the percentage of specimens with infectious virus was typically higher for Omicron vs Delta, and was significantly higher in adults [27.3% vs 9.5%]. In low-Ct specimens (Ct ≤ 30), the percentage with infectious virus was similar or higher for Omicron vs Delta, and was significantly higher in children [87.5% vs 53.8%] and in those unvaccinated [94.1% vs 47.4%].
![]() Conclusion CDC does not recommend the use of Ct values as a proxy for infectiousness. These data further highlight that Ct values may not provide a reliable or consistent proxy for infectiousness across variants. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | | | - Sharon Saydah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Michael J Peluso
- University of California San Francisco, San Francisco, California
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11
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Lu S, Anglin K, Tassetto M, Garcia-Knight M, Pineda-Ramirez J, Sanchez RD, Zhang A, Romero M, Goldberg SA, Chen JY, Donohue K, Davidson M, Lugtu K, Yee B, Chenna A, Winslow J, Petropoulos CJ, Briggs-Hagen M, Peluso MJ, Andino R, Midgley C, Martin J, Saydah S, Kelly D, Deeks S. 1048. Biological Determinants of Post-Acute Sequelae of SARS-CoV-2. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
The biological determinants of post-acute sequelae of SARS-CoV-2 infection (PASC), defined as the persistence or recurrence of symptoms not explained by an alternative medical diagnosis, are poorly understood. We assessed viral and immunological determinants during acute SARS-CoV-2 infection for an association with PASC at 4 to 8 months.
Methods
From September 2020 to February 2022, symptomatic non-hospitalized individuals with laboratory-confirmed SARS-CoV-2 infection were identified within 5 days of symptom onset. We used anterior nasal biospecimens to measure the magnitude and duration of RNA and infectious viral shedding as well as blood samples to measure soluble markers of inflammation during the acute phase (first 28 days post-enrollment). PASC was defined as self-report of 1 or more COVID-19 attributed symptoms between 4 and 8 months after initial illness. We compared virologic and inflammatory markers, GFAP (a marker of neuronal damage) and neutralizing antibody levels from the acute phase between those with and without PASC using Mann-Whitney U tests or repeated measures mixed effects linear models.
Results
Among 71 SARS-CoV-2-positive participants with a completed follow-up visit between 4 to 8 months, we included 69 with virologic data and 61 with inflammatory marker data. Median age was 37 (IQR: 29 to 48) Overall, 16/72 (23%) reported at least one qualifying PASC symptom. Report of PASC was associated with >9 days of RNA shedding (p=0.04); all participants stopped RNA shedding by day 20. During acute illness, those with subsequent PASC had increased levelsof INF-alpha, INF-gamma, IP-10, IL-10, and MCP-1; these differences were greatest in the early period and normalized over 2 to 3 weeks post-illness onset. Compared to those without PASC, during the acute illness those with PASC had increased levels of GFAP and decreased levels of neutralizing antibodies but these differences were not statistically significant.
Conclusion
We found indications that viral and immunological factors during acute illness may be associated with PASC, suggesting acute immunologic response to SARS-CoV-2 may have longer term effects and play a role in PASC. Further understanding of the clinically significance of these observations is needed.
Disclosures
Ahmed Chenna, PhD, LabCorp: Employee John Winslow, PhD, Labcorp-Monogram Bioscience: Issued patents on VeraTag immunoassay-not applicable to present work|Labcorp-Monogram Bioscience: Employee|Labcorp-Monogram Biosciences: Issued patents on VeraTag immunoassay-not applicable to present work|Labcorp-Monogram Biosciences: Employee of Labcorp-Monogram Biosciences Christos J. Petropoulos, PhD, Labcorp-Monogram Biosciences: employee, corporate officer|Labcorp-Monogram Biosciences: Stocks/Bonds.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Brandon Yee
- Monogram Biosciences , San Francisco, California
| | - Ahmed Chenna
- Monogram Biosciences-LabCorp , South San Francisco, California
| | - John Winslow
- Labcorp-Monogram Biosciences , South San Francisco, California
| | | | | | - Michael J Peluso
- University of California San Francisco , San Francisco, California
| | | | - Claire Midgley
- Centers for Disease Control and Prevention , Atlanta , Georgia
| | | | - Sharon Saydah
- Centers for Disease Control and Prevention , Atlanta , Georgia
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12
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Taback-Esra R, Morof D, Briggs-Hagen M, Savva H, Mthethwa S, Williams D, Drummond J, Rothgerber N, Smith M, McMorrow M, Ndlovu M, Adelekan A, Kindra G, Olivier J, Mpofu N, Motlhaoleng K, Khuzwayo L, Makapela D, Manjengwa P, Ochieng A, Porter S, Grund J, Diallo K, Lacson R. Use of Epidemiology Surge Support to Enhance Robustness and Expand Capacity of SARS-CoV-2 Pandemic Response, South Africa. Emerg Infect Dis 2022; 28:S177-S180. [PMID: 36502381 DOI: 10.3201/eid2813.212522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As COVID-19 cases increased during the first weeks of the pandemic in South Africa, the National Institute of Communicable Diseases requested assistance with epidemiologic and surveillance expertise from the US Centers for Disease Control and Prevention South Africa. By leveraging its existing relationship with the National Institute of Communicable Diseases for >2 months, the US Centers for Disease Control and Prevention South Africa supported data capture and file organization, data quality reviews, data analytics, laboratory strengthening, and the development and review of COVID-19 guidance This case study provides an account of the resources and the technical, logistical, and organizational capacity leveraged to support a rapid response to the COVID-19 pandemic in South Africa.
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13
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Daniel Kelly J, Lu S, Anglin K, Garcia-Knight M, Pineda-Ramirez J, Goldberg SA, Tassetto M, Zhang A, Donohue K, Davidson MC, Romero M, Sanchez RD, Djomaleu M, Mathur S, Chen JY, Forman CA, Servellita V, Montejano RD, Shak JR, Rutherford GW, Deeks SG, Abedi GR, Rolfes MA, Saydah S, Briggs-Hagen M, Peluso MJ, Chiu C, Midgley CM, Andino R, Martin JN. Magnitude and Determinants of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Household Transmission: A Longitudinal Cohort Study. Clin Infect Dis 2022; 75:S193-S204. [PMID: 35788827 PMCID: PMC9278251 DOI: 10.1093/cid/ciac545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Households have emerged as important venues for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Little is known, however, regarding the magnitude and determinants of household transmission in increasingly vaccinated populations. METHODS From September 2020 to January 2022, symptomatic nonhospitalized individuals with SARS-CoV-2 infection by RNA detection were identified within 5 days of symptom onset; all individuals resided with at least 1 other SARS-CoV-2-uninfected household member. These infected persons (cases) and their household members (contacts) were subsequently followed with questionnaire-based measurement and serial nasal specimen collection. The primary outcome was SARS-CoV-2 infection among contacts. RESULTS We evaluated 42 cases and their 74 household contacts. Among the contacts, 32 (43%) became infected, of whom 5 (16%) were asymptomatic; 81% of transmissions occurred by 5 days after the case's symptom onset. From 21 unvaccinated cases, 14-day cumulative incidence of SARS-CoV-2 infection among contacts was 18/40 (45% [95% confidence interval {CI}, 29%-62%]), most of whom were unvaccinated. From 21 vaccinated cases, 14-day cumulative incidence of SARS-CoV-2 infection was 14/34 (41% [95% CI, 25%-59%]) among all contacts and 12/29 (41% [95% CI, 24%-61%]) among vaccinated contacts. At least 1 comorbid condition among cases and 10 or more days of RNA detection in cases were associated with increased risk of infection among contacts. CONCLUSIONS Among households including individuals with symptomatic SARS-CoV-2 infection, both vaccinated-to-vaccinated and unvaccinated-to-unvaccinated transmission of SARS-CoV-2 to household contacts was common. Because vaccination alone did not notably reduce risk of infection, household contacts will need to employ additional interventions to avoid infection.
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Affiliation(s)
- J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Khamal Anglin
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | | | - Jesus Pineda-Ramirez
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | - Kevin Donohue
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Mariela Romero
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Ruth Diaz Sanchez
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Manuella Djomaleu
- School of Medicine, University of California, San Francisco, CA, USA
| | - Sujata Mathur
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jessica Y Chen
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Carrie A Forman
- School of Medicine, Drexel University, Philadelphia, PA, USA
| | - Venice Servellita
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Rubi D Montejano
- School of Medicine, University of California, San Francisco, CA, USA
| | - Joshua R Shak
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Steven G Deeks
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Glen R Abedi
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, GA, USA
| | - Melissa A Rolfes
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, GA, USA
| | - Sharon Saydah
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, GA, USA
| | | | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Charles Chiu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Claire M Midgley
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, GA, USA
| | - Raul Andino
- Department of Microbiology and Immunology, UCSF
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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14
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Tassetto M, Garcia-Knight M, Anglin K, Lu S, Zhang A, Romero M, Pineda-Ramirez J, Sanchez RD, Donohue KC, Pfister K, Chan C, Saydah S, Briggs-Hagen M, Peluso MJ, Martin JN, Andino R, Midgley CM, Kelly JD. Detection of Higher Cycle Threshold Values in Culturable SARS-CoV-2 Omicron BA.1 Sublineage Compared with Pre-Omicron Variant Specimens - San Francisco Bay Area, California, July 2021-March 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1151-1154. [PMID: 36074732 PMCID: PMC9470222 DOI: 10.15585/mmwr.mm7136a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Before emergence in late 2021 of the highly transmissible B.1.1.529 (Omicron) variant of SARS-CoV-2, the virus that causes COVID-19 (1,2), several studies demonstrated that SARS-CoV-2 was unlikely to be cultured from specimens with high cycle threshold (Ct) values§ from real-time reverse transcription-polymerase chain reaction (RT-PCR) tests (suggesting low viral RNA levels) (3). Although CDC and others do not recommend attempting to correlate Ct values with the amount of infectious virus in the original specimen (4,5), low Ct values are sometimes used as surrogate markers for infectiousness in clinical, public health, or research settings without access to virus culture (5). However, the consistency in reliability of this practice across SARS-CoV-2 variants remains uncertain because Omicron-specific data on infectious virus shedding, including its relationship with RNA levels, are limited. In the current analysis, nasal specimens collected from an ongoing longitudinal cohort¶ (6,7) of nonhospitalized participants with positive SARS-CoV-2 test results living in the San Francisco Bay Area** were used to generate Ct values and assess for the presence of culturable SARS-CoV-2 virus; findings were compared between specimens from participants infected with pre-Omicron variants and those infected with the Omicron BA.1 sublineage. Among specimens with culturable virus detected, Ct values were higher (suggesting lower RNA levels) during Omicron BA.1 infections than during pre-Omicron infections, suggesting variant-specific differences in viral dynamics. Supporting CDC guidance, these data show that Ct values likely do not provide a consistent proxy for infectiousness across SARS-CoV-2 variants.
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15
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Garcia-Knight M, Anglin K, Tassetto M, Lu S, Zhang A, Goldberg SA, Catching A, Davidson MC, Shak JR, Romero M, Pineda-Ramirez J, Diaz-Sanchez R, Rugart P, Donohue K, Massachi J, Sans HM, Djomaleu M, Mathur S, Servellita V, McIlwain D, Gaudiliere B, Chen J, Martinez EO, Tavs JM, Bronstone G, Weiss J, Watson JT, Briggs-Hagen M, Abedi GR, Rutherford GW, Deeks SG, Chiu C, Saydah S, Peluso MJ, Midgley CM, Martin JN, Andino R, Kelly JD. Infectious viral shedding of SARS-CoV-2 Delta following vaccination: A longitudinal cohort study. PLoS Pathog 2022; 18:e1010802. [PMID: 36095030 PMCID: PMC9499220 DOI: 10.1371/journal.ppat.1010802] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/22/2022] [Accepted: 08/05/2022] [Indexed: 11/18/2022] Open
Abstract
The impact of vaccination on SARS-CoV-2 infectiousness is not well understood. We compared longitudinal viral shedding dynamics in unvaccinated and fully vaccinated adults. SARS-CoV-2-infected adults were enrolled within 5 days of symptom onset and nasal specimens were self-collected daily for two weeks and intermittently for an additional two weeks. SARS-CoV-2 RNA load and infectious virus were analyzed relative to symptom onset stratified by vaccination status. We tested 1080 nasal specimens from 52 unvaccinated adults enrolled in the pre-Delta period and 32 fully vaccinated adults with predominantly Delta infections. While we observed no differences by vaccination status in maximum RNA levels, maximum infectious titers and the median duration of viral RNA shedding, the rate of decay from the maximum RNA load was faster among vaccinated; maximum infectious titers and maximum RNA levels were highly correlated. Furthermore, amongst participants with infectious virus, median duration of infectious virus detection was reduced from 7.5 days (IQR: 6.0-9.0) in unvaccinated participants to 6 days (IQR: 5.0-8.0) in those vaccinated (P = 0.02). Accordingly, the odds of shedding infectious virus from days 6 to 12 post-onset were lower among vaccinated participants than unvaccinated participants (OR 0.42 95% CI 0.19-0.89). These results indicate that vaccination had reduced the probability of shedding infectious virus after 5 days from symptom onset.
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Affiliation(s)
- Miguel Garcia-Knight
- Department of Microbiology and Immunology, UCSF, California, United States of America
| | - Khamal Anglin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Michel Tassetto
- Department of Microbiology and Immunology, UCSF, California, United States of America
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Amethyst Zhang
- Department of Microbiology and Immunology, UCSF, California, United States of America
| | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Adam Catching
- Department of Microbiology and Immunology, UCSF, California, United States of America
| | - Michelle C Davidson
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Joshua R Shak
- School of Medicine, University of California, San Francisco, California, United States of America
- San Francisco VA Medical Center, San Francisco, California, United States of America
| | - Mariela Romero
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Jesus Pineda-Ramirez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Ruth Diaz-Sanchez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Paulina Rugart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Kevin Donohue
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Jonathan Massachi
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Hannah M Sans
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Manuella Djomaleu
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Sujata Mathur
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Venice Servellita
- Division of Infectious Diseases, UCSF, California, United States of America
| | - David McIlwain
- Department of Microbiology and Immunology, Stanford, California, United States of America
| | - Brice Gaudiliere
- Department of Microbiology and Immunology, Stanford, California, United States of America
| | - Jessica Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Enrique O Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Jacqueline M Tavs
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Grace Bronstone
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Jacob Weiss
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - John T Watson
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, Georgia, United States of America
| | - Melissa Briggs-Hagen
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, Georgia, United States of America
| | - Glen R Abedi
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, Georgia, United States of America
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Steven G Deeks
- Division of HIV, Infectious Disease, and Global Medicine, UCSF, California, United States of America
| | - Charles Chiu
- Division of Infectious Diseases, UCSF, California, United States of America
| | - Sharon Saydah
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, Georgia, United States of America
| | - Michael J Peluso
- Division of HIV, Infectious Disease, and Global Medicine, UCSF, California, United States of America
| | - Claire M Midgley
- Respiratory Viruses Branch, Division of Viral Diseases, CDC, Atlanta, Georgia, United States of America
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Raul Andino
- Department of Microbiology and Immunology, UCSF, California, United States of America
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- San Francisco VA Medical Center, San Francisco, California, United States of America
- F.I. Proctor Foundation, University of California, San Francisco, California, United States of America
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16
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Tenforde MW, Devine OJ, Reese HE, Silk BJ, Iuliano AD, Threlkel R, Vu QM, Plumb ID, Cadwell BL, Rose C, Steele MK, Briggs-Hagen M, Ayoubkhani D, Pawelek P, Nafilyan V, Saydah SH, Bertolli J. Point Prevalence Estimates of Activity-Limiting Long-Term Symptoms among U.S. Adults ≥1 Month After Reported SARS-CoV-2 Infection, November 1, 2021. J Infect Dis 2022; 227:855-863. [PMID: 35776165 PMCID: PMC9278232 DOI: 10.1093/infdis/jiac281] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although most adults infected with SARS-CoV-2 fully recover, a proportion have ongoing symptoms, or post-COVID conditions (PCC), after infection. The objective of this analysis was to estimate the number of US adults with activity-limiting PCC on November 1, 2021. Methods We modeled the prevalence of PCC using reported infections occurring from February 1, 2020 – September 30, 2021, and population-based, household survey data on new activity-limiting symptoms ≥1 month following SARS-CoV-2 infection. From these data sources, we estimated the number and proportion of US adults with activity-limiting PCC on November 1, 2021, as 95% uncertainty intervals, stratified by sex and age. Sensitivity analyses adjusted for under-ascertainment of infections and uncertainty about symptom duration. Results On November 1, 2021, at least 3.0–5.0 million US adults were estimated to have activity-limiting PCC of ≥1 month duration, or 1.2%–1.9% of US adults. Population prevalence was higher in females (1.4%–2.2%) than males. The estimated prevalence after adjusting for under-ascertainment of infections was 1.7%–3.8%. Conclusion Millions of US adults were estimated to have activity-limiting PCC. These estimates can support future efforts to address the impact of PCC on the U.S. population.
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Affiliation(s)
| | | | | | | | | | - Ryan Threlkel
- General Dynamics Information Technology, Inc., Atlanta, GA, USA
| | - Quan M Vu
- CDC COVID-19 Response Team, Atlanta, GA, USA
| | - Ian D Plumb
- CDC COVID-19 Response Team, Atlanta, GA, USA
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17
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León TM, Dorabawila V, Nelson L, Lutterloh E, Bauer UE, Backenson B, Bassett MT, Henry H, Bregman B, Midgley CM, Myers JF, Plumb ID, Reese HE, Zhao R, Briggs-Hagen M, Hoefer D, Watt JP, Silk BJ, Jain S, Rosenberg ES. COVID-19 Cases and Hospitalizations by COVID-19 Vaccination Status and Previous COVID-19 Diagnosis - California and New York, May-November 2021. MMWR Morb Mortal Wkly Rep 2022; 71:125-131. [PMID: 35085222 PMCID: PMC9351527 DOI: 10.15585/mmwr.mm7104e1] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Gentles LE, Kehoe L, Crawford KH, Lacombe K, Dickerson J, Wolf C, Yuan J, Schuler S, Watson JT, Nyanseor S, Briggs-Hagen M, Saydah S, Midgley CM, Pringle K, Chu H, Bloom JD, Englund JA. Dynamics of infection-elicited SARS-CoV-2 antibodies in children over time. medRxiv 2022:2022.01.14.22269235. [PMID: 35118481 PMCID: PMC8811949 DOI: 10.1101/2022.01.14.22269235] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection elicits an antibody response that targets several viral proteins including spike (S) and nucleocapsid (N); S is the major target of neutralizing antibodies. Here, we assess levels of anti-N binding antibodies and anti-S neutralizing antibodies in unvaccinated children compared with unvaccinated older adults following infection. Specifically, we examine neutralization and anti-N binding by sera collected up to 52 weeks following SARS-CoV-2 infection in children and compare these to a cohort of adults, including older adults, most of whom had mild infections that did not require hospitalization. Neutralizing antibody titers were lower in children than adults early after infection, but by 6 months titers were similar between age groups. The neutralizing activity of the children's sera decreased modestly from one to six months; a pattern that was not significantly different from that observed in adults. However, infection of children induced much lower levels of anti-N antibodies than in adults, and levels of these anti-N antibodies decreased more rapidly in children than in adults, including older adults. These results highlight age-related differences in the antibody responses to SARS-CoV-2 proteins and, as vaccines for children are introduced, may provide comparator data for the longevity of infection-elicited and vaccination-induced neutralizing antibody responses.
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Affiliation(s)
- Lauren E. Gentles
- Division of Basic Sciences and Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Leanne Kehoe
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Katharine H.D. Crawford
- Division of Basic Sciences and Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
- Medical Scientist Training Program, University of Washington, Seattle, Washington, USA
| | - Kirsten Lacombe
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Jane Dickerson
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Caitlin Wolf
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Joanna Yuan
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Susanna Schuler
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, Washington, USA
| | - John T. Watson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sankan Nyanseor
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Briggs-Hagen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Saydah
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire M. Midgley
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kimberly Pringle
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helen Chu
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Jesse D. Bloom
- Division of Basic Sciences and Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
- Howard Hughes Medical Institute, Seattle, Washington, USA
| | - Janet A. Englund
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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19
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Shah MM, Rasheed MAU, Harcourt JL, Abedi GR, Stumpf MM, Kirking HL, Tamin A, Mills L, Armstrong M, Salvatore PP, Surasi K, Scott SE, Killerby ME, Briggs-Hagen M, Saydah S, Tate JE, Fry AM, Hall AJ, Thornburg NJ, Midgley CM. Twelve-month Follow-up of Early COVID-19 Cases in the United States: Cellular and Humoral Immune Longevity. Open Forum Infect Dis 2022; 9:ofab664. [PMID: 35141347 PMCID: PMC8755399 DOI: 10.1093/ofid/ofab664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/03/2022] [Indexed: 12/03/2022] Open
Abstract
We quantify antibody and memory B-cell responses to severe acute respiratory syndrome coronavirus 2 at 6 and 12 months postinfection among 7 unvaccinated US coronavirus disease 2019 cases. All had detectable S-specific memory B cells and immunoglobulin G at both time points, with geometric mean titers of 117.2 BAU/mL and 84.0 BAU/mL at 6 and 12 months, respectively.
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Affiliation(s)
- Melisa M Shah
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jennifer L Harcourt
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Glen R Abedi
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan M Stumpf
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah L Kirking
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Azaibi Tamin
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Mills
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Phillip P Salvatore
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krishna Surasi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- California State Public Health Department
| | - Sarah E Scott
- Maricopa County Department of Public Health, Phoenix, AZ, USA
| | - Marie E Killerby
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sharon Saydah
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E Tate
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aron J Hall
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natalie J Thornburg
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claire M Midgley
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Pathmanathan I, Nelson R, de Louvado A, Thompson R, Pals S, Casavant I, Cardoso MJA, Ujamaa D, Bonzela J, Mikusova S, Chivurre V, Tamele S, Sleeman K, Zhang G, Zeh C, Dobbs T, Vubil A, Auld A, Briggs-Hagen M, Vergara A, Couto A, MacKellar D. High Coverage of Antiretroviral Treatment With Annual Home-Based HIV Testing, Follow-up Linkage Services, and Implementation of Test and Start: Findings From the Chókwè Health Demographic Surveillance System, Mozambique, 2014-2019. J Acquir Immune Defic Syndr 2021; 86:e97-e105. [PMID: 33252546 PMCID: PMC7970427 DOI: 10.1097/qai.0000000000002583] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early antiretroviral therapy (ART) is necessary for HIV epidemic control and depends on early diagnosis and successful linkage to care. Since 2014, annual household-based HIV testing and counseling and linkage services have been provided through the Chókwè Health and Demographic Surveillance System for residents testing HIV positive in this high HIV-burden district. METHODS District-wide Test and Start [T&S, ART for all people living with HIV (PLHIV)] began in August 2016, supported by systematic interventions to improve linkage to care and treatment. Annual rounds (R) of random household surveys were conducted to assess trends in population prevalence of ART use and viral load suppression (<1000 viral RNA copies/mL). RESULTS Between R1 (April 2014-April 2015) and R5 (April 2018-Mar 2019), 46,090 (67.2%) of 68,620 residents aged 15-59 years were tested for HIV at home at least once, and 3711 were newly diagnosed with HIV and provided linkage services. Population prevalence of current ART use among PLHIV increased from 65.0% to 87.5% between R1 and R5. ART population prevalence was lowest among men aged 25-34 years (67.8%) and women aged 15-24 (78.0%), and highest among women aged 35-44 years (93.6%) and 45-59 years (93.7%) in R5. Viral load suppression prevalence increased among all PLHIV aged 15-59 years from 52.0% in R1 to 78.3% in R5. DISCUSSION Between 2014 and 2019, Chókwè Health and Demographic Surveillance System residents surpassed the UNAIDS targets of ≥81% of PLHIV on ART and ≥73% virally suppressed. This achievement supports the combination of efforts from household-based HIV testing and counseling, support for linkage to care and treatment, and continued investments in T&S implementation.
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Affiliation(s)
| | - Robert Nelson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ricardo Thompson
- Chókwè Health Research and Training Center, National Institute of Health, Maputo, Mozambique
| | - Sherri Pals
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Dawud Ujamaa
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Juvêncio Bonzela
- Chókwè Health Research and Training Center, National Institute of Health, Maputo, Mozambique
| | - Silvia Mikusova
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Victor Chivurre
- Provincial Directorate of Public Health, Xai-Xai, Gaza, Mozambique
| | - Stelio Tamele
- District Directorate of Public Health, Chókwè, Gaza, Mozambique
| | - Katrina Sleeman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Guoqing Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clement Zeh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trudy Dobbs
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adolfo Vubil
- National Institute of Health, Maputo, Mozambique
| | - Andrew Auld
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Alfredo Vergara
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Aleny Couto
- Mozambique Ministry of Health (MISAU), Maputo, Mozambique
| | - Duncan MacKellar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Marinda E, Simbayi L, Zuma K, Zungu N, Moyo S, Kondlo L, Jooste S, Nadol P, Igumbor E, Dietrich C, Briggs-Hagen M. Towards achieving the 90-90-90 HIV targets: results from the south African 2017 national HIV survey. BMC Public Health 2020; 20:1375. [PMID: 32907565 PMCID: PMC7487872 DOI: 10.1186/s12889-020-09457-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 04/23/2020] [Accepted: 08/27/2020] [Indexed: 12/27/2022] Open
Abstract
Background Measuring progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 treatment targets is key to assessing progress towards turning the HIV epidemic tide. In 2017, the UNAIDS model estimated that 75% of people living with HIV (PLHIV) globally knew their HIV positive status, 79% of those who knew their status were on antiretroviral therapy (ART), and 81% of those who knew their HIV status and were on ART had a suppressed viral load. The fifth South African national HIV sero-behavioural survey collected nationally representative data that enabled the empirical estimation of these 90–90–90 targets for the country stratified by a variety of key factors. Methods To evaluate progress towards achievement of the 90–90–90 targets for South Africa, data obtained from a national, representative, cross-sectional population-based multi-stage stratified cluster random survey conducted in 2017 were analysed. The Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM V), collected behavioural and biomarker data from individuals residing in households from 1000 randomly selected Small Area Layers (SALs), across all nine provinces of the country. Structured questionnaires were used to collect socio-demographic data, knowledge and perceptions about HIV, and related risk behaviours. Blood samples were collected to test for HIV infection, antiretroviral use, and viral suppression (defined as < 1000 copies/ml). Weighted proportions of study participants aged 15 years and older who tested HIV positive were computed for those who reported awareness of their status (1st 90), and among these, those who were currently on ART (2nd 90) and of these, those who were virally suppressed (3rd 90). Results Among persons 15 years and older who were HIV positive, 84.8% were aware of their HIV positive status, of whom 70.7% were currently on ART, with 87.4% of these estimated to have suppressed viral load at the time of the survey. These estimates varied by sex, age, and geo-location type. Relatively higher percentages across all three indicators for women compared to men were observed: 88.7% versus 78.2% for those aware of their status, 72.3% versus 67.7% for on ART, and 89.8% versus 82.3% for viral suppression. Knowing one’s positive HIV status increased with age: 74.0, 85.8, and 88.1% for age groups 15–24 years old, 25–49 years old and 50–64 years old, although for those 65 years and older, 78.7% knew their HIV positive status. A similar pattern was observed for the 2nd 90, among those who knew their HIV positive status, 51.7% of 15 to 24 year olds, 70.5% of those aged 25–49 years old, 82.9% of those aged 50–64 years old and 82.4% of those aged 65 years or older were currently on ART. Viral suppression for the above mentioned aged groups, among those who were on ART was 85.2, 87.2, 89.5, and 84.6% respectively. The 90–90–90 indicators for urban areas were 87.7, 66.5, and 87.2%, for rural settings was 85.8, 79.8, and 88.4%, while in commercial farming communities it was 56.2, 67.6 and 81.4%. Conclusions South Africa appears to be on track to achieve the first 90 indicator by 2020. However, it is behind on the second 90 indicator with ART coverage that was ~ 20-percentage points below the target among people who knew their HIV status, this indicates deficiencies around linkage to and retention on ART. Overall viral suppression among those on ART is approaching the target at 87.4%, but this must be interpreted in the context of low reported ART coverage as well as with variation by age and sex. Targeted diagnosis, awareness, and treatment programs for men, young people aged 15–24 years old, people who reside in farming communities, and in specific provinces are needed. More nuanced 90–90–90 estimates within provinces, specifically looking at more granular sub-national level (e.g. districts), are needed to identify gaps in specific regions and to inform provincial interventions.
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Affiliation(s)
- Edmore Marinda
- Human Sciences Research Council, Pretoria, South Africa. .,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Leickness Simbayi
- Human Sciences Research Council, Pretoria, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Khangelani Zuma
- Human Sciences Research Council, Pretoria, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sizulu Moyo
- Human Sciences Research Council, Pretoria, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Lwando Kondlo
- Human Sciences Research Council, Pretoria, South Africa
| | - Sean Jooste
- Human Sciences Research Council, Pretoria, South Africa
| | - Patrick Nadol
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Pretoria, GA, South Africa
| | - Ehimario Igumbor
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Pretoria, GA, South Africa.,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Cheryl Dietrich
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Pretoria, GA, South Africa
| | - Melissa Briggs-Hagen
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Pretoria, GA, South Africa
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22
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Tsegaye Sahle E, Blumenthal J, Jain S, Sun S, Young J, Manyazewal T, Woldeamanuel H, Teferra L, Feleke B, Vandenberg O, Rey Z, Briggs-Hagen M, Haubrich R, Amogne W, McCutchan JA. Bacteriologically-confirmed pulmonary tuberculosis in an Ethiopian prison: Prevalence from screening of entrant and resident prisoners. PLoS One 2019; 14:e0226160. [PMID: 31830092 PMCID: PMC6907752 DOI: 10.1371/journal.pone.0226160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary Tuberculosis (PTB) is a major health problem in prisons. Multiple studies of TB in regional Ethiopian prisons have assessed prevalence and risk factors but have not examined recently implemented screening programs for TB in prisons. This study compares bacteriologically-confirmed PTB (BC-PTB) prevalence in prison entrants versus residents and identifies risk factors for PTB in Kality prison, a large federal Ethiopian prison located in Addis Ababa, through a study of an enhanced TB screening program. METHODS Participating prisoners (n = 13,803) consisted of 8,228 entrants screened continuously and 5,575 residents screened in two cross-sectional waves for PTB symptoms, demographics, TB risk factors, and medical history. Participants reporting at least one symptom of PTB were asked to produce sputum which was examined by microscopy for acid-fast bacilli, Xpert MTB/RIF assay and MGIT liquid culture. Prevalence of BC-PTB, defined as evidence of Mycobacterium tuberculosis (MTB) in sputum by the above methods, was compared in entrants and residents for the study. Descriptive analysis of prevalence was followed by bivariate and multivariate analyses of risk factors. RESULTS Prisoners were mainly male (86%), young (median age 26 years) and literate (89%). Prevalence of TB symptoms by screening was 17% (2,334/13,803) with rates in residents >5-fold higher than entrants. Prevalence of BC-PTB detected by screening in participating prisoners was 0.16% (22/13,803). Prevalence in residents increased in the second resident screening compared to the first (R1 = 0.10% and R2 = 0.39%, p = 0.027), but remained higher than in entrants (4.3-fold higher during R1 and 3.1-fold higher during R2). Drug resistance (DR) was found in 38% (5/13) of culture-isolated MTB. Risk factors including being ever diagnosed with TB, history of TB contact and low Body Mass Index (BMI) (<18.5) were significantly associated with BC-PTB (p<0.05). CONCLUSIONS BC-PTB prevalence was strikingly lower than previously reported from other Ethiopian prisons. PTB appears to be transmitted within this prison based on its higher prevalence in residents than in entrants. Whether a sustained program of PTB screening of entrants and/or residents reduces prevalence of PTB in prisons is not clear from this study, but our findings suggest that resources should be prioritized to resident, rather than entrant, screening due to higher BC-PTB prevalence. Detection of multi- and mono-DR TB in both entrant and resident prisoners warrants regular screening for active TB and adoption of methods to detect drug resistance.
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Affiliation(s)
- Eliyas Tsegaye Sahle
- ADDIS-VP Project, Ethiopian Public Health Association, Addis Ababa, Ethiopia
- École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Jill Blumenthal
- University of California San Diego, San Diego, California, United States of America
| | - Sonia Jain
- University of California San Diego, San Diego, California, United States of America
| | - Shelly Sun
- University of California San Diego, San Diego, California, United States of America
| | - Jason Young
- University of California San Diego, San Diego, California, United States of America
| | - Tsegahun Manyazewal
- ADDIS-VP Project, Ethiopian Public Health Association, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | - Lemma Teferra
- Ethiopian Federal Prison Administration, Addis Ababa, Ethiopia
| | - Beniam Feleke
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Olivier Vandenberg
- Environmental and Occupational Health Research Centre (CRSET), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Zilma Rey
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa Briggs-Hagen
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard Haubrich
- Gilead Sciences, Foster City, California, United States of America
| | - Wondwossen Amogne
- ADDIS-VP Project, Ethiopian Public Health Association, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - John Allen McCutchan
- University of California San Diego, San Diego, California, United States of America
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23
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Hennessee I, Chinkhumba J, Briggs-Hagen M, Bauleni A, Shah MP, Chalira A, Moyo D, Dodoli W, Luhanga M, Sande J, Ali D, Gutman J, Lindblade KA, Njau J, Mathanga DP. Household costs among patients hospitalized with malaria: evidence from a national survey in Malawi, 2012. Malar J 2017; 16:395. [PMID: 28969643 PMCID: PMC5625606 DOI: 10.1186/s12936-017-2038-y] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With 71% of Malawians living on < $1.90 a day, high household costs associated with severe malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi. METHODS A cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June-August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level. RESULTS Out of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs. CONCLUSIONS Although malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect households from potentially catastrophic health expenditures.
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Affiliation(s)
- Ian Hennessee
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Melissa Briggs-Hagen
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Andy Bauleni
- Malaria Alert Center, Malawi College of Medicine, Blantyre, Malawi
| | - Monica P. Shah
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Alfred Chalira
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Dubulao Moyo
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | | | - Misheck Luhanga
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - John Sande
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Doreen Ali
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Kim A. Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Joseph Njau
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Don P. Mathanga
- Malaria Alert Center, Malawi College of Medicine, Blantyre, Malawi
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24
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Lipke V, Emerson C, McCarthy C, Briggs-Hagen M, Farley J, Verani AR, Riley PL. Highlighting the need for more infection control practitioners in low- and middle-income countries. Public Health Action 2016; 6:160-163. [PMID: 27695677 DOI: 10.5588/pha.16.0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background: Many low- and middle-income countries struggle to implement, monitor and evaluate the efficacy of infection control (IC) measures within health care facilities. This hampers their ability to prevent nosocomial infections, identify emerging pathogens and rapidly alert officials to possible outbreaks. The lack of dedicated and trained IC practitioners (ICPs) is a serious deficit in the health care workforce, and is worsened by the lack of institutions that offer IC training. Discussion: While no single individual can entirely eliminate the risk of nosocomial transmission, there is literature to support the value of designated IC persons. Recommendations from the World Health Organization in 2008 and 2009 describe the need for this specialized cadre of workers, but many countries lack the national regulations to authorize, train and manage such professionals at the national or local level. This article provides an overview of how ICPs are trained and credentialed in several countries, and discusses approaches countries can use to train ICPs. Conclusion: Trained ICPs can help prevent future outbreaks and control nosocomial transmission of diseases in health care facilities. For this to occur, supportive national policies, availability of training institutions and local administrative support will be required.
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Affiliation(s)
- V Lipke
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C Emerson
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C McCarthy
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M Briggs-Hagen
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J Farley
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - A R Verani
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - P L Riley
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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25
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Shah MP, Briggs-Hagen M, Chinkhumba J, Bauleni A, Chalira A, Moyo D, Dodoli W, Luhanga M, Sande J, Ali D, Gutman J, Mathanga DP, Lindblade KA. Adherence to national guidelines for the diagnosis and management of severe malaria: a nationwide, cross-sectional survey in Malawi, 2012. Malar J 2016; 15:369. [PMID: 27430311 PMCID: PMC4950799 DOI: 10.1186/s12936-016-1423-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/25/2016] [Accepted: 07/04/2016] [Indexed: 11/25/2022] Open
Abstract
Background Severe malaria has a case fatality rate of 10-20 %; however, few studies have addressed the quality of severe malaria case management. This study evaluated the diagnostic and treatment practices of malaria patients admitted to inpatient health facilities (HF) in Malawi. Methods In July–August 2012, a nationwide, cross-sectional survey of severe malaria management was conducted in 36 HFs selected with equal probability from all eligible public sector HFs in Malawi. Patient records from all admissions during October 2011 and April 2012 (low and high season, respectively) were screened for an admission diagnosis of malaria or prescription of any anti-malarial. Eligible records were stratified by age (< 5 or ≥ 5 years). A maximum of eight records was randomly selected within each age and month stratum. Severe malaria was defined by admission diagnosis or documentation of at least one sign or symptom of severe malaria. Treatment with intravenous (IV) quinine or artesunate was considered correct. Patients without documentation of severe malaria were analysed as uncomplicated malaria patients; treatment with an artemisinin-based combination therapy (ACT) or oral quinine based on malaria test results was considered correct. All analyses accounted for HF level clustering and sampling weights. Results The analysis included 906 records from 35 HFs. Among these, 42 % (95 % confidence interval [CI] 35–49) had a severe malaria admission diagnosis and 50 % (95 % CI 44–57) had at least one severe malaria sign or symptom documented. Severe malaria patients defined by admission diagnosis (93, 95 % CI 86–99) were more likely to be treated correctly compared to patients defined by a severe sign (82, 95 % CI 75–89) (p < 0.0001). Among uncomplicated malaria patients, 26 % (95 % CI 18–35) were correctly treated and 53 % (95 % CI 42–64) were adequately treated with IV quinine alone or in combination with an ACT or oral quinine. Conclusions A majority of patients diagnosed with severe malaria received the recommended IV therapy in accordance with national treatment guidelines. However, the inconsistencies between diagnosis of severe malaria and documentation of severe signs and symptoms highlight the need to improve healthcare worker recognition and documentation of severe signs and symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1423-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica P Shah
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA.
| | - Melissa Briggs-Hagen
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA
| | | | - Andy Bauleni
- Malaria Alert Centre, Malawi College of Medicine, Blantyre, Malawi
| | - Alfred Chalira
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Dubulao Moyo
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | | | - Misheck Luhanga
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - John Sande
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Doreen Ali
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA
| | - Don P Mathanga
- Malaria Alert Centre, Malawi College of Medicine, Blantyre, Malawi
| | - Kim A Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA
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